The nurse is caring for a patient with type 2 diabetes who has been diagnosed with hyperglycemic hyperosmolar syndrome. What clinical manifestation will the nurse expect to find in this patient?

Arterial pH less than 7.3

Altered mental status

Presence of ketones in urine

Serum bicarbonate less than 15 mEq/L

Answer and Explanation

The Correct Answer is B

Choice A reason: An arterial pH less than 7.3 indicates acidosis, which is common in diabetic ketoacidosis but not typical in hyperglycemic hyperosmolar syndrome. Patients with hyperglycemic hyperosmolar syndrome typically have a near-normal pH.

Choice B reason: Altered mental status is a significant clinical manifestation in hyperglycemic hyperosmolar syndrome due to severe hyperglycemia and the hyperosmolar state, which can lead to dehydration and impaired brain function.

Choice C reason: The presence of ketones in urine is more commonly associated with diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome. The absence of significant ketonemia differentiates hyperglycemic hyperosmolar syndrome from diabetic ketoacidosis.

Choice D reason: Serum bicarbonate less than 15 mEq/L is indicative of metabolic acidosis, typically seen in diabetic ketoacidosis rather than hyperglycemic hyperosmolar syndrome, where bicarbonate levels are usually normal or slightly decreased.

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Correct Answer is B

Explanation

Choice A reason: "Abdominal ultrasound should not be performed if you are pregnant" is incorrect. Abdominal ultrasound is a safe and non-invasive diagnostic test that can be performed during pregnancy without any risk to the patient or the fetus.

Choice B reason: "Guaiac-based fecal occult blood testing is a non-invasive test that is commonly performed" is correct. This test is used to detect hidden blood in the stool and is commonly used for diagnostic purposes in patients with irritable bowel syndrome (IBS). It is safe and non-invasive.

Choice C reason: "You will have to remove any device containing metal for a flexible sigmoidoscopy" is correct but does not address the safety concern regarding IBS. Patients do need to remove metal objects for certain diagnostic procedures, but the focus should be on providing information about the non-invasive nature of specific tests.

Choice D reason: "The radiologist will perform the hydrogen breath test under general anesthesia to protect your airway" is incorrect. Hydrogen breath tests are typically performed without anesthesia. Patients simply need to blow into a device at specific intervals after ingesting a substance. The test is non-invasive and does not require anesthesia.

A. pH 7.46, PaCO2 30, HCO3 24 B. pH 7.48, PaCO2 42, HCO3 29 C. pH 7.31, PaCO2 34, HCO3 18

Correct Answer is B

Explanation

Choice A reason: The lab results pH 7.46, PaCO2 30, HCO3 24 suggest a slightly alkaline state with normal bicarbonate levels, which could indicate respiratory alkalosis with compensation. However, for a patient with a small bowel obstruction and nasogastric suction, this is less likely.

Choice B reason: The lab results pH 7.48, PaCO2 42, HCO3 29 indicate metabolic alkalosis. This is a common finding in patients with small bowel obstruction who have been on nasogastric suction, which removes stomach acids and leads to an increase in bicarbonate levels. The elevated pH and bicarbonate levels are consistent with this condition.

Choice C reason: The lab results pH 7.31, PaCO2 34, HCO3 18 indicate metabolic acidosis. This finding is inconsistent with the expected results for a patient with small bowel obstruction and nasogastric suction, which typically leads to metabolic alkalosis due to loss of gastric acid.

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The nurse is caring for a patient with type 2 diabetes who has been diagnosed with hyperglycemic hyperosmolar syndrome. What clinical manifestation will the nurse expect to find in this patient?

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