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

The client has hypoglycemia during the night and hyperglycemia in the morning.

The client has not taken the prescribed insulin dose prior to the evening meal.

The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months.

The client will experience complications earlier than other clients with type 1 diabetes mellitus do.

Answer and Explanation

The Correct Answer is A

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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Correct Answer is B

Explanation

Choice A reason: Hyperplasia is not the best term because it is a condition where the number of cells in a tissue or organ increases, which can be caused by various factors, such as hormones, inflammation, or stress. Hyperplasia does not involve the change of cell type, but the increase of cell number.

Choice B reason: Metaplasia is the best term because it is a condition where the type of cells in a tissue or organ changes, usually in response to chronic irritation or injury. Metaplasia involves the replacement of one type of cell with another type of cell that is more resistant to the harmful stimulus, but less specialized in function. Metaplasia can occur in the bronchi, which are the airways that branch from the trachea to the lungs, and are normally lined with ciliated columnar cells, which are cells that have hair-like projections that help to move mucus and foreign particles out of the respiratory tract. Metaplasia can replace the ciliated columnar cells with stratified squamous epithelial cells, which are cells that have multiple layers and a flat shape, and are more durable, but less effective in clearing the airways.

Choice C reason: Neoplasia is not the best term because it is a condition where the growth of cells in a tissue or organ is abnormal and uncontrolled, which can result in the formation of tumors, which are masses of abnormal cells that can be benign or malignant. Neoplasia does not involve the change of cell type, but the abnormal proliferation of cells.

Choice D reason: Dysplasia is not the best term because it is a condition where the shape, size, and organization of cells in a tissue or organ are abnormal, which can be caused by various factors, such as chronic inflammation, infection, or precancerous changes. Dysplasia does not involve the change of cell type, but the alteration of cell morphology and arrangement.

A. Prostaglandins B. Histamine C. Leukotrienes D. Bradykinin

Correct Answer is B

Explanation

Choice A reason: Prostaglandins are inflammatory mediators that are derived from arachidonic acid. They are involved in both the early and late phases of type 1 hypersensitivity response, but they do not cause immediate bronchoconstriction and vasodilation. They mainly cause pain, fever, and inflammation.

Choice B reason: Histamine is an inflammatory mediator that is stored in mast cells and basophils. It is released during the early phase of type 1 hypersensitivity response, which occurs within minutes of exposure to an allergen. It causes immediate bronchoconstriction and vasodilation, as well as increased vascular permeability, mucus secretion, and itching.

Choice C reason: Leukotrienes are inflammatory mediators that are derived from arachidonic acid. They are involved in the late phase of type 1 hypersensitivity response, which occurs several hours after exposure to an allergen. They cause sustained bronchoconstriction and inflammation, as well as increased mucus production and airway edema.

Choice D reason: Bradykinin is an inflammatory mediator that is formed from plasma proteins. It is not directly involved in type 1 hypersensitivity response, but it may be activated by the complement system, which is part of the innate immune system. It causes vasodilation, increased vascular permeability, and pain.

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

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Naxlex Comprehensive Predictor Exams

Which term is best for the nurse to use to describe replacement of ciliated columnar cells to stratified squamous epithelial cells in the bronchi that were diagnosed in a client?

Correct Answer is B

Explanation

Which term describes the inflammatory mediator released during the early phase of type 1 hypersensitivity response causing immediate bronchoconstriction and vasodilation?

Correct Answer is B

Explanation

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