A nurse is providing care for several clients who have type 2 diabetes mellitus. Which of the following clients is most at risk for developing hyperosmolar hyperglycemic syndrome (HHS)?

A client admitted for hip fracture surgery.

A client who is awaiting cataract surgery.

A client who is receiving an antibiotic for a urinary tract infection.

A client who is being evaluated for a breast lump.

Answer and Explanation

The Correct Answer is C

Choice A reason:

A client admitted for hip fracture surgery is at risk for various complications, but not specifically for hyperosmolar hyperglycemic syndrome (HHS). HHS is more commonly triggered by infections, severe dehydration, or other acute illnesses. While surgery can be a stressor, it is not as directly linked to HHS as infections are.

Choice B reason:

A client who is awaiting cataract surgery is not typically at high risk for developing HHS. Cataract surgery is generally a planned and controlled procedure that does not usually involve the acute stressors or infections that can precipitate HHS.

Choice C reason:

A client who is receiving an antibiotic for a urinary tract infection is at a higher risk for developing HHS. Infections are a common precipitating factor for HHS because they can cause significant stress on the body, leading to elevated blood glucose levels. The body’s response to infection can exacerbate hyperglycemia, especially in individuals with type 2 diabetes.

Choice D reason:

A client who is being evaluated for a breast lump is not typically at high risk for HHS. While the evaluation process can be stressful, it does not usually involve the acute physiological stressors or infections that are more directly linked to the development of HHS.

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Correct Answer is C

Explanation

Choice A reason:

A serum potassium level of 5.0 mEq/L is within the normal range (3.5-5.0 mEq/L). While it is on the higher end of normal, it does not require immediate intervention in the context of SIADH. Potassium levels are crucial for cardiac and muscle function, but this value does not indicate a critical imbalance.

Choice B reason:

A serum calcium level of 8.0 mg/dL is slightly below the normal range (8.5-10.2 mg/dL). Mild hypocalcemia can occur in various conditions, but it is not typically associated with SIADH and does not require immediate intervention unless symptomatic or significantly lower.

Choice C reason:

A serum sodium level of 125 mEq/L indicates hyponatremia, which is a hallmark of SIADH. Hyponatremia can lead to severe neurological symptoms, including seizures, confusion, and coma, especially if it develops rapidly. Immediate intervention is required to correct the sodium imbalance and prevent serious complications.

Choice D reason:

A blood urea nitrogen (BUN) level of 24 mg/dL is within the upper normal range (7-20 mg/dL). While slightly elevated, it is not critically high and does not require immediate intervention in the context of SIADH. BUN levels can be influenced by various factors, including hydration status and renal function.

A. Conivaptan hydrochloride 20 mg IV over 30 minutes STAT B. Vasopressin 10 mcg PO daily C. Sodium chloride tablets 1 g PO three times daily D. Tolvaptan 30 mg PO twice daily

Correct Answer is B

Explanation

Choice A Reason:

Conivaptan hydrochloride is a vasopressin receptor antagonist used to treat hyponatremia associated with SIADH. It works by blocking the action of ADH, thereby promoting water excretion without losing sodium. This medication is appropriate for managing SIADH.

Choice B Reason:

Vasopressin, also known as antidiuretic hormone (ADH), is not appropriate for a patient with SIADH. SIADH is characterized by excessive release of ADH, leading to water retention and hyponatremia. Administering vasopressin would exacerbate the condition by increasing water retention and further lowering sodium levels.

Choice C Reason:

Sodium chloride tablets are used to manage hyponatremia by increasing sodium levels in the blood. This treatment is appropriate for patients with SIADH to help correct the sodium imbalance caused by excessive ADH.

Choice D Reason:

Tolvaptan is another vasopressin receptor antagonist that is used to treat hyponatremia associated with SIADH. It helps to increase serum sodium levels by promoting water excretion while retaining sodium. This medication is suitable for managing SIADH.

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A nurse is providing care for several clients who have type 2 diabetes mellitus. Which of the following clients is most at risk for developing hyperosmolar hyperglycemic syndrome (HHS)?

Nursing Test Bank

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Correct Answer is C

Explanation

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Correct Answer is B

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