In caring for a client with exacerbations of multiple sclerosis, the nurse recognizes that the exacerbations result in which pathologic change?

Choice A reason: Hypertension increases cardiac workload, causing left ventricular hypertrophy and eventual heart failure. Chronic high blood pressure impairs the heart’s pumping ability, a leading cause of HF in older adults. This history is strongly associated with HF development, per cardiovascular pathophysiology evidence.

Choice B reason: Renal lithiasis (kidney stones) causes pain or obstruction but is not directly linked to heart failure. While renal issues may complicate HF management, lithiasis itself does not strain the heart or cause HF, making it irrelevant to the client’s HF development history.

Choice C reason: Atrial fibrillation reduces cardiac efficiency by impairing atrial contraction, decreasing cardiac output, and increasing HF risk. In older adults, it can cause tachycardia-induced cardiomyopathy, exacerbating HF. This arrhythmia is a significant contributor to HF, supported by cardiology evidence.

Choice D reason: Emphysema, a COPD form, causes pulmonary hypertension and right heart strain, leading to right-sided HF (cor pulmonale). Chronic hypoxia from emphysema exacerbates cardiac stress, contributing to HF in comorbid patients, making it a relevant historical factor for HF development.

Choice E reason: Gouty arthritis involves uric acid crystal deposition, causing joint inflammation but not cardiac strain. While linked to metabolic syndrome, it does not directly cause HF. Other factors like hypertension are more directly associated, making gout irrelevant to HF development in this client.

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.