The nurse provides care for a client with a 10-year history of Crohn's disease. Which finding best describes a common complication of Crohn's disease?

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.

Choice A reason: Enlargement of the spleen is not a common sign of non-Hodgkin lymphoma, but it may occur in some cases. It is more likely to be associated with chronic lymphocytic leukemia or Hodgkin lymphoma.

Choice B reason: Confusion and agitation are not typical symptoms of non-Hodgkin lymphoma, but they may indicate central nervous system involvement or metabolic disturbances. They are more common in patients with brain tumors or infections.

Choice C reason: Frequent respiratory infections are a possible manifestation of non-Hodgkin lymphoma, as the disease affects the immune system and makes the client more susceptible to infections. The respiratory tract is one of the most common sites of infection in patients with non-Hodgkin lymphoma.

Choice D reason: Painful lesions of the lips and oral mucosa are not characteristic of non-Hodgkin lymphoma, but they may be caused by other conditions such as herpes simplex virus, aphthous ulcers, or oral cancer. They are more common in patients with immunodeficiency or poor oral hygiene.