Nurse Is Caring for a Client Admitted with Hyperosmolar Hyperglycemic Nonketotic Syndrome (hhns). When the Client Asks Why Her Blood Glucose Is So High, Wha

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Sample questions from Nurse Is Caring for a Client Admitted with Hyperosmolar Hyperglycemic Nonketotic Syndrome (hhns). When the Client Asks Why Her Blood Glucose Is So High, Wha

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 52-year-old client with type 2 diabetes is being treated for hyperosmolar hyperglycemic syndrome (HHS). The client asks, "Why is my blood sugar so high if I have been taking my pills?" The client has a glucose level of 886 mg/dL, dry mucous membranes, and a temperature of 38.1 C; the client reports missing two doses while ill. Which response by the nurse is best?

   • A."Your pills caused your body to release too much glucose, so you should stop taking them permanently."
   • B."The glucose is high because your kidneys have stopped removing sugar from your blood."
   • C."This happens because your body has produced ketones that prevent glucose from entering your cells."
   • D."Your illness may have increased your body's need for insulin, and dehydration can make the glucose level rise further; we are treating both problems."

   Rationale: Illness can increase counterregulatory hormones and insulin requirements, while dehydration concentrates serum glucose and reduces renal glucose clearance; the missed doses may also have contributed. The kidney explanation is too absolute, stopping medication permanently is unsafe, and significant ketone production is not the defining mechanism of HHS. A useful explanation connects the acute illness and fluid deficit to the glucose rise without assigning blame.

2. 2.At change of shift in a medical unit, a 73-year-old client admitted with HHS has received IV fluids and an insulin infusion for 2 hours. The client is more difficult to arouse than at admission; glucose has fallen from 1,020 to 640 mg/dL, sodium is 151 mEq/L, and urine output has decreased from 45 to 15 mL/hr. Which action should the nurse take first?

   • A.Ask the nursing assistant to obtain another glucose level in 1 hour.
   • B.Continue the current plan because a falling glucose level indicates the treatment is working.
   • C.Notify the provider promptly about the change in level of consciousness and falling urine output.
   • D.Increase the insulin infusion to normalize the glucose more quickly.

   Rationale: Worsening mental status and declining urine output despite treatment require prompt clinical reassessment for complications such as inadequate perfusion or a rapid change in effective osmolality. Increasing insulin without an order or assessment could accelerate osmotic shifts, and waiting an hour or assuming improvement from glucose alone delays evaluation. HHS treatment requires close monitoring of neurologic status, renal perfusion, electrolytes, and the rate of glucose change.

3. 3.Refer to the client's chart. Which actions should the nurse take now for the 67-year-old client with HHS? Select all that apply.

   • A.Continue frequent neurologic and vital-sign reassessment and report the declining level of consciousness.
   • B.Restrict fluids because the sodium is above the reference range.
   • C.Delegate interpretation of the electrolyte trend and adjustment of the insulin infusion to the nursing assistant.
   • D.Implement the prescribed isotonic IV fluid and insulin plan while monitoring the response.
   • E.Request prompt review of the rising potassium and falling urine output by the provider.

   Rationale: The client is less responsive, tachycardic, and producing less urine, so close reassessment and prompt communication about perfusion and electrolyte trends are priorities; prescribed fluids and insulin should be administered with monitoring. Fluid restriction would worsen the documented volume deficit, and a nursing assistant cannot interpret laboratory trends or adjust an insulin infusion. The chart's rising potassium and reduced urine output make the trend clinically important even though potassium may shift during insulin therapy.

4. 4.During a home visit, a 16-year-old client with newly diagnosed type 2 diabetes is recovering from HHS after a viral illness. The client's caregiver says, "I will just give the insulin whenever the glucose looks high." Which response by the nurse best supports a safe transition home?

   • A."Let's review the written sick-day plan, including when to check glucose, how to follow prescribed medication instructions, and when to call the diabetes team or seek urgent care."
   • B."Use the insulin dose from the hospital whenever the client has a fever, even if the glucose is low."
   • C."That is reasonable as long as the client avoids all carbohydrates until the glucose is normal."
   • D."Stop checking glucose during illness because the readings will be temporarily unreliable."

   Answer and rationale are in the full material.

5. 5.A provider prescribes transfer from the emergency department to the intensive care unit for a 79-year-old client with HHS. The client is receiving an insulin infusion, has a Glasgow Coma Scale score that has fallen from 14 to 11, and has blood pressure 88/54 mm Hg. Which task is appropriate for the nurse to delegate to an experienced nursing assistant during preparation for transfer?

   • A.Titrate the insulin infusion according to the latest glucose result.
   • B.Obtain and report a current set of vital signs while the nurse continues the assessment and stabilization.
   • C.Decide whether the client is stable enough to travel without a nurse.
   • D.Determine whether the change in consciousness is caused by cerebral edema.

   Answer and rationale are in the full material.