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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

Answer and Explanation

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.

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Correct Answer is D

Explanation

Choice A Reason:

Decreasing activity is not recommended for managing peripheral venous disease. Regular physical activity, such as walking, helps improve blood circulation and can reduce symptoms. Inactivity can lead to worsening of the condition and increase the risk of complications.

Choice B Reason:

Massaging the legs frequently is not typically recommended for preventing fluid buildup in peripheral venous disease. Instead, compression therapy, such as wearing compression stockings, is more effective in managing symptoms and preventing fluid accumulation.

Choice C Reason:

Keeping the legs in a dependent position (hanging down) can worsen symptoms of peripheral venous disease. Elevating the legs above heart level helps reduce swelling and improve blood flow, which is beneficial for managing the condition.

Choice D Reason:

Inspecting the legs daily for changes in color, size, and temperature is crucial for managing peripheral venous disease. This practice helps in early detection of complications such as infections, ulcers, or worsening of the condition, allowing for timely medical intervention.

A. Take this medication with high-protein foods. B. Take this medication with a full glass of water or fruit juice. C. Take this medication before a meal or several hours after a meal. D. Take this medication during your morning meal.

Correct Answer is C

Explanation

Choice A Reason:

Taking levothyroxine with high-protein foods can interfere with the absorption of the medication. High-protein foods can bind to the medication, reducing its effectiveness. Therefore, it is not recommended to take levothyroxine with high-protein foods.

Choice B Reason:

While it is important to take levothyroxine with a full glass of water to ensure the tablet is swallowed properly and to aid in its absorption, taking it with fruit juice is not recommended. Certain juices, like grapefruit juice, can interfere with the absorption of levothyroxine.

Choice C Reason:

Levothyroxine should be taken on an empty stomach, ideally 30 to 60 minutes before breakfast or at least 3 to 4 hours after the last meal. This timing helps ensure optimal absorption of the medication. Food can significantly reduce the absorption of levothyroxine, making it less effective.

Choice D Reason:

Taking levothyroxine during a meal is not recommended because food can interfere with the absorption of the medication. It is best to take it on an empty stomach to ensure maximum absorption and effectiveness.

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