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.
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Related Questions
Correct Answer is D
Explanation
A. Elevated serum carbon dioxide is incorrect because in diabetic ketoacidosis (DKA), serum bicarbonate (CO2 content) is usually decreased, reflecting metabolic acidosis rather than an elevation.
B. No urinary ketones is incorrect because the presence, not absence, of ketones is characteristic of DKA. Children in DKA typically have ketonuria and ketonemia, which contribute to acidosis.
C. Elevated serum phosphorus is incorrect because phosphorus levels in DKA are often normal or low due to urinary losses and shifts associated with acidosis and insulin therapy. It is not a diagnostic marker for DKA.
D. Low arterial pH is correct because DKA is characterized by metabolic acidosis, reflected by a low arterial pH (<7.35). The accumulation of ketone bodies (acetoacetate and beta-hydroxybutyrate) lowers blood pH, confirming the presence of DKA.
Correct Answer is D
Explanation
A. Psychosocial environment is incorrect because while a stimulating and supportive environment can influence growth indirectly, the primary concern for minimal weight gain and fatigue in an infant is related to intake and nutritional status rather than parental interaction or emotional factors alone.
B. Genetics is incorrect because both parents are of average height, suggesting that hereditary factors are unlikely to explain poor weight gain in this infant. Genetic potential affects height and weight trends but would not typically cause sudden minimal weight gain and fatigue.
C. Daycare setting is incorrect because while meal patterns and activity level at daycare could influence intake, the report of decreased appetite and fatigue suggests a direct nutritional or health issue rather than environmental influence alone.
D. Nutrition is correct because insufficient caloric or nutrient intake is the most likely cause of poor weight gain, low energy, and fatigue in a 9-month-old. At this age, infants rely on adequate nutrition from breast milk, formula, or complementary foods to support rapid growth and development.
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