The nurse provides care for several clients. Which client is most at risk to develop metabolic acidosis?

A client with a 10-year history of chronic lung disease

A client receiving parenteral nutrition for 2 weeks

A client with a history of severe diarrhea for 5 days

A client with a temperature of 102°F (38.9°C) for 48 hours

Answer and Explanation

The Correct Answer is C

Choice A reason: A client with a 10-year history of chronic lung disease is not the most at risk to develop metabolic acidosis because chronic lung disease causes respiratory acidosis, not metabolic acidosis. Respiratory acidosis is a condition where the lungs cannot eliminate enough carbon dioxide, resulting in a low pH and a high bicarbonate level in the blood.

Choice B reason: A client receiving parenteral nutrition for 2 weeks is not the most at risk to develop metabolic acidosis because parenteral nutrition does not affect the acid-base balance of the body, unless there is an infection or a complication. Parenteral nutrition is a method of providing nutrients through a vein, bypassing the digestive system.

Choice C reason: A client with a history of severe diarrhea for 5 days is the most at risk to develop metabolic acidosis because diarrhea causes loss of bicarbonate, which is a base that helps maintain the pH of the blood. Loss of bicarbonate leads to a low pH and a low bicarbonate level in the blood, indicating metabolic acidosis.

Choice D reason: A client with a temperature of 102°F (38.9°C) for 48 hours is not the most at risk to develop metabolic acidosis because fever does not directly cause metabolic acidosis, unless there is dehydration or sepsis. Fever is a symptom of an infection or inflammation, which can increase the metabolic rate and the production of carbon dioxide, but the lungs can usually compensate by increasing the ventilation.

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Correct Answer is B

Explanation

Choice A reason: Liver failure is not the most common cause of this type of pain because it is a condition where the liver loses its ability to perform its vital functions, such as detoxifying the blood, producing bile, and metabolizing nutrients. Liver failure can cause symptoms such as jaundice, ascites, or bleeding, but it does not usually cause burning pain in the feet.

Choice B reason: Diabetes mellitus is the most common cause of this type of pain because it is a condition where the blood glucose level is too high, either due to insufficient insulin production or reduced insulin sensitivity. Diabetes mellitus can cause damage to the nerves, especially in the peripheral areas, such as the feet, which is called diabetic neuropathy. Diabetic neuropathy can cause symptoms such as burning pain, numbness, or tingling in the feet, which can worsen at night or with pressure.

Choice C reason: Mercury toxicity is not the most common cause of this type of pain because it is a condition where the body is exposed to high levels of mercury, which is a toxic metal that can be found in some fish, dental fillings, or thermometers. Mercury toxicity can cause damage to the nervous system, causing symptoms such as tremors, memory loss, or mood changes, but it does not usually cause burning pain in the feet.

Choice D reason: Vitamin B12 deficiency is not the most common cause of this type of pain because it is a condition where the body does not have enough vitamin B12, which is a nutrient that is essential for the production of red blood cells and the maintenance of the nervous system. Vitamin B12 deficiency can cause symptoms such as anemia, fatigue, or weakness, but it does not usually cause burning pain in the feet.

A. The client has hypoglycemia during the night and hyperglycemia in the morning. B. The client has not taken the prescribed insulin dose prior to the evening meal. C. The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months. D. The client will experience complications earlier than other clients with type 1 diabetes mellitus do.

Correct Answer is A

Explanation

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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The nurse provides care for several clients. Which client is most at risk to develop metabolic acidosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse provides care for a client who reports burning pain, which is worse at night, in both feet. The client states the pressure of the sheets on the feet is "unbearable". Which reason is the most common cause of this type of pain?

Correct Answer is B

Explanation

A client diagnosed with type 1 diabetes mellitus has experienced the Somogyi effect. Which explanation best describes this phenomenon?

Correct Answer is A

Explanation

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