The nurse is assigned to an adolescent who is admitted with out-of-control diabetes. There are high levels of ketones in the urine. The child has Kussmaul's respirations and is confused and somewhat lethargic
The nurse knows that this child is in: a. respiratory alkalosis c. metabolic acidosis
b. respiratory acidosis d. metabolic alkalosis
C
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A Incorrect: The nurse knows that this child is not in respiratory alkalosis.
B Incorrect: The nurse knows that this child is not in respiratory acidosis.
C Correct: The nurse is assigned to an adolescent who is admitted with out-of-control diabetes. There are high levels of ketones in the urine. The child has Kussmaul's respirations and is confused and somewhat lethargic. The nurse knows that this child is in metabolic acidosis. Metabolic acidosis is commonly caused by an increase of ketone bodies in the blood and urine, as seen in diabetic ketoacidosis. The child is confused, lethargic, and tachycardic. The body compensates by increasing the depth and rate of respirations.
D Incorrect: The nurse knows that this child is not in metabolic alkalosis.
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