The nurse is caring for a client with type 1 diabetes mellitus who has been taught the dosage of insulin.

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.

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.