A nurse is caring for a male client who has a urinary tract infection. Which of the following conditions is the client most likely to develop as a result of the UTI?

A. Slow heart rate: HHS usually triggers a compensatory tachycardia as the body attempts to maintain cardiac output in the face of severe dehydration and hyperosmolarity. A slow heart rate is not consistent with the physiological response seen in this disorder and could indicate another underlying issue.

B. Elevated blood glucose: Marked hyperglycemia, often exceeding 600 mg/dL, is a hallmark of HHS caused by insufficient insulin action and increased hepatic glucose production. This severe elevation in blood glucose contributes to the osmotic diuresis and fluid loss characteristic of the syndrome.

C. Taut, dry skin: Dehydration due to excessive osmotic diuresis results in decreased skin turgor, making the skin appear taut and dry. These changes reflect significant fluid volume deficits that require prompt correction to prevent complications such as shock.

D. Decreased osmolality: Osmolality in HHS is elevated due to high serum glucose pulling water from cells into the extracellular space, increasing plasma concentration. A decreased osmolality would suggest overhydration or other metabolic disturbances, which do not align with the pathophysiology of HHS.

E. Elevated BUN and creatinine: The dehydration and hypovolemia in HHS reduce renal perfusion, leading to prerenal azotemia characterized by elevated BUN and creatinine levels. These markers indicate impaired kidney function secondary to volume depletion and must be closely monitored.

A. Oxygen at 2 liters via nasal cannula is not indicated as the patient’s oxygen saturation is within normal limits. There is no evidence of hypoxia or respiratory compromise to justify supplemental oxygen.

B. Tylenol 650 mg po every 6 hours prn pain is unnecessary at this time because the patient denies pain. Giving medication without indication can mask emerging symptoms or cause side effects.

C. Capillary blood glucose (CBG) before meals and at bedtime ensures tight glucose monitoring and guides insulin adjustments. Frequent checks help prevent hypoglycemia and track the effectiveness of IV insulin.

D. Regular insulin IV is critical for reversing diabetic ketoacidosis by reducing hyperglycemia and halting ketone production. Continuous infusion allows for precise titration to correct acidosis and prevent complications.

E. Measure intake and output every shift is necessary due to fluid losses from polyuria and vomiting. Monitoring helps detect dehydration and guides fluid replacement to stabilize hemodynamics.

F. Repeat urinalysis in the morning helps track ketone clearance and monitor renal involvement. It supports clinical decision-making about progression or resolution of the DKA episode.

G. Calorie count is important to assess nutritional intake, especially as the patient has had recent weight loss. It supports recovery and helps tailor dietary adjustments post-stabilization.

H. Ambulate with assistance is unsafe due to hypotension and dehydration, which increase fall risk. The patient should remain on bedrest until volume status and perfusion are stabilized.