Which of the following findings is expected in a client with hyperosmolar hyperglycemic state?

In hyperosmolar hyperglycemic state (HHS), one of the hallmark findings is a significantly elevated blood glucose level, typically exceeding 600 mg/dL. HHS is characterized by severe hyperglycemia, which leads to increased osmolarity and dehydration without significant ketone production.

The high blood glucose levels occur due to a relative insulin deficiency and increased counter-regulatory hormone activity, which promotes gluconeogenesis and glycogenolysis. Unlike diabetic ketoacidosis (DKA), in which the body produces ketones due to the lack of insulin, HHS often presents with minimal or no ketonuria, making the presence of a hyperglycemic crisis with elevated glucose levels the key distinguishing feature.

It is also important to recognize that while other symptoms like abdominal pain or unique respiratory patterns (like Kussmaul respirations) may occur, they are not definitive for HHS. Kussmaul respirations are primarily associated with metabolic acidosis, typically seen in DKA. The presence of ketones in urine suggests a state of ketosis, which is more relevant to DKA rather than HHS. Thus, the significant elevation in blood glucose is the most expected and notable finding in a client experiencing HHS.