A client with Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) has a blood glucose level of 925 mg/dL and is confused and lethargic. What is the priority nursing intervention?

Rationale: A. The priority in HHNS is fluid resuscitation, as severe hyperglycemia causes profound dehydration, hyperosmolarity, and electrolyte imbalances. Rapid IV fluid replacement helps restore circulating volume, improve perfusion, and reduce blood glucose concentration indirectly. Fluids are given before insulin to avoid rapid fluid shifts and hypotension. Correcting dehydration is life-saving and is always the first step in HHNS management. B. While confusion and lethargy may indicate altered mental status, airway compromise is not typically the immediate priority in HHNS. Intubation is only required if the patient’s airway is at risk due to decreased consciousness or respiratory failure. Immediate fluid resuscitation and stabilization are higher priorities. C. Insulin therapy is important in HHNS to reduce blood glucose, but starting insulin before fluid replacement can cause rapid shifts in osmolarity, potentially leading to cerebral edema or cardiovascular collapse. Fluids must be administered first, and insulin is usually started after initial hydration. D. Dextrose is used to treat hypoglycemia, not severe hyperglycemia. In HHNS, blood glucose is extremely high (925 mg/dL), so administering dextrose would worsen hyperosmolarity and exacerbate the patient’s condition. This intervention is completely inappropriate in this scenario.