A 49-year-old female patient with type 2 diabetes (T2DM) and a BMI of 31 presents to the nurse practitioner with a swollen, thick, rubbery area of the skin on her abdomen. She recently went to the ED for a hypoglycemic episode, but today her fasting blood glucose level is 197. Which of the following most closely aligns with this clinical scenario?
The client is taking an antiplatelet, which is causing the swelling. The blood sugar changes are unrelated.
The client has developed lipodystrophy (LD) due to repeated insulin injections in the abdomen, and the injection of insulin into parts of the body affected by LD may cause wide glycemic oscillations, including inappropriately high glucose levels and a high risk of hyperglycemia.
The client has an underlying autoimmune disorder that predisposes her to rejecting the type of insulin she is currently receiving. She and the NP must find a different type of insulin to ensure no more glycemic oscillations. The swollen abdomen is unrelated.
The client is not taking her insulin as directed, and she is trying to distract the NP with the swollen stomach issue.
The Correct Answer is B
Choice A reason: Antiplatelet therapy does not cause localized swelling or lipodystrophy, making this unlikely.
Choice B reason: Repeated insulin injections in the same area can lead to lipodystrophy, characterized by thickened, rubbery skin. Injecting into these areas alters insulin absorption, causing unpredictable glycemic fluctuations, including hyperglycemia.
Choice C reason: There is no evidence of insulin “rejection” by autoimmune disorders; this is an inaccurate explanation for the physical findings and glycemic instability.
Choice D reason: Nonadherence may affect blood glucose, but the localized abdominal swelling is clinically consistent with lipodystrophy rather than deception.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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Correct Answer is B
Explanation
Choice A reason: Fluoxetine is an SSRI that may be used off-label for PTSD, but it is not specifically FDA-approved for this condition.
Choice B reason: This is correct. Sertraline is an SSRI and one of the first-line medications approved by the FDA for PTSD treatment, demonstrating efficacy in reducing core PTSD symptoms.
Choice C reason: Mirtazapine is not FDA-approved for PTSD but may be used off-label to target sleep disturbances or depressive symptoms.
Choice D reason: Lamotrigine is a mood stabilizer used primarily for bipolar disorder and not FDA-approved for PTSD management.
Correct Answer is C
Explanation
Choice A reason: The raphe nucleus primarily regulates serotonin production and mood but is not the central mechanism in anxiety pathophysiology.
Choice B reason: The ventral tegmental area is part of the reward pathway and is associated with dopamine, relevant to motivation and addiction, not primary anxiety mechanisms.
Choice C reason: This is correct. Dysregulation of the HPA axis is central to anxiety disorders. Activation of the amygdala triggers the hypothalamus to release CRH, stimulating ACTH from the pituitary, which then triggers cortisol release from the adrenal glands. Chronic activation can lead to persistent anxiety symptoms.
Choice D reason: The locus coeruleus regulates norepinephrine and arousal; while it contributes to anxiety responses, the HPA axis is the primary system implicated in sustained anxiety disorders.
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