An older adult client is diagnosed with a severe urinary tract infection. The nurse assesses the client for which most serious complication?

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.

Choice A reason: Hepatomegaly is not the expected finding because it is a condition where the liver is enlarged, which can be caused by various factors, such as infections, tumors, or cirrhosis. Hepatomegaly is not a common manifestation of systemic lupus erythematosus, which is an autoimmune disease that causes inflammation and damage to various organs and tissues in the body.

Choice B reason: Abdominal cramping pain is not the expected finding because it is a symptom that can be caused by various conditions, such as irritable bowel syndrome, appendicitis, or diverticulitis. Abdominal cramping pain is not a specific manifestation of systemic lupus erythematosus, although some clients may experience abdominal discomfort due to gastritis, pancreatitis, or peritonitis, which are possible complications of the disease.

Choice C reason: Whitish patches on the tongue are not the expected finding because they are a sign of oral candidiasis, which is a fungal infection that affects the mouth and throat. Oral candidiasis can be caused by various factors, such as weakened immune system, antibiotic use, or diabetes. Oral candidiasis is not a typical manifestation of systemic lupus erythematosus, although some clients may have oral ulcers, which are painful sores that appear on the lips, gums, or tongue.

Choice D reason: Arthritis with papular rash is the expected finding because it is a characteristic manifestation of systemic lupus erythematosus, which affects the joints and the skin. Arthritis is a condition where the joints are inflamed, causing pain, stiffness, and swelling. Arthritis can affect any joint in the body, but it is more common in the hands, wrists, and knees. Papular rash is a type of skin rash that consists of small, raised bumps that are red or purple. Papular rash can appear on any part of the body, but it is more common on the face, especially on the cheeks and the bridge of the nose. Papular rash is also known as malar rash or butterfly rash, because of its shape and location.