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
Correct Answer : B,D,E,F
Choice A reason: 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 reason: 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 reason: 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 reason: 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 reason: 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 reason: 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Insulin is stable at room temperature (between 59°F and 86°F) for up to one month. This is important for patients to know, especially if they do not have immediate access to refrigeration. However, it is crucial to avoid exposing insulin to extreme temperatures, such as direct sunlight or freezing conditions, as these can degrade the medication’s effectiveness.
Choice B Reason:
While some types of insulin can be mixed in the same syringe, this practice is not universally applicable to all insulin types. For example, rapid-acting and intermediate-acting insulins can sometimes be mixed, but long-acting insulins should not be mixed with other insulins. Therefore, this statement is not entirely accurate and should be clarified based on the specific types of insulin being used.
Choice C Reason:
Storing insulin in the freezer is not recommended as freezing can damage the insulin, rendering it ineffective. Insulin should be stored in a refrigerator at temperatures between 36°F and 46°F. If insulin is accidentally frozen, it should not be used.
Choice D Reason:
While it is advisable for clients with type 1 diabetes to have backup medication and supplies, storing them in a car is not recommended due to the potential for extreme temperature fluctuations. Insulin and other diabetes supplies should be kept in a stable, controlled environment to ensure their efficacy.
Correct Answer is ["A","B","D"]
Explanation
Choice A reason:
Heart murmur is a common manifestation of valvular dysfunction. It occurs when there is turbulent blood flow across a damaged or abnormal heart valve. This can be due to stenosis (narrowing of the valve) or regurgitation (leakage of the valve). The murmur’s characteristics, such as timing, location, and intensity, can help in diagnosing the specific type of valvular disease. For example, a systolic murmur might indicate aortic stenosis or mitral regurgitation, while a diastolic murmur could suggest aortic regurgitation or mitral stenosis.
Choice B reason:
Chest pain is another symptom that can be associated with valvular dysfunction. This pain can result from increased workload on the heart due to inefficient blood flow through the valves. Conditions like aortic stenosis can lead to angina (chest pain) because the heart muscle may not receive enough oxygenated blood. This symptom is particularly concerning and warrants immediate medical attention to prevent complications such as myocardial infarction.
Choice C reason:
Varicose veins are not typically associated with valvular dysfunction in the heart. They are more related to issues with the veins in the legs, where the valves that prevent backflow of blood become weakened or damaged. This condition is generally referred to as chronic venous insufficiency and is not directly linked to the heart’s valvular problems.
Choice D reason:
Palpitations, or the sensation of irregular or rapid heartbeats, are common in clients with valvular dysfunction. These can occur due to arrhythmias, which are often seen in conditions like mitral valve prolapse or aortic regurgitation. The irregular heartbeats can be a result of the heart trying to compensate for the inefficient blood flow caused by the faulty valve.
Choice E reason:
Abdominal pain is not a typical manifestation of valvular dysfunction. While severe heart conditions can sometimes lead to generalized symptoms, abdominal pain is more commonly associated with gastrointestinal issues rather than heart valve problems. Therefore, it is not a primary symptom to anticipate in clients with valvular dysfunction.
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