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.
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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Related Questions
Correct Answer is C
Explanation
Choice A reason: Blood flow is diverted from the abdominal muscles to the liver due to increased intravascular pressure is not the best description because it is a condition that affects the distribution of blood in the body, not the accumulation of fluid in the abdomen. Intravascular pressure is the pressure exerted by the blood on the walls of the blood vessels, which can be affected by various factors, such as blood volume, cardiac output, or vascular resistance. Increased intravascular pressure can cause blood flow to be diverted from the peripheral areas, such as the abdominal muscles, to the central areas, such as the liver, which can result in symptoms such as portal hypertension, which is a high blood pressure in the vein that carries blood from the digestive organs to the liver.
Choice B reason: Vasodilation of the mesenteric blood vessels promotes movement of sodium into the peritoneum is not the best description because it is a condition that affects the diameter of the blood vessels in the abdomen, not the accumulation of fluid in the abdomen. Vasodilation is the widening of the blood vessels, which can be caused by various factors, such as nitric oxide, prostaglandins, or histamine. Vasodilation of the mesenteric blood vessels, which are the blood vessels that supply the intestines, can increase the blood flow and the permeability of the capillaries, which are the smallest blood vessels, allowing sodium and water to move from the blood to the peritoneum, which is the membrane that covers the abdominal organs and the abdominal wall. However, this is not the main mechanism for ascites development in this client, because the amount of sodium and water that moves through the capillaries is normally balanced by the lymphatic system, which is a network of vessels that drains the excess fluid and returns it to the blood.
Choice C reason: Fluid moves from the intravascular space to the interstitial space due to decreased serum albumin levels is the best description because it is a condition that affects the osmotic pressure of the blood, which is the main mechanism for ascites development in this client. Osmotic pressure is the pressure that is exerted by the solutes, such as proteins, in a solution, which determines the movement of water across a semipermeable membrane, such as the capillary wall. Albumin is the most abundant protein in the blood, which is produced by the liver and helps to maintain the osmotic pressure of the blood. Decreased serum albumin levels can be caused by various factors, such as liver failure, malnutrition, or inflammation. Decreased serum albumin levels can reduce the osmotic pressure of the blood, which means that the blood cannot retain enough water, causing fluid to move from the intravascular space, which is the space within the blood vessels, to the interstitial space, which is the space between the cells and the blood vessels. This can result in edema, which is the swelling of the tissues due to fluid accumulation, especially in the abdomen, which is called ascites.
Choice D reason: The liver metabolizes increased amounts of antidiuretic hormone and aldosterone is not the best description because it is a condition that affects the hormonal regulation of water and sodium balance, not the accumulation of fluid in the abdomen. Antidiuretic hormone and aldosterone are hormones that help the kidneys retain water and sodium, respectively, and regulate the fluid and electrolyte balance in the body. Antidiuretic hormone is produced by the hypothalamus and secreted by the pituitary gland, while aldosterone is produced by the adrenal glands. The liver is involved in the metabolism and clearance of these hormones, which means that it breaks them down and removes them from the blood. Increased amounts of antidiuretic hormone and aldosterone can be caused by various factors, such as dehydration, heart failure, or renal failure. Increased amounts of antidiuretic hormone and aldosterone can cause the kidneys to reabsorb more water and sodium, which can increase the blood volume and the blood pressure, but this is not the main mechanism for ascites development in this client, because the fluid that accumulates in the abdomen is not from the kidneys, but from the capillaries.
Correct Answer is D
Explanation
Choice A reason: Bronchial constriction after inhalation of an irritant is a possible trigger for an asthma attack, not emphysema. It causes wheezing, coughing, and dyspnea, but it does not affect the alveolar structure or function.
Choice B reason: Damage to the mucociliary lining of the segmental bronchi is a consequence of chronic bronchitis, not emphysema. It impairs the clearance of mucus and pathogens from the airways, leading to recurrent infections and inflammation.
Choice C reason: Infiltration of bacteria and inflammatory exudates into the alveoli is a sign of pneumonia, not emphysema. It causes fever, chills, productive cough, and chest pain, but it does not cause permanent damage to the alveoli.
Choice D reason: Enlargement of the alveoli with destruction of the alveolar walls is the hallmark of emphysema. It reduces the surface area for gas exchange, increases the dead space, and decreases the elastic recoil of the lungs. It causes tachypnea, use of accessory muscles, and hypoxia, which can lead to decreased mental alertness.
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