Which of the following assessment findings is most important in determining nursing care for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)?
A) Hypotension
B) Blood pH 7.38
C) Mental changes
D) Fever
A
Feedback:
Hypotension signifies a loss of fluids from the extracellular compartment. In HHNKS, fluid movement from intracellular to extracellular compartments can be significant and must be corrected to decrease incidence of coma and/or death. The blood pH of 7.38 is within normal range and is not significant with HHNKS. Mental changes and fever are symptoms associated with NNHKS but are not as primary concern as fluid electrolyte imbalances.
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