A nurse is assessing a client who has Graves’ disease and recently diagnosed with hyperthyroidism. With the negative feedback loop mechanism in mind, the nurse should expect which of the following baseline laboratory results for this client?

Choice A reason: Kussmaul’s breathing is characteristic of DKA, not HHS, as it compensates for severe metabolic acidosis from ketone accumulation. HHS has minimal acidosis due to low ketosis, so rapid, deep breathing is not typical, making this an incorrect symptom for HHS.

Choice B reason: Fruity breath, caused by acetone from ketogenesis, is a hallmark of DKA, not HHS. HHS involves severe hyperglycemia with minimal ketone production, so this odor is absent, making this an incorrect symptom for the client’s understanding of HHS.

Choice C reason: Myoclonic jerking is a symptom of HHS, resulting from severe hyperosmolarity and electrolyte imbalances (e.g., hyponatremia) affecting neurological function. These involuntary muscle movements reflect CNS irritability, making this a correct symptom demonstrating understanding of HHS manifestations.

Choice D reason: Anuria is associated with HHS due to severe dehydration from osmotic diuresis caused by extreme hyperglycemia. Reduced urine output reflects hypovolemia and renal hypoperfusion, making this a correct symptom indicating the client’s understanding of HHS’s clinical presentation.

Choice E reason: Seizures can occur in HHS due to extreme hyperosmolarity and electrolyte disturbances (e.g., hyponatremia) disrupting neuronal activity. This neurological complication is a hallmark of severe HHS, making it a correct symptom reflecting the client’s understanding of the condition.

Choice A reason: TPN contains high dextrose, and abrupt cessation risks hypoglycemia, causing shakiness and diaphoresis due to low blood glucose triggering sympathetic responses. Monitoring for these signs is critical, as TPN-dependent clients rely on continuous glucose, making this the correct choice.

Choice B reason: Fever and chills suggest infection, possibly from a contaminated TPN line, but are not immediate concerns of a non-infusing pump. Hypoglycemia is the primary risk of infusion failure, making this choice less relevant.

Choice C reason: Hypertension and crackles indicate fluid overload, not directly related to TPN infusion failure. TPN cessation causes hypoglycemia, not fluid shifts, making this choice incorrect for the immediate condition to monitor.

Choice D reason: Excessive thirst and urination are symptoms of hyperglycemia, not TPN infusion failure. Stopping TPN risks hypoglycemia due to high dextrose content, not high glucose levels, making this choice incorrect.