After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?

Choice A rationale: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is characterized by extremely high blood glucose levels (often over 600 mg/dL), severe dehydration, and altered mental status. The presence of negative ketones differentiates it from diabetic ketoacidosis. The body's remaining insulin production is enough to prevent ketosis but not enough to control severe hyperglycemia.
Choice B rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, dehydration, and the presence of ketones in the blood and urine. The client's lab results in this scenario specifically state "negative ketones," which rules out DKA as the primary diagnosis. Fruity breath would also be present in DKA.
Choice C rationale: Diabetic neuropathy is a long-term complication of diabetes that affects the nerves, leading to symptoms like numbness, tingling, or pain. It is a chronic condition and does not manifest with the acute metabolic crisis of extremely high blood glucose (1000 mg/dL), dehydration, and malaise described in the scenario.
Choice D rationale: Diabetic nephropathy is a chronic complication affecting the kidneys, characterized by progressive kidney damage and eventual kidney failure. While elevated BUN can be a sign, the acute presentation with extremely high glucose and dehydration is more indicative of a life-threatening metabolic emergency like HHNS rather than chronic organ damage.

Choice A rationale: Encouraging incentive spirometry is a pulmonary intervention designed to prevent atelectasis and pneumonia by promoting deep breathing. While important post-surgically, it does not address the metabolic emergency indicated by the fruity breath odor, which is a classic sign of excessive ketone production from fat metabolism due to severe insulin deficiency.
Choice B rationale: Increasing intravenous fluids could worsen fluid overload in a dehydrated client without addressing the underlying metabolic imbalance. Although fluid resuscitation is part of the treatment for severe hyperglycemia, the primary intervention involves insulin administration to correct the metabolic derangement and halt ketone production, which is the root cause of the fruity odor.
Choice C rationale: The fruity breath odor is caused by the exhalation of acetone, a type of ketone body produced during lipolysis when glucose is unavailable for cellular energy. This indicates the body is in a state of ketoacidosis, a life-threatening complication of uncontrolled diabetes. Consulting the provider for immediate testing and treatment is the priority action.
Choice D rationale: Performing meticulous pulmonary hygiene, such as suctioning and chest physiotherapy, is indicated for clients with respiratory secretions or compromised lung function. While important for general post-operative care, it does not address the specific metabolic emergency of ketoacidosis indicated by the fruity breath odor, which requires immediate medical intervention.