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A nurse is providing care for an older adult client who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following clinical manifestations support the diagnosis? Select all that apply.

Acetone breath

Fever

68 years of age

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,D,E,F

Choice A: Acetone Breath

Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). In DKA, the body produces high levels of ketones, leading to a fruity or acetone-like breath odor. HHS, on the other hand, does not usually involve significant ketone production, so acetone breath is not a characteristic feature of HHS.

Choice B: Fever

Fever can be a clinical manifestation of HHS, often indicating an underlying infection, which is a common precipitating factor for HHS. Infections can exacerbate hyperglycemia and contribute to the development of HHS, making fever a relevant symptom to consider.

Choice C: 68 Years of Age

While age itself is not a clinical manifestation, HHS predominantly affects older adults, particularly those with type 2 diabetes. Therefore, being 68 years old is consistent with the typical demographic affected by HHS, but it is not a direct clinical manifestation.

Choice D: Serum Glucose 800 mg/dL

A serum glucose level of 800 mg/dL is significantly elevated and is a hallmark of HHS2. Normal serum glucose levels range from 74 to 106 mg/dL. Such high levels of glucose are indicative of severe hyperglycemia, which is a defining characteristic of HHS.

Choice E: Serum Bicarbonate 15 mEq/L

A serum bicarbonate level of 15 mEq/L is below the normal range of 21 to 28 mEq/L. This indicates metabolic acidosis, which can occur in HHS due to severe dehydration and impaired renal function. Although metabolic acidosis is more pronounced in DKA, it can still be present in HHS.

Choice F: Insidious Onset

HHS typically has an insidious onset, developing slowly over days to weeks. This gradual progression contrasts with the rapid onset of DKA and is a key feature in the clinical presentation of HHS.

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Correct Answer is D

Explanation

Choice A reason:

Thickening of the walls of the ventricles is not typically associated with restrictive cardiomyopathy (RCM). This condition is more characteristic of hypertrophic cardiomyopathy (HCM), where the heart muscle becomes abnormally thick, making it harder for the heart to pump blood. In RCM, the walls of the ventricles are usually not thickened but become rigid due to fibrosis or infiltration, which restricts the heart’s ability to fill with blood during diastole.

Choice B reason:

Stretching of the ventricles is more commonly seen in dilated cardiomyopathy (DCM), not restrictive cardiomyopathy. In DCM, the heart’s ventricles become enlarged and weakened, which impairs the heart’s ability to pump blood efficiently. RCM, on the other hand, involves stiffening of the ventricular walls without significant dilation.

Choice C reason:

Thickening of the ventricular walls and septum is a hallmark of hypertrophic cardiomyopathy (HCM), not restrictive cardiomyopathy. In HCM, the thickened walls can obstruct blood flow and lead to various complications. RCM is characterized by the stiffening of the ventricular walls due to fibrosis or infiltration, which restricts diastolic filling.

Choice D reason:

When the ventricular tissue becomes fibrous and fatty is the correct description of restrictive cardiomyopathy (RCM). In RCM, the heart’s ventricles become stiff and less elastic due to fibrosis (scarring) or infiltration by abnormal substances, such as amyloid proteins. This rigidity impairs the heart’s ability to fill properly during diastole, leading to symptoms of heart failure

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A. Increased serum sodium B. Decreased serum osmolality C. Decreased urinary sodium D. Decreased urine osmolality

Correct Answer is B

Explanation

Choice A: Increased Serum Sodium

Increased serum sodium, or hypernatremia, is not consistent with SIADH. SIADH typically results in hyponatremia, which is a low level of sodium in the blood due to excessive water retention. The excess antidiuretic hormone (ADH) causes the kidneys to retain water, diluting the sodium in the bloodstream. Therefore, increased serum sodium is not a characteristic finding in SIADH.

Choice B: Decreased Serum Osmolality

Decreased serum osmolality is a hallmark of SIADH3. Serum osmolality measures the concentration of solutes in the blood. In SIADH, the excessive release of ADH leads to water retention, diluting the blood and lowering serum osmolality. This is a key diagnostic feature of SIADH and helps differentiate it from other conditions.

Choice C: Decreased Urinary Sodium

Decreased urinary sodium is not typically seen in SIADH. In fact, patients with SIADH usually have increased urinary sodium levels. This is because the kidneys excrete more sodium in an attempt to balance the excess water retained due to high ADH levels. Therefore, decreased urinary sodium is not consistent with SIADH.

Choice D: Decreased Urine Osmolality

Decreased urine osmolality is also not consistent with SIADH. In SIADH, urine osmolality is typically increased because the kidneys concentrate the urine due to the action of ADH. The high levels of ADH cause the kidneys to reabsorb water, resulting in more concentrated urine. Thus, decreased urine osmolality is not a characteristic finding in SIADH.

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A nurse is providing care for an older adult client who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following clinical manifestations support the diagnosis? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has restrictive cardiomyopathy (RCM). Which of the following statements should the nurse cue in the client?

Correct Answer is D

Explanation

A nurse is providing care for a client who has the syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings is consistent with a diagnosis of SIADH?

Correct Answer is B

Explanation

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