A nurse is caring for a client who has type 2 diabetes mellitus and their glucose levels are rising. Which of the following would indicate the client is in a hyperosmolar hyperglycemic state (HHS)?

Rationale: A. 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. B. 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). C. Plasma osmolarity of 350 mOsm/L: A plasma osmolarity greater than 320 mOsm/L is a defining diagnostic feature of HHS. The marked hyperosmolarity results from extreme hyperglycemia and profound dehydration, leading to severe neurological manifestations. D. 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.