A nurse is assessing a client who is experiencing a hyperglycemic hyperosmolar state. Which of the following findings should the nurse expect? (Select all that apply)

Choice A reason: Absence of urine ketones is expected in hyperglycemic hyperosmolar state (HHS). Unlike diabetic ketoacidosis (DKA), HHS does not involve significant ketone production because insulin levels are usually sufficient to prevent lipolysis and ketogenesis. Choice B reason: Blood glucose levels in HHS are extremely elevated, often exceeding 600 mg/dL. A value of 685 mg/dL is consistent with this condition and reflects the severe hyperglycemia that drives osmotic diuresis and dehydration. Choice C reason: A BUN of 8 mg/dL is within normal range and would not be expected in HHS. Typically, BUN is elevated due to dehydration and reduced renal perfusion. Therefore, this finding is not consistent with HHS. Choice D reason: Fruity breath odor is characteristic of diabetic ketoacidosis due to acetone accumulation from ketone metabolism. It is not expected in HHS, which lacks significant ketosis. Choice E reason: Dehydration is a hallmark of HHS. Severe hyperglycemia causes osmotic diuresis, leading to profound fluid loss, hemoconcentration, and electrolyte imbalance.