A 72-year-old patient comes to the clinic complaining of sudden onset eye pain, nausea, and seeing halos around lights. The nurse notes that the patient’s pupil is mid-dilated and non-reactive to light. What is the most likely cause of these symptoms?

Optic neuritis

Macular degeneration

Narrow angle glaucoma

Cataract

Answer and Explanation

The Correct Answer is C

Choice A: Optic Neuritis

Optic neuritis is an inflammation of the optic nerve that can cause pain and vision loss. The pain typically worsens with eye movement, and vision loss usually occurs in one eye. Symptoms include temporary vision loss, visual field loss, loss of color vision, and flashing lights. However, optic neuritis does not typically cause nausea or seeing halos around lights, and the pupil reaction to light is usually preserved.

Choice B: Macular Degeneration

Macular degeneration primarily affects central vision and is more common in older adults. It can cause blurred or reduced central vision, difficulty recognizing faces, and visual distortions such as straight lines appearing bent. However, it does not cause sudden onset eye pain, nausea, or seeing halos around lights. The pupil reaction to light remains normal in macular degeneration.

Choice C: Narrow Angle Glaucoma

Narrow angle glaucoma, also known as acute angle-closure glaucoma, is a medical emergency characterized by a sudden increase in intraocular pressure. Symptoms include severe eye pain, nausea, vomiting, seeing halos around lights, and a mid-dilated, non-reactive pupil. This condition occurs when the drainage angle between the iris and cornea becomes blocked, leading to a rapid rise in eye pressure. Immediate treatment is necessary to prevent permanent vision loss.

Choice D: Cataract

Cataracts cause clouding of the lens, leading to symptoms such as blurred vision, difficulty seeing at night, sensitivity to light, and seeing halos around lights. However, cataracts develop gradually and do not cause sudden onset eye pain or nausea. The pupil reaction to light is also typically normal in cataract patients.

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Free Nursing Study Resources

Correct Answer is ["B","C","D","F"]

Explanation

Choice A Reason:

Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). DKA occurs when there is a significant production of ketones due to the breakdown of fat for energy, leading to a fruity or acetone-like smell on the breath. HHS, on the other hand, does not usually involve significant ketone production.

Choice B Reason:

Fever can be a manifestation of HHS, especially if there is an underlying infection or illness that has precipitated the hyperglycemic crisis. Infections are common triggers for HHS and can contribute to the severity of the condition.

Choice C Reason:

Older age is a risk factor for HHS. HHS is more commonly seen in older adults with type 2 diabetes, often those who have underlying chronic conditions or are experiencing acute illness. The patient’s age of 68 years supports the likelihood of HHS.

Choice D Reason:

A serum glucose level of 800 mg/dL is indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketone production. This high glucose level leads to severe dehydration and hyperosmolarity.

Choice E Reason:

A serum bicarbonate level of 15 mEq/L is more indicative of DKA rather than HHS. In HHS, serum bicarbonate levels are typically normal or only mildly decreased because there is no significant ketoacidosis. Therefore, this choice does not support the clinical presentation of HHS.

Choice F Reason:

An insidious onset is characteristic of HHS. Unlike DKA, which can develop rapidly, HHS often develops over days to weeks. Patients may experience gradually worsening symptoms such as increased thirst, frequent urination, and confusion before seeking medical attention.

A. Random blood glucose 126 mg/dL B. History of poor wound healing C. Report of decreased urinary output D. Clammy skin

Correct Answer is B

Explanation

Choice A Reason:

A random blood glucose level of 126 mg/dL is not typically indicative of hyperglycemia. Hyperglycemia is generally defined as a blood glucose level above 180 mg/dL. A level of 126 mg/dL is closer to the threshold for diagnosing diabetes but does not necessarily indicate hyperglycemia.

Choice B Reason:

A history of poor wound healing is a common manifestation of hyperglycemia. High blood sugar levels can impair the body’s ability to heal wounds by affecting blood flow and the function of immune cells. This can lead to prolonged wound healing times and an increased risk of infections.

Choice C Reason:

Decreased urinary output is not a typical symptom of hyperglycemia. In fact, hyperglycemia often causes increased urinary output (polyuria) due to the body’s attempt to excrete excess glucose through urine. Decreased urinary output could be indicative of other conditions, such as dehydration or kidney issues.

Choice D Reason:

Clammy skin is more commonly associated with hypoglycemia (low blood sugar) rather than hyperglycemia. Hypoglycemia can cause symptoms such as sweating, shakiness, and clammy skin due to the body’s response to low blood sugar levels. Hyperglycemia, on the other hand, does not typically cause clammy skin.

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A 72-year-old patient comes to the clinic complaining of sudden onset eye pain, nausea, and seeing halos around lights. The nurse notes that the patient’s pupil is mid-dilated and non-reactive to light. What is the most likely cause of these symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care for an older adult client who has hyperglycemia, polydipsia, and polyuria. Which of the following manifestations supports the clinical presentation of hyperosmolar hyperglycemic syndrome (HHS)? (Select All that Apply.)

Correct Answer is ["B","C","D","F"]

Explanation

A nurse in a provider’s office is collecting data from an older adult client who has type 2 diabetes mellitus. Which of the following findings is a manifestation of hyperglycemia?

Correct Answer is B

Explanation

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