A patient with Type 2 Diabetes has been diagnosed with Hyperglycemic Hyperosmolar Syndrome (HHS). The patient's spouse asks the Registered Nurse which symptoms characterize this disorder. Which are the most appropriate responses by the Registered Nurse? (Select all that apply.)

Choice A rationale Taut, dry skin is a classic finding in Hyperglycemic Hyperosmolar Syndrome (HHS) due to profound osmotic diuresis caused by severely elevated blood glucose (often >600 mg/dL). The resulting severe dehydration, as water moves from the intracellular to the extracellular space and is lost via the kidneys, causes the skin turgor to decrease and the skin to become dry and inelastic. Choice B rationale A slow heart rate (bradycardia) is typically not characteristic of HHS. The severe dehydration and volume depletion that define HHS lead to hypovolemia. The compensatory mechanism for hypovolemia is an increase in heart rate (tachycardia) to maintain cardiac output and perfuse vital organs, not a slowing of the heart rate. Choice C rationale Elevated Blood Urea Nitrogen (BUN) and creatinine are expected findings in HHS. The severe dehydration and reduced intravascular volume lead to decreased renal perfusion, causing a pre-renal acute kidney injury. This impaired blood flow to the kidneys decreases the glomerular filtration rate, resulting in the retention and subsequent elevation of BUN (normal range 8-20 mg/dL) and creatinine (normal range 0.6-1.2 mg/dL). Choice D rationale Elevated blood glucose, typically exceeding 600 mg/dL, is a defining characteristic of HHS. This severe hyperglycemia is caused by insulin resistance or deficiency, which prevents glucose uptake by cells. The high glucose concentration drives the massive osmotic shift of fluid out of the cells and into the blood, leading to the profound hyperosmolarity central to the syndrome's pathophysiology. Choice E rationale Decreased osmolality is incorrect. HHS is named for Hyperglycemic Hyperosmolar Syndrome, meaning the serum osmolality is significantly elevated, often greater than 320 mOsm/kg (normal range 275-295 mOsm/kg). This hyperosmolality is primarily driven by the extremely high blood glucose levels, leading to the osmotic diuresis and severe dehydration characteristic of the condition.