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
Related Questions
Correct Answer is D
Explanation
Choice A reason: Low self-esteem is common in social anxiety disorder as individuals perceive themselves negatively in social situations.
Choice B reason: Sensitivity to rejection is a hallmark, as patients fear social disapproval or negative evaluation.
Choice C reason: Hypersensitivity to criticism drives avoidance of social interactions and contributes to distress.
Choice D reason: Individuals with social anxiety disorder typically do not experience significant reduction in anxiety merely by being accompanied by someone trusted; the disorder is situation-focused, and anxiety remains despite support.
Correct Answer is A
Explanation
Choice A reason: This is correct. The patient demonstrates both obsessions (intrusive thoughts about knocking) and compulsions (repetitive checking behavior). The duration exceeds six months and causes functional impairment in sleep and work, fulfilling DSM-5 criteria for OCD.
Choice B reason: Generalized anxiety disorder involves excessive worry across multiple domains but does not include specific compulsive behaviors performed in response to intrusive thoughts.
Choice C reason: Schizophrenia is characterized by psychosis, including delusions, hallucinations, and disorganized thinking. The patient recognizes that the knocking is imagined, which is inconsistent with schizophrenia.
Choice D reason: Agoraphobia involves fear of being in situations where escape might be difficult. The patient’s symptoms are not related to avoidance of public spaces or panic attacks in such settings.
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