Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

A patient presents with headache, confusion, and fruity breath. What condition is this patient most likely experiencing?

1. Respiratory alkalosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Metabolic acidosis

The correct answer is: Metabolic acidosis

The symptoms of headache, confusion, and fruity breath strongly suggest that the patient is experiencing metabolic acidosis, specifically diabetic ketoacidosis (DKA). In this condition, the body produces an excess of ketones due to the breakdown of fat for energy when glucose is not available, often seen in uncontrolled diabetes. Fruity breath, a result of the volatile nature of acetone (one of the ketone bodies), is a classic indicator of this metabolic disturbance. The headache and confusion are indicative of cerebral effects caused by acidosis and the resulting electrolyte imbalances, as well as the potential for dehydration and hypoperfusion associated with DKA. In contrast, respiratory alkalosis and metabolic alkalosis pertain to conditions that cause an increase in pH and bicarbonate level, symptoms of which would typically not include fruity breath or that specific neurological presentation. Respiratory acidosis, while it does relate to an accumulation of carbon dioxide and resultant acidosis, would not lead to fruity breath either. Thus, the combination of symptoms is consistent with metabolic acidosis, particularly in the context of diabetic complications.