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.)

Acetone breath.

Fever.

Serum glucose 800 mg/dL (74 to 106 mg/dL).

Serum bicarbonate 15 mEq/L (21 to 28 mEq/L).

Insidious onset.

Answer and Explanation

Correct Answer : B,C,E

Choice A rationale
Acetone breath is a characteristic symptom of diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). In DKA, the body produces ketones, leading to a fruity or acetone-like breath odor. HHS, on the other hand, does not typically involve significant ketone production.
Choice B rationale
Fever can be a manifestation of HHS, often due to an underlying infection or illness that precipitates the hyperglycemic state. Infections are common triggers for HHS, leading to elevated body temperature.
Choice C rationale
Serum glucose levels of 800 mg/dL are indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketoacidosis.
Choice D rationale
Serum bicarbonate levels of 15 mEq/L are more indicative of DKA rather than HHS. In HHS, bicarbonate levels are usually within the normal range because there is no significant ketoacidosis.
Choice E rationale
Insidious onset is a hallmark of HHS. The condition develops gradually over days to weeks, unlike DKA, which has a more rapid onset.

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Correct Answer is B

Explanation

Choice A rationale
Phenazopyridine hydrochloride does not turn the urine purple. This color change is not associated with the medication.

Choice B rationale
Phenazopyridine hydrochloride turns the urine orange. This is a common and expected side effect of the medication and is harmless.
Choice C rationale
Phenazopyridine hydrochloride does not turn the urine blue. This color change is not associated with the medication.
Choice D rationale
Phenazopyridine hydrochloride does not turn the urine green. This color change is not associated with the medication.

A. Diaphoresis. B. Hypotension. C. Peripheral edema. D. Facial flushing.

Correct Answer is C

Explanation

Choice A rationale
Diaphoresis is incorrect. Diaphoresis, or excessive sweating, is not a typical symptom of end- stage kidney disease.
Choice B rationale
Hypotension is incorrect. While hypotension can occur in end-stage kidney disease, it is not as common as other symptoms like edema.
Choice C rationale
Peripheral edema is correct. Peripheral edema is a common symptom of end-stage kidney disease due to the kidneys’ inability to remove excess fluid from the body.

Choice D rationale
Facial flushing is incorrect. Facial flushing is not a typical symptom of end-stage kidney disease.

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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.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Phenazopyridine hydrochloride turns the urine which color?

Correct Answer is B

Explanation

A nurse is collecting data from a client who has end-stage kidney disease and is waiting for transport to dialysis. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse in a clinic is caring for a client who has heart failure and is taking digoxin. Which of the following statements by the client indicates the client is experiencing digoxin toxicity?

A nurse is reinforcing teaching with a client who has a new prescription for phenazopyridine. The nurse should reinforce to the client to expect which of the following while taking this medication?

A nurse is administering morning medications and realizes that nifedipine was administered to the wrong client. Which of the following is the priority nursing action?

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