A nurse is reinforcing teaching about the purpose of quadruple screening for a client who is at 16 weeks of gestation. Which of the following statements should the nurse make?

A. A toddler who has a new diagnosis of cystic fibrosis: Cystic fibrosis primarily affects the respiratory and gastrointestinal systems due to abnormal chloride transport and thick mucus production. While long-term illness can influence development, speech articulation is not directly impaired by the underlying pathophysiology of cystic fibrosis.

B. An infant who is postoperative following a cleft palate repair: A cleft palate alters normal oral cavity structure, affecting resonance, articulation, and proper sound production. Even after surgical repair, children are at risk for speech delays. Early referral to speech therapy supports proper phonation, articulation development, and prevention of compensatory speech patterns.

C. A school-age child who has chronic asthma: Asthma is characterized by airway inflammation, bronchoconstriction, and reversible airflow limitation. Although severe episodes may temporarily affect vocal quality, chronic asthma does not structurally impair speech production mechanisms. Management focuses on bronchodilators and anti-inflammatory therapy.

D. An adolescent who has juvenile idiopathic arthritis: Juvenile idiopathic arthritis primarily affects synovial joints, leading to inflammation, pain, and reduced mobility. Interdisciplinary care often includes physical and occupational therapy to maintain joint function. Speech production is not compromised unless there is rare temporomandibular joint involvement.

A. Negative urine ketones: Diabetic ketoacidosis (DKA) is characterized by increased production of ketone bodies due to insulin deficiency and enhanced lipolysis. Ketones accumulate in the blood and spill into the urine, producing positive urine ketone results. The absence of urine ketones does not support the presence of ketoacidosis, as ketosis is a defining metabolic feature.

B. Kussmaul respirations: Kussmaul respirations are deep, rapid breathing patterns that occur as a compensatory response to metabolic acidosis. In DKA, excess ketone production leads to accumulation of hydrogen ions and decreased serum bicarbonate. The respiratory system compensates by increasing ventilation to eliminate carbon dioxide.

C. Hypoglycemia: DKA is associated with hyperglycemia due to insufficient insulin, which prevents glucose from entering cells and leads to elevated serum glucose levels. Hypoglycemia involves low blood glucose and does not trigger the ketone overproduction seen in DKA. The pathophysiology of DKA centers on insulin deficiency and high circulating glucose.

D. Hypertension: Clients with DKA often experience osmotic diuresis from severe hyperglycemia, leading to dehydration and volume depletion. This intravascular fluid loss more commonly results in hypotension rather than elevated blood pressure. The hemodynamic changes in DKA are primarily related to dehydration and electrolyte imbalance.