ESTUDYR
NCLEX-STYLE CASE STUDY: PEDIATRIC TYPE 1 DIABETES
MELLITUS (DIABETIC KETOACIDOSIS)
Client Scenario (Applies to all items)
The nurse in the pediatric emergency department cares for a 10-year-old female client.
Health History, Assessment, and Vital Signs:
A 10-year-old child presents with her mother, who reports the child has had increased
thirst, frequent urination, fatigue, and weight loss over the past 2 weeks.
Over the past 24 hours, the child developed abdominal pain, vomiting, and rapid breathing.
On assessment, the child appears dehydrated, with dry mucous membranes and sunken
eyes. Her breath has a fruity odor. She is lethargic but responsive.
Vital signs on arrival:
Temperature: 37.4°C (99.3°F)
Heart rate: 128/min
Respiratory rate: 34/min (deep, rapid)
Blood pressure: 90/56 mmHg
Blood glucose: 420 mg/dL
Item 1 of 6
Question:
Click to select the findings that require immediate follow-up by the nurse.
(Select all that apply)
Blood glucose 420 mg/dL
Fruity breath odor
Deep, rapid respirations
Lethargy
Dry mucous membranes
Weight loss
Correct Answers:
, ESTUDYR
Blood glucose 420 mg/dL
Deep, rapid respirations
Lethargy
Fruity breath odor
Rationale:
These findings indicate diabetic ketoacidosis (DKA), a life-threatening condition.
Hyperglycemia → metabolic imbalance
Deep, rapid respirations (Kussmaul) → metabolic acidosis compensation
Fruity breath → ketone accumulation
Lethargy → possible cerebral involvement
Dry mucous membranes and weight loss are important but less urgent than metabolic
instability.
Item 2 of 6
Question:
For each finding, indicate whether it is most consistent with hyperglycemia, hypoglycemia,
or dehydration.
Finding Hyperglycemia Hypoglycemia Dehydration
Polyuria ☐ ☐ ☐
Fruity breath odor ☐ ☐ ☐
Lethargy ☐ ☐ ☐
Dry mucous membranes ☐ ☐ ☐
Rapid breathing ☐ ☐ ☐
Correct Answers:
Polyuria → Hyperglycemia
Fruity breath odor → Hyperglycemia
Lethargy → Hyperglycemia, Hypoglycemia
Dry mucous membranes → Dehydration
Rapid breathing → Hyperglycemia
Rationale:
Hyperglycemia causes osmotic diuresis (polyuria), ketone production (fruity breath), and
metabolic acidosis (rapid breathing).
NCLEX-STYLE CASE STUDY: PEDIATRIC TYPE 1 DIABETES
MELLITUS (DIABETIC KETOACIDOSIS)
Client Scenario (Applies to all items)
The nurse in the pediatric emergency department cares for a 10-year-old female client.
Health History, Assessment, and Vital Signs:
A 10-year-old child presents with her mother, who reports the child has had increased
thirst, frequent urination, fatigue, and weight loss over the past 2 weeks.
Over the past 24 hours, the child developed abdominal pain, vomiting, and rapid breathing.
On assessment, the child appears dehydrated, with dry mucous membranes and sunken
eyes. Her breath has a fruity odor. She is lethargic but responsive.
Vital signs on arrival:
Temperature: 37.4°C (99.3°F)
Heart rate: 128/min
Respiratory rate: 34/min (deep, rapid)
Blood pressure: 90/56 mmHg
Blood glucose: 420 mg/dL
Item 1 of 6
Question:
Click to select the findings that require immediate follow-up by the nurse.
(Select all that apply)
Blood glucose 420 mg/dL
Fruity breath odor
Deep, rapid respirations
Lethargy
Dry mucous membranes
Weight loss
Correct Answers:
, ESTUDYR
Blood glucose 420 mg/dL
Deep, rapid respirations
Lethargy
Fruity breath odor
Rationale:
These findings indicate diabetic ketoacidosis (DKA), a life-threatening condition.
Hyperglycemia → metabolic imbalance
Deep, rapid respirations (Kussmaul) → metabolic acidosis compensation
Fruity breath → ketone accumulation
Lethargy → possible cerebral involvement
Dry mucous membranes and weight loss are important but less urgent than metabolic
instability.
Item 2 of 6
Question:
For each finding, indicate whether it is most consistent with hyperglycemia, hypoglycemia,
or dehydration.
Finding Hyperglycemia Hypoglycemia Dehydration
Polyuria ☐ ☐ ☐
Fruity breath odor ☐ ☐ ☐
Lethargy ☐ ☐ ☐
Dry mucous membranes ☐ ☐ ☐
Rapid breathing ☐ ☐ ☐
Correct Answers:
Polyuria → Hyperglycemia
Fruity breath odor → Hyperglycemia
Lethargy → Hyperglycemia, Hypoglycemia
Dry mucous membranes → Dehydration
Rapid breathing → Hyperglycemia
Rationale:
Hyperglycemia causes osmotic diuresis (polyuria), ketone production (fruity breath), and
metabolic acidosis (rapid breathing).
