A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?

Choice A reason: Acetone odor to the breath is a hallmark manifestation of diabetic ketoacidosis (DKA). In DKA, the body shifts to fat metabolism due to insufficient insulin, leading to the production of ketone bodies such as acetoacetate, beta-hydroxybutyrate, and acetone. Acetone is volatile and excreted via the lungs, producing the characteristic fruity odor on the breath. This clinical sign is a direct reflection of severe metabolic derangement and is often used by clinicians as a bedside indicator of ketoacidosis. It correlates with hyperglycemia, metabolic acidosis, and dehydration, all of which are central features of DKA. Choice B reason: Malignant hypertension is not a manifestation of diabetic ketoacidosis. Malignant hypertension refers to a severe, rapidly progressive elevation in blood pressure that can cause end-organ damage such as retinal hemorrhages, renal failure, or encephalopathy. While DKA can cause hemodynamic instability due to dehydration and electrolyte imbalance, it does not directly cause malignant hypertension. Blood pressure changes in DKA are more often related to hypovolemia and shock rather than hypertensive crises. Choice C reason: Blood glucose level below 40 mg/dL is not expected in diabetic ketoacidosis. DKA is characterized by severe hyperglycemia, typically with blood glucose levels greater than 250 mg/dL. Hypoglycemia occurs when insulin or oral hypoglycemic agents are excessive relative to glucose intake, but in DKA, the problem is insulin deficiency leading to uncontrolled hyperglycemia. Therefore, a glucose level below 40 mg/dL would be inconsistent with the pathophysiology of DKA and would instead suggest an insulin overdose or other hypoglycemic condition. Choice D reason: Cheyne-Stokes breathing is not typical of diabetic ketoacidosis. Cheyne-Stokes respiration is a cyclical pattern of breathing characterized by periods of apnea followed by gradually increasing and then decreasing tidal volumes, often seen in conditions such as heart failure, stroke, or traumatic brain injury. In DKA, the expected respiratory pattern is Kussmaul respirations—deep, rapid breathing—as the body attempts to compensate for metabolic acidosis by blowing off carbon dioxide. Cheyne-Stokes breathing does not serve the same compensatory purpose and is not associated with DKA.