A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
"I will carry a complex carbohydrate snack with me when I exercise."
"I should exercise first thing in the morning before eating breakfast."
"I should avoid injecting insulin into my thigh if I am going to go running."
"I will increase the intensity of my exercise routine if my urine is positive for ketones."
The Correct Answer is C
Rationale:
A. Carrying a simple carbohydrate snack (not a complex one) is recommended during exercise to prevent hypoglycemia, but this is not the correct statement.
B. Exercising first thing in the morning before eating can cause hypoglycemia due to low glucose levels after fasting.
C. Injecting insulin into the thigh before running can increase absorption rates, leading to hypoglycemia. Rotating injection sites and avoiding muscle groups that will be heavily exercised is recommended.
D. Exercise should be avoided if ketones are present in the urine, as it can indicate inadequate insulin and the risk of diabetic ketoacidosis.
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Correct Answer is C
Explanation
Rationale:
A. Bradycardia is not specifically associated with Addison's disease and can occur in various conditions.
B. Addison's disease typically causes hyperkalemia, not hypokalemia, due to insufficient aldosterone production.
C. Hypotension is a common manifestation in Addison's disease because of inadequate cortisol and aldosterone, leading to decreased blood volume and vascular resistance.
D. Hypernatremia is not typical in Addison's disease; rather, clients usually experience hyponatremia due to the lack of aldosterone leading to sodium loss.
Correct Answer is D
Explanation
Rationale:
A. An insufficient dose of insulin would likely cause hyperglycemia, not hypoglycemia.
B. Sugar substitutes do not affect blood glucose levels significantly and would not lead to hypoglycemia.
C. Birth control pills generally do not cause hypoglycemia.
D. Prolonged exercise increases insulin sensitivity and glucose uptake, which can lead to hypoglycemia if insulin or food intake is not adjusted accordingly. The 2-hour exercise session is the most likely cause of the hypoglycemic episode.