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 D
Explanation
Rationale:
A. Abruptly withdrawing corticosteroid therapy can lead to adrenal insufficiency, not Cushing syndrome.
B. Poorly functioning adrenal glands cause Addison’s disease, not Cushing syndrome.
C. Lacking ACTH leads to secondary adrenal insufficiency, not Cushing syndrome.
D. Taking corticosteroids for many years can result in exogenous Cushing syndrome due to prolonged exposure to high cortisol levels, which mimic the effects of endogenous Cushing syndrome.
Correct Answer is D
Explanation
Rationale:
A. Taking a laxative yesterday is not directly relevant to the IVP procedure and does not typically pose a significant risk.
B. Not eating or drinking since the night before is expected for clients scheduled for an IVP due to the need for fasting prior to the procedure.
C. Reporting painful voiding may indicate a urinary tract issue, but it is not directly related to the IVP itself.
D. Taking metformin before breakfast is concerning because metformin should generally be withheld prior to IV contrast studies due to the risk of lactic acidosis, especially if renal function is compromised.