A nurse is assessing a child newly diagnosed with type 1 diabetes mellitus. Which of the following clinical manifestations should the nurse recognize as symptoms of diabetic ketoacidosis in this child? (Select all that apply)
Fruity (ketone) breath odor
Dehydration
Hypotension without dehydration
Kussmaul respirations (deep, rapid breathing)
Weight gain
Correct Answer : A,B,D
A. Fruity (ketone) breath odor is correct because diabetic ketoacidosis (DKA) causes the production of ketone bodies, including acetone, which gives the breath a sweet, fruity odor. This is a classic and easily recognizable sign of DKA.
B. Dehydration is correct because hyperglycemia leads to osmotic diuresis, causing excessive urination and fluid loss. Children with DKA often present with dry mucous membranes, poor skin turgor, tachycardia, and decreased urine output, all indicating dehydration.
C. Hypotension without dehydration is incorrect because hypotension in DKA is typically secondary to dehydration and volume depletion. Hypotension in the absence of dehydration is not characteristic of DKA.
D. Kussmaul respirations (deep, rapid breathing) are correct because metabolic acidosis in DKA stimulates the respiratory center to blow off excess carbon dioxide. These deep, labored respirations are a compensatory mechanism and are a hallmark sign of severe DKA.
E. Weight gain is incorrect because children with DKA usually experience weight loss, not gain, due to fat and muscle breakdown, dehydration, and insulin deficiency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Teaching the family about long-term management of asthma is incorrect because asthma management is not directly related to latex allergy, although children with latex allergy may have an increased risk of atopy. The focus should be on latex avoidance.
B. Avoiding using any latex product is correct. Children with spina bifida are at high risk for latex allergy due to frequent surgical procedures and exposure to latex-containing medical products. Complete avoidance of latex in medical equipment, gloves, toys, and household items is the most important preventive intervention to reduce the risk of anaphylaxis or allergic reactions.
C. Administering medication for long-term desensitization is incorrect because there is currently no safe or standard desensitization therapy for latex allergy. Management focuses on prevention and avoidance.
D. Using only nonallergenic latex products is partially misleading. There is no guarantee that “nonallergenic” latex products are completely safe; therefore, latex-free alternatives should be used instead of relying on “nonallergenic” labels.
Correct Answer is C
Explanation
A. Treatments are done in hospitals is incorrect because peritoneal dialysis is typically performed at home, not exclusively in hospitals. Home-based treatment is one of its key distinctions from hemodialysis.
B. Protein loss is less extensive is incorrect because peritoneal dialysis is associated with greater protein loss compared with hemodialysis due to protein leakage across the peritoneal membrane.
C. Parents and older children can perform treatments is correct because peritoneal dialysis can be done at home after proper training. This allows greater independence, flexibility, and a more normal lifestyle for children and families.
D. Dietary limitations are not necessary is incorrect because dietary and fluid restrictions are still required with peritoneal dialysis, although they may be less strict than with hemodialysis.
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