A client diagnosed with type 1 diabetes mellitus has experienced the Somogyi effect. Which explanation best describes this phenomenon?
The client has hypoglycemia during the night and hyperglycemia in the morning.
The client has not taken the prescribed insulin dose prior to the evening meal.
The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months.
The client will experience complications earlier than other clients with type 1 diabetes mellitus do.
The Correct Answer is A
Choice A reason: The client has hypoglycemia during the night and hyperglycemia in the morning is the best explanation because it is the definition of the Somogyi effect, which is a rebound phenomenon that occurs in some people with type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition where the pancreas does not produce enough insulin, which is a hormone that helps the cells use glucose, which is a sugar that provides energy for the body. The Somogyi effect happens when the blood glucose level drops too low during the night, usually due to taking too much insulin or not eating enough carbohydrates before bedtime. This triggers the release of hormones, such as glucagon, epinephrine, and cortisol, that raise the blood glucose level by stimulating the liver to produce more glucose and by preventing the cells from using glucose. This results in a high blood glucose level in the morning, which is called hyperglycemia.
Choice B reason: The client has not taken the prescribed insulin dose prior to the evening meal is not the best explanation because it is a factor that can cause the opposite of the Somogyi effect, which is the dawn phenomenon. The dawn phenomenon is a condition where the blood glucose level rises in the early morning, usually due to the natural increase of hormones, such as growth hormone and cortisol, that occur during the night. These hormones reduce the effectiveness of insulin and increase the blood glucose level. The dawn phenomenon can be worsened by not taking enough insulin or by eating too many carbohydrates in the evening.
Choice C reason: The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months is not the best explanation because it is a consequence, not a cause, of the Somogyi effect. Glycosylated hemoglobin (HbA1c) is a test that measures the average blood glucose level over the past two to three months, by showing how much glucose is attached to the hemoglobin, which is the protein that carries oxygen in the red blood cells. The Somogyi effect can cause the HbA1c level to be higher than expected, because it reflects the high blood glucose level in the morning, not the low blood glucose level during the night.
Choice D reason: The client will experience complications earlier than other clients with type 1 diabetes mellitus do is not the best explanation because it is a general statement, not a specific explanation, of the Somogyi effect. The Somogyi effect can increase the risk of complications, such as eye, kidney, nerve, and heart problems, because it causes fluctuations in the blood glucose level, which can damage the blood vessels and the organs. However, the Somogyi effect is not the only factor that can affect the development and progression of complications. Other factors, such as genetics, lifestyle, and comorbidities, can also play a role.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: A sacculated aneurysm in the circle of Willis is not the most likely cause of a left-sided embolic stroke. A sacculated aneurysm is a bulging of a weak spot in the wall of an artery, which may occur in the circle of Willis, a network of arteries at the base of the brain. A sacculated aneurysm may cause a hemorrhagic stroke, which is a bleeding into the brain, not an embolic stroke, which is a blockage of a blood vessel by a clot.
Choice B reason: Rupture of small cerebral blood vessels is not the most likely cause of a left-sided embolic stroke. Rupture of small cerebral blood vessels may occur due to hypertension, diabetes, or aging, which may damage the integrity of the blood vessel walls. Rupture of small cerebral blood vessels may cause a hemorrhagic stroke, which is a bleeding into the brain, not an embolic stroke, which is a blockage of a blood vessel by a clot.
Choice C reason: Diffuse inflammation of the small diameter blood vessels is not the most likely cause of a left-sided embolic stroke. Diffuse inflammation of the small diameter blood vessels may occur due to vasculitis, which is an autoimmune disorder that causes inflammation and narrowing of the blood vessels. Diffuse inflammation of the small diameter blood vessels may cause a thrombotic stroke, which is a formation of a clot within the blood vessel, not an embolic stroke, which is a blockage of a blood vessel by a clot that travels from another site.
Choice D reason: Migration of a clot from the left atrium of the heart is the best explanation for the most likely cause of a left-sided embolic stroke. An embolic stroke is a type of ischemic stroke, which is a lack of blood flow to the brain due to a blockage of a blood vessel by a clot. A clot may form in the left atrium of the heart due to conditions such as atrial fibrillation, which is an irregular heartbeat that causes blood to pool and clot in the heart. A clot may then break off and travel through the bloodstream until it reaches a smaller blood vessel in the brain, where it causes an embolic stroke.
Correct Answer is C
Explanation
Choice A reason: Increased serum hydrostatic pressure is not the best explanation for the edema because it is caused by fluid overload, not malnutrition. Fluid overload can result from heart failure, kidney failure, or excessive fluid intake.
Choice B reason: Increased kidney filtration pressure is not the best explanation for the edema because it is caused by increased blood flow to the kidneys, not malnutrition. Increased blood flow to the kidneys can result from hypertension, diabetes, or renal artery stenosis.
Choice C reason: Decreased capillary osmotic pressure is the best explanation for the edema because it is caused by low plasma protein levels, which are common in malnutrition. Low plasma protein levels reduce the force that pulls fluid back into the capillaries from the interstitial space, leading to fluid accumulation in the tissues.
Choice D reason: Intracellular dehydration is not the best explanation for the edema because it is caused by loss of water from the cells, not malnutrition. Loss of water from the cells can result from hypernatremia, hyperglycemia, or osmotic diuresis.
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