An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?

Choice A reason: While some patients in a crisis may have elevated blood pressure, HHS is characterized by extreme dehydration and potential hypovolemic shock. Administering antihypertensive medications without first correcting the severe fluid volume deficit could lead to a catastrophic drop in blood pressure and impaired perfusion to vital organs like the brain and kidneys. Choice B reason: Offering orange juice is an intervention for hypoglycemia (low blood glucose). This patient has a blood glucose of 623 mg/dL, which is severe hyperglycemia. Adding more simple sugars would worsen the hyperosmolar state, increase osmotic diuresis, and further dehydrate the patient, potentially leading to coma or death. Choice C reason: Acidosis is a primary feature of Diabetic Ketoacidosis (DKA), not HHS. Furthermore, IV dextrose is used to treat hypoglycemia or to prevent a rapid drop in blood sugar during insulin therapy; it is never used to "reverse acidosis." HHS patients typically have enough insulin to prevent ketosis but not enough to prevent hyperglycemia. Choice D reason: The hallmark of HHS is profound dehydration caused by osmotic diuresis; patients can lose 6 to 10 liters of fluid. The priority is aggressive fluid resuscitation with isotonic or hypotonic saline and the replacement of electrolytes (especially potassium). This restores circulatory volume and begins to dilute the concentrated blood glucose levels.