The nurse cares for a client recently diagnosed with infectious mononucleosis. Which explanation best describes the microorganism that causes this disease?

Choice A reason: Non-Hodgkin lymphoma is not the correct answer because it is a type of cancer that affects the lymphocytes, which are a type of white blood cell that are part of the immune system. Non-Hodgkin lymphoma does not have Reed-Sternberg cells, which are abnormal, large, and multinucleated cells that are characteristic of Hodgkin lymphoma.

Choice B reason: Multiple myeloma is not the correct answer because it is a type of cancer that affects the plasma cells, which are a type of lymphocyte that produce antibodies. Multiple myeloma does not have Reed-Sternberg cells, but it can have abnormal plasma cells that are called myeloma cells.

Choice C reason: Hodgkin lymphoma is the correct answer because it is a type of cancer that affects the lymphatic system, which is a network of organs, tissues, and vessels that help fight infections and diseases. Hodgkin lymphoma has Reed-Sternberg cells, which are the hallmark of this disease. Reed-Sternberg cells are thought to be derived from B lymphocytes, which are a type of lymphocyte that produce antibodies.

Choice D reason: Acute lymphocytic leukemia is not the correct answer because it is a type of cancer that affects the immature lymphocytes, which are called lymphoblasts. Acute lymphocytic leukemia does not have Reed-Sternberg cells, but it can have abnormal lymphoblasts that are called leukemic cells.

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.