A nurse is preparing to receive a client from the emergency department who is being treated for a blood glucose of 750 mg/dL. Which of the following laboratory findings would support the provider’s diagnosis of hyperglycemic hyperosmolar state (HHS)? (Select all that apply)

HCO3 23 mEq/L

Positive ketones in urine

pH 7.43

Serum osmolarity 330 mOsm/L

pH 7.23

Answer and Explanation

Correct Answer : C,D

Choice A reason: HCO3 23 mEq/L (normal 21-28 mEq/L) is within normal range but not specific to HHS. HHS typically has normal or slightly reduced HCO3 due to minimal acidosis, but this finding alone does not strongly support HHS diagnosis compared to elevated osmolarity or normal pH.

Choice B reason: Positive ketones in urine are more typical of DKA, not HHS. HHS involves severe hyperglycemia with minimal ketosis due to sufficient insulin to prevent ketogenesis. Positive ketones suggest DKA’s metabolic profile, making this finding inconsistent with an HHS diagnosis.

Choice C reason: pH 7.43 (normal 7.35-7.45) supports an HHS diagnosis, as HHS typically presents with normal or near-normal pH due to minimal ketone production compared to DKA’s acidosis. This reflects HHS’s primary issue of hyperglycemia and hyperosmolarity, making it a key finding.

Choice D reason: Serum osmolarity 330 mOsm/L (normal 270-300 mOsm/L) is a hallmark of HHS, driven by severe hyperglycemia (e.g., 750 mg/dL) causing osmotic shifts and dehydration. Elevated osmolarity distinguishes HHS from DKA, supporting the diagnosis and guiding fluid therapy.

Choice E reason: pH 7.23 indicates significant acidosis, typical of DKA, not HHS. HHS has minimal ketosis, resulting in normal or slightly acidotic pH. This low pH is inconsistent with HHS’s metabolic profile, making it an incorrect finding for supporting the diagnosis.

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Correct Answer is C

Explanation

Choice A reason: 0.9% sodium chloride provides hydration but no glucose, risking hypoglycemia in TPN-dependent clients, as TPN contains high dextrose. Abrupt cessation of glucose can cause metabolic instability, making this choice inappropriate for temporary TPN replacement.

Choice B reason: Lactated Ringer’s provides electrolytes and hydration but lacks sufficient glucose to prevent hypoglycemia in clients reliant on TPN’s high dextrose content. It does not match TPN’s nutritional profile, making this choice incorrect for interim infusion.

Choice C reason: Dextrose 10% in water provides glucose to prevent hypoglycemia, mimicking TPN’s carbohydrate component. It maintains blood sugar stability in TPN-dependent clients until the new solution arrives, making this the correct choice for temporary infusion.

Choice D reason: 3% sodium chloride is hypertonic and used for severe hyponatremia, not TPN replacement. It lacks glucose, risking hypoglycemia, and its high sodium content can cause fluid shifts, making this choice incorrect for this scenario.

A. Administer 2 units of packed RBCs B. Administer propranolol as prescribed C. Position the client supine with legs elevated D. Decrease the rate of the IV fluids

Correct Answer is C

Explanation

Choice A reason: Administering packed RBCs is important to restore blood volume in esophageal variceal bleeding, but it is not the immediate priority. Positioning to improve perfusion addresses acute hypotension faster, as RBC transfusion takes time to prepare and administer, making this secondary.

Choice B reason: Administering propranolol, a beta-blocker, reduces portal hypertension in variceal bleeding but is not the priority during active bleeding and hypotension. It is a long-term management strategy, not an immediate intervention to stabilize acute hypovolemic shock, making it less urgent.

Choice C reason: Positioning the client supine with legs elevated is the priority, as it maximizes cerebral and cardiac perfusion in hypotension from variceal bleeding (800 mL loss). This counteracts hypovolemic shock by redistributing blood volume, stabilizing the client until further interventions like transfusion can be implemented.

Choice D reason: Decreasing IV fluid rate is inappropriate during active bleeding and hypotension, as fluid resuscitation is critical to restore intravascular volume in hypovolemic shock. Increasing or maintaining fluids is needed, making this an incorrect and potentially harmful intervention.

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A nurse is preparing to receive a client from the emergency department who is being treated for a blood glucose of 750 mg/dL. Which of the following laboratory findings would support the provider’s diagnosis of hyperglycemic hyperosmolar state (HHS)? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is caring for a client who has esophageal varices, is hypotensive after vomiting 800 mL of blood, and is still actively bleeding. Which of the following actions is the nurse’s priority?

Correct Answer is C

Explanation

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