The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find?

A. Unruptured membranes: Internal fetal monitoring devices, such as a fetal scalp electrode or intrauterine pressure catheter, require rupture of membranes to access the amniotic fluid and fetal scalp. Attempting insertion with intact membranes increases the risk of trauma, infection, and procedural failure.

B. Cervix is dilated to 4 cm: A cervical dilation of 4 cm is typically sufficient for safe internal monitoring once membranes are ruptured. The degree of dilation itself does not prevent application, provided other criteria for internal monitoring are met.

C. External monitors are currently being used: External monitoring is noninvasive and can be used concurrently or as an initial step. The presence of external monitors does not contraindicate internal monitoring; internal devices are considered when more accurate fetal heart rate or contraction data are needed.

D. Fetus has a known heart defect: Some fetal heart defects may alter baseline heart rate or variability but do not automatically preclude the use of internal monitoring devices. Internal monitoring can still be applied safely if membranes are ruptured and other clinical criteria are met.

A. The parents report that their child had “a cold or flu” recently: Recent viral illness is more commonly associated with the onset of type 1 diabetes due to autoimmune pancreatic beta-cell destruction. Type 2 diabetes develops gradually and is related to insulin resistance rather than an acute immune trigger.

B. Blood pressure is decreased when checking vital signs: Hypotension is not an early or expected finding in type 2 diabetes mellitus. Blood pressure is often normal or elevated due to insulin resistance and associated metabolic changes. Decreased blood pressure may suggest dehydration or another acute condition rather than chronic hyperglycemia.

C. The parents report that their son “can’t drink enough water.”: Excessive thirst, or polydipsia, is a classic manifestation of hyperglycemia in diabetes mellitus. Elevated blood glucose causes osmotic diuresis, leading to increased urine output and compensatory thirst. This symptom is commonly reported in adolescents with type 2 diabetes.

D. Auscultation reveals Kussmaul breathing: Kussmaul respirations are deep, rapid breaths associated with metabolic acidosis, particularly diabetic ketoacidosis. DKA is more frequently seen in type 1 diabetes than type 2, especially in children. This respiratory pattern indicates a severe acute metabolic disturbance rather than typical type 2 presentation.