A nurse is discussing growth with the parents of a 6-month-old infant who weighed 7 lbs at birth. Which statement best reflects the expected weight at this age?

A. Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain.

B. Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies.

C. Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children.

D. Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.

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.