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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. You have many dangerously low blood sugar levels. B. Your average blood sugar is high. C. Your blood sugar is too high after meals. D. Your blood sugar is very unstable.

Correct Answer is B

Explanation

Choice A Reason:

This statement is incorrect because a hemoglobin A1C level of 9% indicates that the client’s blood sugar levels have been consistently high over the past two to three months. Hemoglobin A1C is a measure of average blood glucose levels, not low blood sugar levels. Therefore, it would be inappropriate to suggest that the client has dangerously low blood sugar levels based on this result.

Choice B Reason:

This statement is correct because a hemoglobin A1C level of 9% indicates that the client’s average blood sugar levels are high. Hemoglobin A1C reflects the average blood glucose levels over the past two to three months. A normal A1C level is below 5.7%, while an A1C level between 5.7% and 6.4% indicates prediabetes, and an A1C level of 6.5% or higher indicates diabetes. Therefore, an A1C level of 9% clearly shows that the client’s average blood sugar is high.

Choice C Reason:

This statement is partially correct but not the most appropriate. While it is true that a high hemoglobin A1C level can indicate that blood sugar levels are high after meals, it is not specific enough. Hemoglobin A1C measures the average blood glucose levels over a period of time, not just after meals. Therefore, the statement “Your average blood sugar is high” is more accurate and appropriate.

Choice D Reason:

This statement is incorrect because it is too vague and does not provide specific information about the client’s blood sugar levels. While a high hemoglobin A1C level can indicate variability in blood sugar levels, it primarily reflects the average blood glucose levels over the past two to three months. Therefore, it would be more appropriate to state that the client’s average blood sugar is high.

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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.

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