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 A

Explanation

Choice A reason: Intermittent claudication in PAD results from arterial occlusion, reducing blood flow to muscles during activity, causing ischemic pain. Atherosclerotic plaques narrow arteries, limiting oxygen delivery, leading to pain relieved by rest. This is the core pathophysiology, aligning with evidence-based explanations for PAD’s hallmark symptom in client education.

Choice B reason: Muscle atrophy may occur in advanced PAD due to chronic ischemia, but it is not the primary cause of claudication. Claudication is acute ischemic pain during activity from arterial occlusion. Atrophy is a long-term consequence, making this incorrect for explaining the immediate pathophysiology of claudication.

Choice C reason: Reduced blood flow when legs are elevated may worsen PAD symptoms but is not the primary cause of claudication. Claudication occurs during activity due to arterial occlusion limiting oxygen delivery. Elevation affects chronic symptoms, not the acute ischemic pain central to claudication’s pathophysiology.

Choice D reason: Reddened color in dependent feet (rubor) indicates advanced PAD but does not cause claudication. Claudication is ischemic pain from arterial occlusion during activity, not a positional color change. This choice misrepresents the pathophysiology, as rubor is a sign, not the mechanism of claudication pain.

A. Maintain a normal amount of circulating antidiuretic hormone. B. Increase the client’s serum osmolarity. C. Increase the excretion of acetone in the client’s urine. D. Control the client’s blood glucose levels.

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.

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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?

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Naxlex Comprehensive Predictor Exams

When developing a teaching plan for a client with peripheral artery disease (PAD), the nurse should explain that intermittent claudication occurs as the result of which underlying pathophysiology?

Correct Answer is A

Explanation

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

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?

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