The nurse is teaching a client with diabetes mellitus about the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The client shows an understanding of the teaching by stating which of the following symptoms develop with hyperosmolar hyperglycemic state (HHS)? (Select all that apply)

Kussmaul’s breathing

Fruity breath

Myoclonic jerking

Anuria

Seizures

Answer and Explanation

Correct Answer : C,D,E

Choice A reason: Kussmaul’s breathing is characteristic of DKA, not HHS, as it compensates for severe metabolic acidosis from ketone accumulation. HHS has minimal acidosis due to low ketosis, so rapid, deep breathing is not typical, making this an incorrect symptom for HHS.

Choice B reason: Fruity breath, caused by acetone from ketogenesis, is a hallmark of DKA, not HHS. HHS involves severe hyperglycemia with minimal ketone production, so this odor is absent, making this an incorrect symptom for the client’s understanding of HHS.

Choice C reason: Myoclonic jerking is a symptom of HHS, resulting from severe hyperosmolarity and electrolyte imbalances (e.g., hyponatremia) affecting neurological function. These involuntary muscle movements reflect CNS irritability, making this a correct symptom demonstrating understanding of HHS manifestations.

Choice D reason: Anuria is associated with HHS due to severe dehydration from osmotic diuresis caused by extreme hyperglycemia. Reduced urine output reflects hypovolemia and renal hypoperfusion, making this a correct symptom indicating the client’s understanding of HHS’s clinical presentation.

Choice E reason: Seizures can occur in HHS due to extreme hyperosmolarity and electrolyte disturbances (e.g., hyponatremia) disrupting neuronal activity. This neurological complication is a hallmark of severe HHS, making it a correct symptom reflecting the client’s understanding of the condition.

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Correct Answer is C

Explanation

Choice A reason: PaCO2 31 mmHg (normal 35-45 mmHg) suggests respiratory alkalosis, not typical in HHS. HHS primarily causes metabolic acidosis or normal pH due to severe hyperglycemia and dehydration, not respiratory compensation, making this an incorrect finding for HHS’s acid-base profile.

Choice B reason: HCO3 15 mEq/L (normal 21-28 mEq/L) indicates metabolic acidosis, more common in DKA than HHS. HHS typically has normal or slightly reduced HCO3 due to minimal ketone production, making this finding less consistent with HHS’s metabolic profile.

Choice C reason: pH 7.39 (normal 7.35-7.45) is expected in HHS, as it typically presents with minimal acidosis due to low ketone production compared to DKA. Severe hyperglycemia and hyperosmolarity dominate, with pH often remaining near normal, making this the correct finding.

Choice D reason: pH 7.27 indicates significant acidosis, typical of DKA, not HHS. HHS involves severe hyperglycemia and dehydration with minimal ketosis, resulting in normal or slightly acidotic pH, making this finding inconsistent with the expected acid-base balance in HHS.

A. Clear, yellow urine B. Tenderness in the left upper abdomen C. Clay-colored stools D. Fever with chills

Correct Answer is C

Explanation

Choice A reason: Clear, yellow urine is not expected with bile duct obstruction, which causes bilirubin accumulation, leading to dark urine. Blocked bile flow prevents bilirubin excretion, making this choice incorrect for chronic cholecystitis complications.

Choice B reason: Tenderness in the left upper abdomen is atypical, as chronic cholecystitis and bile duct obstruction cause right upper quadrant pain due to gallbladder inflammation and bile backup, making this choice incorrect.

Choice C reason: Clay-colored stools result from bile duct obstruction, as bile cannot reach the intestines, reducing bilirubin in stool. This causes pale stools, a hallmark of chronic cholecystitis complications, making this the correct expected finding.

Choice D reason: Fever with chills suggests acute infection, like cholangitis, but is not a primary finding in chronic cholecystitis with obstruction. Jaundice and stool changes are more consistent, making this choice less specific.

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A nurse is reviewing their client’s lab results. Their client is being treated for hyperosmolar hyperglycemic state (HHS). Which of the following arterial blood gas values will the client exhibit?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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