A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar state (HHS) is made. The nurse who is assisting with care for the client obtains which item in preparation for the treatment of this syndrome?

• A. NPH insulin
• B. A nasal cannula
• C. IV infusion of sodium bicarbonate
• D. Intravenous (IV) infusion of normal saline

Answer: (D)

In hyperglycemic hyperosmolar state, the immediate priority is correcting massive fluid loss and improving circulatory volume. Starting an intravenous infusion of normal saline provides isotonic fluid to replenish intravascular volume, restore kidney perfusion, reduce serum osmolality gradually, and create a stable base for subsequent glucose control with insulin. This approach is essential before insulin therapy, because giving insulin without sufficient fluids can worsen dehydration and shift potassium too rapidly. The other options don’t address the main urgent need: a nasal cannula only supports oxygenation, bicarbonate is reserved for rare severe acidosis, and long-acting insulin isn’t suitable for acute stabilization—the patient needs fluids first, with insulin therapy considered after perfusion and electrolytes are assessed.

In hyperglycemic hyperosmolar state, the immediate priority is correcting massive fluid loss and improving circulatory volume. Starting an intravenous infusion of normal saline provides isotonic fluid to replenish intravascular volume, restore kidney perfusion, reduce serum osmolality gradually, and create a stable base for subsequent glucose control with insulin. This approach is essential before insulin therapy, because giving insulin without sufficient fluids can worsen dehydration and shift potassium too rapidly. The other options don’t address the main urgent need: a nasal cannula only supports oxygenation, bicarbonate is reserved for rare severe acidosis, and long-acting insulin isn’t suitable for acute stabilization—the patient needs fluids first, with insulin therapy considered after perfusion and electrolytes are assessed.