An older adult client with type 2 diabetes mellitus presents to the emergency department (ED) with a respiratory infection. The nurse recognizes that the client is at risk for hyperosmolar hyperglycemic state (HHS) as a result of which process?

Adverse reaction to IV antibiotics.

Elevated white blood cell (WBC) count.

Fever greater than 103°F (39.4°C).

Stress-induced release of hormones.

Answer and Explanation

The Correct Answer is D

Choice A reason: Adverse reactions to IV antibiotics may cause side effects but do not trigger hyperosmolar hyperglycemic state (HHS). HHS results from severe hyperglycemia driven by stress hormones in diabetes. Antibiotics treat infection but do not directly cause the metabolic decompensation leading to HHS in this client.

Choice B reason: Elevated WBC count indicates infection but is not the primary driver of HHS. Infection may contribute to stress, but HHS is caused by stress-induced hormones raising glucose levels. WBC elevation is a secondary marker, making this incorrect for the process causing HHS risk in this diabetic client.

Choice C reason: Fever above 103°F reflects infection severity but is not the direct cause of HHS. Stress from infection triggers hormone release, driving hyperglycemia and HHS. Fever is a symptom, not the pathophysiological process, making this less accurate than stress-induced hormonal changes for HHS risk.

Choice D reason: Stress-induced release of hormones (e.g., cortisol, glucagon) in response to infection raises blood glucose in type 2 diabetes, leading to HHS. These hormones promote gluconeogenesis and insulin resistance, causing severe hyperglycemia and hyperosmolality. This is the primary process driving HHS risk, per endocrine pathophysiology.

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Correct Answer is D

Explanation

Choice A reason: Normal antidiuretic hormone levels regulate water balance but do not address thirst in diabetes mellitus, which is caused by hyperglycemia-induced osmotic diuresis. Controlling blood glucose corrects the osmotic imbalance driving thirst, making ADH maintenance less relevant and incorrect for this manifestation’s control.

Choice B reason: Increasing serum osmolarity would worsen thirst, as high osmolarity from hyperglycemia causes dehydration and polydipsia. The goal is to reduce osmolarity by controlling blood glucose, which mitigates osmotic diuresis. This choice is incorrect, as it exacerbates the mechanism driving the client’s symptom.

Choice C reason: Increased acetone excretion occurs in diabetic ketoacidosis, not directly related to thirst in new diabetes mellitus. Thirst results from hyperglycemia causing osmotic diuresis. Controlling glucose levels addresses the root cause, making acetone excretion irrelevant and incorrect for managing polydipsia in this client.

Choice D reason: Increased thirst in diabetes mellitus results from hyperglycemia causing osmotic diuresis, leading to dehydration. Controlling blood glucose levels reduces serum osmolarity, preventing fluid loss and alleviating thirst. This is the primary physiologic mechanism, supported by endocrinology evidence for managing diabetes-related polydipsia effectively.

A. Hypertensive crisis requires immediate treatment to prevent a stroke. B. The drug may be needed to treat a sudden systemic allergic reaction. C. Stress increases the body’s need for additional replacement hormone. D. Hyperglycemia may require cortisol to lower the blood glucose level.

Correct Answer is C

Explanation

Choice A reason: Hypertensive crisis is not a feature of Addison’s disease, which causes hypotension due to cortisol and aldosterone deficiency. Cortisol kits address adrenal insufficiency during stress, not hypertension. This choice is incorrect, as it misaligns with Addison’s pathophysiology and cortisol’s role.

Choice B reason: Cortisol is not used for systemic allergic reactions, which require antihistamines or epinephrine. Addison’s patients need cortisol for adrenal insufficiency during stress, as their bodies cannot produce it. This choice is incorrect, as cortisol kits address hypoadrenalism, not anaphylaxis.

Choice C reason: Addison’s disease involves adrenal insufficiency, impairing cortisol production. Stress increases cortisol demand, which the patient cannot meet, risking adrenal crisis. Carrying a cortisol kit allows rapid administration during stress, preventing life-threatening hypotension or shock, aligning with endocrinology evidence for Addison’s management.

Choice D reason: Hyperglycemia is unrelated to Addison’s disease, which does not typically affect glucose metabolism. Cortisol kits address adrenal insufficiency, not blood glucose. This choice is incorrect, as cortisol replacement is for stress-induced hypoadrenalism, not glycemic control, per Addison’s pathophysiological basis.

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An older adult client with type 2 diabetes mellitus presents to the emergency department (ED) with a respiratory infection. The nurse recognizes that the client is at risk for hyperosmolar hyperglycemic state (HHS) as a result of which process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client newly diagnosed with diabetes mellitus is experiencing increased thirst. Which physiologic mechanism must take place to control this manifestation?

Correct Answer is D

Explanation

The nurse is preparing a female client with Addison’s disease for self-care after discharge. Which is the pathophysiological basis to support the need for the client to carry a cortisol kit at all times?

Correct Answer is C

Explanation

The nurse should recognize which response is the immune system’s reaction to a source of inflammation?

A client is admitted with gastrointestinal (GI) bleeding and a flat plate of the abdomen reveals an orange-sized mass in the stomach. After identifying the mass upon palpation of the abdomen, which location should the nurse document this finding?

A client who is admitted to the hospital with a diagnosis of primary diabetes insipidus (DI) asks the nurse if they will need insulin therapy. Which response should the nurse provide?

The nurse is caring for a client who has been diagnosed with primary hypertension. Which pathophysiological mechanism does the nurse recognize as the cause of primary hypertension?

The laboratory findings of a client with cirrhosis of the liver indicate high serum ammonia levels. As a result of this increased ammonia level, which symptom is this client likely to exhibit?

A female client with rheumatoid arthritis (RA) comes to the clinic with swelling of her wrists after she braced herself against a fall in the bathroom. Which pathophysiological mechanism should the nurse explain to the client regarding RA?

The nurse is assessing a client’s skin and notices a raised nodule on the right forearm that is tender and filled with purulent secretions. The healthcare provider (HCP) diagnosed the abscess as a furuncle. Which pathological etiology places the client at risk for the development of a furuncle?