A client is admitted to the medical unit with fluid volume overload due to heart failure. Clinical manifestations of this problem are [Select all that apply]:

Choice A reason: Purplish streaks on the abdomen are also known as striae. They are caused by the thinning and weakening of the skin due to excess cortisol, a hormone that is elevated in Cushing syndrome. Striae are a common sign of Cushing syndrome, along with weight gain, moon face, and buffalo hump.

Choice B reason: Chronically low blood pressure is not associated with Cushing syndrome. Cushing syndrome can cause high blood pressure, due to the effects of cortisol on the cardiovascular system. Low blood pressure can be a sign of adrenal insufficiency, which is the opposite of Cushing syndrome.

Choice C reason: Bronzed appearance of the skin is not related to Cushing syndrome. Bronzed skin can be a sign of Addison's disease, which is a condition of low cortisol and low aldosterone. Addison's disease can cause hyperpigmentation of the skin, especially in the areas exposed to sun, such as the face, neck, and hands.

Choice D reason: Decreased axillary and pubic hair is also not related to Cushing syndrome. Cushing syndrome can cause increased hair growth, especially on the face, chest, and back. This is due to the androgenic effects of cortisol. Decreased hair growth can be a sign of hypothyroidism, which is a condition of low thyroid hormone.

Choice A reason: Weight loss is a common clinical manifestation of type 1 diabetes mellitus in children. Type 1 diabetes mellitus is a condition where the pancreas does not produce enough insulin, a hormone that helps the cells use glucose for energy. Without insulin, the glucose stays in the blood and causes high blood sugar levels. The body then breaks down fat and muscle for energy, resulting in weight loss.

Choice B reason: Low urine output is not a typical clinical manifestation of type 1 diabetes mellitus in children. In fact, the opposite is true: high urine output is a sign of type 1 diabetes mellitus. This is because the excess glucose in the blood draws water from the cells and tissues, causing dehydration and increased thirst. The kidneys then try to flush out the glucose and water through urine, leading to frequent urination.

Choice C reason: Weight gain is not a usual clinical manifestation of type 1 diabetes mellitus in children. As explained in choice A, type 1 diabetes mellitus causes weight loss due to the lack of insulin and the breakdown of fat and muscle. Weight gain can be a sign of type 2 diabetes mellitus, which is a condition where the cells become resistant to insulin and the pancreas cannot produce enough insulin to overcome the resistance. Weight gain can also be a side effect of insulin therapy, which is used to treat both types of diabetes mellitus.

Choice D reason: Hand tremors are not a specific clinical manifestation of type 1 diabetes mellitus in children. Hand tremors can be caused by many factors, such as anxiety, stress, caffeine, medication, or neurological disorders. Hand tremors can also be a symptom of hypoglycemia, which is a condition of low blood sugar that can occur in people with diabetes mellitus. However, hypoglycemia is not exclusive to diabetes mellitus, and can affect anyone who has a low intake of food, a high expenditure of energy, or a high dose of insulin or oral hypoglycemic agents.