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Giving 50% dextrose: Dextrose 50% is given in severe hypoglycemia, not HHS, since the patient is already hyperglycemic. Administering it would worsen the condition.

Administering glargine (Lantus) insulin: Glargine is a long-acting insulin, not used for acute management of HHS. IV regular insulin is preferred after fluids are started to reduce glucose gradually and avoid cerebral edema.

Initiating O2 by nasal cannula: Oxygen may be given if hypoxemia is present, but it is not the first-line intervention. The critical priority in HHS is restoring circulation through IV fluids before addressing secondary needs.

Hypertension: Elevated blood pressure is not a hallmark of hyperosmolar hyperglycemic state. Clients with HHS often present with hypotension and tachycardia due to severe dehydration rather than hypertension.

Ketosis: Ketosis is uncommon in HHS because type 2 diabetes typically maintains enough insulin activity to prevent significant ketone production. Ketosis is more characteristic of diabetic ketoacidosis (DKA).

Glucose level of 500 mg/dl: Although elevated glucose levels are seen in HHS, they are usually much higher, often above 600 mg/dl. A level of 500 mg/dl indicates hyperglycemia but does not by itself confirm HHS.

1 tsp sugar: While sugar contains glucose, 1 teaspoon provides only about 4 g of carbohydrate, which is not enough to adequately correct hypoglycemia. The goal is to administer 15 g of carbohydrates to promptly raise blood glucose.

4 oz diet soda: Diet soda contains artificial sweeteners rather than carbohydrates, so it does not raise blood glucose. Giving this would not address the client’s hypoglycemia and could delay proper treatment.

4 oz skim milk: Skim milk contains some carbohydrate in the form of lactose, but 4 oz provides only about 6 g. This is insufficient to meet the recommended 15 g of carbohydrate needed for hypoglycemia correction.

Withhold your usual daily dose of insulin: Insulin should never be withheld during illness because the body typically needs more insulin to counteract stress hormones. Stopping insulin increases the risk of severe hyperglycemia and development of DKA.

Test your blood glucose level every 8 hours: During illness, blood glucose levels can fluctuate rapidly, requiring monitoring every 2–4 hours. Testing only every 8 hours would delay recognition and treatment of dangerously high glucose levels.

Drink 240 to 360 milliliters of calorie-free liquids every 8 hours: Fluid intake is important to prevent dehydration, but the recommended frequency is every hour rather than every 8 hours. Frequent fluids help maintain hydration and reduce ketone concentration in the urine.

Free T4: In primary hypothyroidism, free T4 levels are typically decreased because the thyroid gland is underactive and not producing sufficient thyroid hormone. An elevation of free T4 would not be expected in this condition.

Serum T4: Total serum T4 is also decreased in primary hypothyroidism for the same reason as free T4. The thyroid gland cannot produce enough hormone, so serum T4 levels fall rather than rise.

Serum T3: Serum T3 levels are usually low or normal in hypothyroidism but not elevated. Because T3 is converted from T4, when T4 production drops, T3 levels also generally decrease over time.

My skin will be warm and moist: Hypoglycemia typically causes cool, clammy skin due to sympathetic nervous system activation. Warm, moist skin is more often associated with hyperglycemia or fever, not low blood glucose.

My appetite will be decreased: Hypoglycemia usually triggers increased hunger rather than decreased appetite. The body attempts to restore glucose levels by stimulating food intake as part of the counter-regulatory response.

I will be more thirsty than usual: Excessive thirst, or polydipsia, is a classic manifestation of hyperglycemia rather than hypoglycemia. It results from osmotic diuresis caused by elevated blood glucose levels.

Provide a low-carbohydrate diet: Clients with Addison’s disease require adequate carbohydrate intake since cortisol deficiency impairs glucose regulation. A low-carbohydrate diet could worsen hypoglycemia risk and is not recommended.

Administer oral corticosteroids: During an Addisonian crisis, the client requires immediate IV corticosteroids, not oral. Oral medications are insufficient in emergencies because absorption is too slow to stabilize the client.

Restrict fluid intake: Fluid restriction would worsen dehydration, which is already a major concern in Addisonian crisis due to sodium loss and volume depletion. Instead, fluids and electrolytes must be carefully replaced to stabilize the client.