CDE Practice Exam Questions #3 fully solved & updated

What is the first step in the process of diabetes self management education? A. Assessment B. Goal setting C. Diagnosis D. Referral - ANSWER-A. Assessment Which of the following options is an outcome of personal record keeping in relation to physical activity, according to recent studies? A. Those who keep logs of physical activity are more adherent to other elements of therapy (ie diet, medication) B. Those who keep exercise logs are more likely to enroll in organized exercise programs (ie gym memberships, classes) C. Keeping a physical activity log is associated with a higher level of self efficacy D. The obligation of record keeping has been identified as a barrier to exercise by study participants - ANSWER-C. Keeping a physical activity log is associated with a higher level of self efficacy Consider the following pt: male, age 46, previously sedentary, mild HTN and hyperlipidemia (both adequately controlled with medications), T2DM, and a BMI of 26. If this pt wishes to begin a moderate-intensity exercise regimen, what additional assessment may be warranted? A. Stress test with ECG B. DEXA scan to assess bone density and strength C. Ankle-Brachial index to rule out peripheral arterial disease D. None, as BP and cholesterol are being controlled and exercise is only moderate intensity - ANSWER-A. Stress test with ECG A stress test with ECG may be warranted, as this person is over 40, previously sedentary, has risk factors for CVD, and is beginning a program that is more intense than brisk walking, which is mild intensity. In your role as a diabetes educator for a clinic, you both assess and instruct pts on a variety of self-care skills. Which teaching strategy provides the best opportunity to both assess and instruct on self-administration of insulin? A. A written quiz in which the patient puts insulin administration steps in order B. A demonstration and return demonstration of insulin administration C. A video that can be viewed and reviewed on proper insulin administration technique D. A printed handout with pictures depicting steps of insulin administration, followed by verbal acknowledgement of understanding - ANSWER-B. A demonstration and return demonstration of insulin administration The following policies are part of your DSME program: asking pts if there are any dietary preferences or restrictions; inviting family members to participate; and being sensitive to your rate of speech and tone of voice. These policies address which specific type of consideration? A. Readiness to change variation among your patients B. Potential low literacy/numeracy levels among your patients C. Cultural characteristics/barriers of your population D. Poor family and social support - ANSWER-C. Cultural characteristics/barriers of your population According to the ADA consensus statement on managing preexisting diabetes for pregnancy (2008), what is the optimal glycemic target for pregnant women with preexisting diabetes (assuming the target may be reached without excessive hypoglycemia)? A. Pre-meal/fasting glucose: 60 to 90 mg/dL; peak postprandial <120 mg/dL; A1C <5.5% B. Pre-meal/fasting glucose: 60 to 99 mg/dL; peak postprandial <129 mg/dL; A1C <6% C. Pre-meal/fasting glucose: 70 to 100 mg/dL; peak postprandial <120 mg/dL; A1C <6.5% D. Pre-meal/fasting glucose: 70 to 110 mg/dL; peak postprandial <140 mg/dL; A1C <7% - ANSWER-B. Pre-meal/fasting glucose: 60 to 99 mg/dL; peak postprandial <129 mg/dL; A1C <6% UPDATED 2019: Fasting <95 mg/dL; 1 hr post prandial <140 mg/dL; 2 hr post prandial <120 mg/dL; A1C <6% During the initial assessment process, your pt answers the question, "How important is it for you to make this change right now?" with a 9 our of 10 (very important) and answers the question, "How confident are you that you will be able to make this change?" with a 2 out of 10 (not very confident). In customizing hr DSME plan, what should your focus be? A. Providing materials and experiences to enhance her knowledge and skills B. Addressing psychosocial needs, such as accepting her diagnosis and managing stress levels C. Highlighting the benefits of good diabetes management as a way to encourage behavior change D. Explaingin the two questions further to confirm understanding, as it is very uncommon for a pt to rate the readiness to change elements this far apart - ANSWER-A. Providing materials and experiences to enhance her knowledge and skills It is important to assess potential barriers to self-monitoring of bg, especially for pts who are not adhering to their plan of care recommendations. Which of the following barriers was NOT one cited by patients in recent studies? A. Cost of testing supplies B. Discomfort of finger sticks C. Lack of instruction and support D. Misplacement of small items - ANSWER-D. Misplacement of small items When assessing for risk of hypoglycemia in relation to exercise, which element of the patient record is most important to consider? A. The patients typical signs and symptoms with hypoglycemia B. Current patient physical/glycemic status (wt, BMI, A1C) C. Timing and content (ie carb content) of meals in relation to activity D. Medication regimen: types, dose, and timing - ANSWER-D. Medication regimen: types, dose, and timing Which of the following behaviors is the MOST likely indication that the pt is at a very low level of readiness to change? A. The pt becomes tearful as you explain how to keep a food diary B. The pt watches your demonstration but does not say anything C. The pt volunteers to answer a review question at the end of class but gets the answer wrong D. The pt denies that she has diabetes and disagrees with the doctor's referral to DSME - ANSWER-D. The pt denies that she has diabetes and disagrees with the doctor's referral to DSME According to ADA Standards, which statement is NOT true regarding medical nutrition therapy and diabetes? A. MNT is recommended for only those person with diabetes who are underweight, overweight, or obese B. MNT is recommended for anyone who has diabetes, regardless of nutritional status C. Children with diabetes and celiac disease should consult with a registered dietitian familiar with both conditions D. Because nutrition in the hospital setting is complex, a registered dietitian should be part of the inpatient diabetes care team to provide MNT - ANSWER-A. MNT is recommended for only those person with diabetes who are underweight, overweight, or obese You are assessing a pt's bg monitoring technique b having her demonstrate a bg test. Which fo the following actions is indicative of improper technique? A. Cleaning her hands with warm water and soap instead of alcohol B. Setting the lancet device to her preference C. Milking the lanced finger at the tip to acquire a sufficient blood sample D. Recording the reading in her notebook rather than on the clinic-provided sheet - ANSWER-C. Milking the lanced finger at the tip to acquire a sufficient blood sample A pt should milk the finger closer to the base of the finger and move towards the tip or milk the finger before lancing. Your pt suffers from obesity, T2DM, HTN, and hyperlipidemia. He recalls his dinner from last night: a low-fat turkey and cheese sandwich with mustard, a side salad with low-fat Italian dressing, pickles, a small serving of baked chips, and one can of club soda. Based on your assessment, which of the pt's conditions is at the greatest risk due to his food choices? A. Hyperlipidemia B. T2DM C. Obesity D. HTN - ANSWER-D. HTN A pt with GDM is convinced she developed GDM from eating too much of her favorite food - popcorn - early in her pregnancy. She insists that if she does not eat any again during her pregnancy, she will not have to start insulin and her bg values will return to normal. What emotional stage associated with chronic disease diagnosis (similar to Kubler-Ross stages of grief) do you assess in your pt? A. Denial B. Anger C. Bargaining D. Frustration and depression - ANSWER-C. Bargaining The bargaining stage is characterized by inaccurate explanations and /or erroneous cures. The pt "makes a deal" with self, provider, God, or others to get rid of the diabetes. Denial is characterized by disbelief in the diagnosis, anger is characterized by irritation, rage, anxiety, or guilt. Frustration and depression can occur at any time and are characterized by feelings of hopelessness and trouble establishing or maintaining good self-care habits. Which instructional strategy is likely to be MOST effective in terms of pt retention? A. PowerPoint presentation with funny visuals and bullet list of main points B. Current, well-referenced booklets with colorful diagrams, written at a patient's optimal reading level, that can be reviewed if desired C. One-on-one conversation over the phone where the educator presents information and then rephrases the information using analogies to ensure understanding D. Small group discussion around a table where pts teach each other a skill after seeing it explained and demonstrated by the educator - ANSWER-D. Small group discussion around a table where pts teach each other a skill after seeing it explained and demonstrated by the educator Which is the strongest predictor of health status? A. Ethnic group B. Literacy skill C. Income level D. Age - ANSWER-B. Literacy skill You pt, a 29 year old Hispanic female, tells you her goal is to lost 15 lbs by her wedding day in 3 months. What element of the nutrition assessment is most important to focus on to help her meet her goal? A. Composition of nutrients (protein/fat vs carbs) B. Energy balance (total calorie vs. expenditure) C. Type and amounts of carbohydrates consumed (glycemic index) D. Total grams of fiber per day - ANSWER-B. Energy balance (total calorie vs. expenditure) Which of the following assessment items is NOT considered a component of the "knowledge" area? A. Literacy/numeracy B. Level of family support C. Previous diabetes self-management education D. Proficiency of self-care skills - ANSWER-B. Level of family support Which of the following dose NOT need to be noted on the medication regimen portion of the initial DSME assessment? A. Daily multiple vitamin with iron B. Two cinnamon capsules with each meal C. Emergency albuterol inhaler for asthma (but has not used in 3 years) D. All of the above should be noted - ANSWER-D. All of the above should be noted An adult male pt who is 6'1", 215 lb, and has T2DM, completes a 24 hour dietary recall. Which of his meals do you assess to be the one MOST in need of modification? A. Breakfast: 1 cup of Raisin Bran with 1 cup skim milk, 12 oz orange juice, 1/2 bagel B. Lunch: Large taco salad (tortilla bowl, chicken, cheese, lettuce, tomato, salsa, refried beans, sour cream), 16 oz Diet Coke C. Dinner: 2 cheese burgers (w/ lean beef), side salad with light Italian dressing, 1 cup green beans, black coffee D. All meals are equally inappropriate and in need of modification - ANSWER-A. Breakfast: 1 cup of Raisin Bran with 1 cup skim milk, 12 oz orange juice, 1/2 bagel When asked about his personal goal for diabetes education, your pt's reply is, "I don't know what you mean." What would be an appropriate response? A. "What do you mean you don't know what I mean?" B. "How do you hope that learning more about diabetes will help you?" C. Do not say anything; allow him to think longer and then respond to you. D. "Well, for example, would you like to achieve your ideal weight, or reach your target bg? You know, things like that." - ANSWER-B. "How do you hope that learning more about diabetes will help you?" A pt who has identified himself as a visual learner would likely most prefer which method of instruction? A. Role-playing a scenario in which he orders a balanced meal at a restaurant B. Seeing pictures of food portions followed by booklets on meal planning C. A spoken explanation of how to adjust insulin depending on pre-meal glucose D. Group discussion on challenges relating to dealing with the stress of diabetes - ANSWER-B. Seeing pictures of food portions followed by booklets on meal planning You are reading the patient chart of a 30 year old African American female, newly diagnosed with diabetes (type is unspecified). Her BMI is recorded as 17.5. Her BMI falls into which category? A. Underweight B. Normal weight C. Overweight D. Obese - ANSWER-A. Underweight <18.5 = underweight 18.5-24.9 normal 25-29.9 overweight 30+ obese 40+ morbidly obese What is the main purpose of personal record keeping with regards to dietary habits? A. The pt is able to look back and feel proud for the positive changes that have been made, thus promoting pt empowerment B. A food record allows the pt and educator to review, evaluate, and reassess choices, which can be used to set or modify nutritional goals C. Insurance providers need to see evidence of the impact of MNT and the food record can be admitted as part of the official pt record D. Keeping a food record forces the pt to pay more attention to what he or she is eating and promotes the important diabetes life skills of recording daily activities - ANSWER-B. A food record allows the pt and educator to review, evaluate, and reassess choices, which can be used to set or modify nutritional goals Which hypothetical situation would you pose if you wanted to assess a pt's ability to deal with a glucose emergency? A. You are shopping for items for a special birthday meal that will also fit into your diabetes meal plan. What will you choose? B. What actions would you take if you were traveling out of state and realized on your trip that you were almost out of insulin. C. Say you are driving your car and you begin to feel shaky, sweaty, and confused. What would you do? D. How would you deal with a colleague who found out you have diabetes and proceeded to give you advice you knew to be incorrect? - ANSWER-C. Say you are driving your car and you begin to feel shaky, sweaty, and confused. What would you do? You assess a pt's self-administration of insulin with a non-refillable insulin pen device and a 5 mm pen needle. The pt performs the following actions: clean the end of the pen with alcohol, attach the pen needle, dial the dose, insert the needle into the skin and fully press the button, withdraw after 10 seconds, detach and dispose of the needle, replace the pen cap. What was incorrect about the way the pt perform this skill? A He needed to clean the skin with alcohol B. He needed to pinch the skin before injecting C. He left the pen needle in the skin for 10 seconds after injecting insulin D. He needed to prime the needle before dialing the dose - ANSWER-D. He needed to prime the needle before dialing the dose In a discussion on meal planning, your pt states, "My whole family is from Mexico, and they get offended when I don't want to eat our traditional foods." What type of barrier do you assess this pt is facing? A. Physical barrier related to problem solving B. Interpersonal barrier related to healthy eating C. Personal independence barrier related to healthy coping D. Financial barrier related to personal independence and family relationships - ANSWER-B. Interpersonal barrier related to healthy eating Which theoretical approach to learning and health behavior change theory maintains that individuals learn from their personal experiences as well as observing actions and experiences of others? A. Social Cognitive Theory B. Health Belief Model C. Theory of Planned Behavior D. Transtheoretical Model - ANSWER-A. Social Cognitive Theory Which of the following has NOT been identified as a major barrier to care, according to the 2006 "Barriers to Optimal Care for Pts with Diabetes and Strategies to Overcome Them?" A. Low level of health literacy B. Lack of interest on the part of the pts C. Limited time to see the provider D. Complexity of diabetes education - ANSWER-B. Lack of interest on the part of the pts Which of the following pt statements represents a situation in which specialty care provider resources are NOT being used according to ADA recommendations? A. "I see a dentist twice a year even though I do not have, and have never had, gum disease." B. I see my ophthalmologist annually even though he says that I have no signs of retinopathy." C. I have my cholesterol checked every year even though my LDL, HDL, and triglyceride levels have always been WNL." D. "I see a nephrologist annually even though my BP is normal and I have no diagnosis of kidney problems." - ANSWER-D. "I see a nephrologist annually even though my BP is normal and I have no diagnosis of kidney problems." How frequently should a diabetes educator assess a pt's tobacco use status and readiness to quit status? A. At every visit for those pts who smoke and only at the initial assessment for this who do not B. Annually, unless the pt brings it up C. At every visit D. Whenever the educator notes signs that indicate a possible change in status - ANSWER-C. At every visit Which of the following assessment findings is most likely to indicate poor circulation in the lower extremities? A. Substantial hair on the tops of toes B. Ankle-brachial index of 1.0 C. Diminished dorsals pedal pulses D. Positive pinprick sensation at the level of the ankle - ANSWER-C. Diminished dorsals pedal pulses Your pt, an older gentleman with T2DM, reports exercising 6x per week: 40 min of jogging on M/W/F and 40 minutes of strength training on T/TH/Sa. As part of your assessment, you should consider whether which type of physical activity recommendation is being addressed? A. Aerobic exercise B. Toning exercise C. Flexibility exercise D. Resistance exercise - ANSWER-C. Flexibility exercise Which of the following examples would you assess to be the MOST appropriate example of SMBG record keeping? A. A pt records her BG values with time, date, medications, food intake, and other activities in a spiral notebook instead of log sheet provided by the clinic. The book is tattered and stained with blood and food. B. A pt simply allows the meter to record all readings, which he then brings to the clinic for each visit. C. A pt does not bring her meter to the clinic but writes her BG values on the log sheet provided by the clinic. She lists only the values and no other information (food, activity, medication). D. A pt writes his BG values in the logbook that came with his meter. He includes times, activity levels, and illnesses, but does not write dates, food intake, or medication doses on the pages. He admits that he just picks any blank page to start the week and that some are out of order. - ANSWER-A. A pt records her BG values with time, date, medications, food intake, and other activities in a spiral notebook instead of log sheet provided by the clinic. The book is tattered and stained with blood and food. As part of the initial comprehensive DSME assessment, you ask your pt to describe his meals and snacks from the past 24 hours. He states that he cannot recall what he ate yesterday. What action or response would be the most appropriate? A. Note, "Pt does not recall" in your documentation and move on the the next question B. Invite his wife, who has accompanied him, to help recall what he ate yesterday C. Give the pt a 24 hour dietary log sheet and ask him to return it completed by the next week D. Encourage him by prompting, "Now, Honey, I can't believe that a man as smart as you can't come up with anything..." - ANSWER-B. Invite his wife, who has accompanied him, to help recall what he ate yesterday You are reviewing recent lab data for a new pt with diabetes but with no other documented co-morbidities. Which lab value is the greatest concern? A. A1C 7.8% B. LDL 101 mg/dL C. HDL 88 mg/dL D. Serum creatinine 2.8 mg/dL - ANSWER-D. Serum creatinine 2.8 mg/dL When asked to explain to you why he takes a specific oral diabetes medication, the pt does not look at the label. Instead, he opens the bottle and takes out a pill. Which possible barrier should you investigate further? A. Financial B. Cognitive C. Health literacy D. Fear of side effects - ANSWER-C. Health literacy What is acanthuses nigricans and what dose it suggest? A. A darkening and thickening of the skin, typically on the back/sides of the neck or the axillae; indicative of insulin resistance B. A pattern of deep, labored breathing; indicative of acidosis, common in advanced DKA C. Darkening of the toe nails; indicative of poor pedal circulation D. Blackening around the edges of an ulcer; indicative of tissue ischemia due to poor circulation and oxygenation - ANSWER-A. A darkening and thickening of the skin, typically on the back/sides of the neck or the axillae; indicative of insulin resistance Which fo the following methods is least recommended as a valid way to perform an initial pt DSME assessment? A. Talking to the nurse of the referring provider and using the information to complete the assessment form B. Meeting with the pt face-to-face and asking questions of the pt and his spouse C. Having pts complete an assessment form online before the first appt. and then following up with a few questions in person D. Observing pts in a group setting while having each member of the group complete personal information on a standardized assessment form - ANSWER-A. Talking to the nurse of the referring provider and using the information to complete the assessment form Which pt statement regarding medication administration would cause you to suspect further education is needed? A. "When I had to skip breakfast and lunch the day of my procedure, I took my Diabeta (glyburide) but skipped my Levemir (determir) B. "I leave my Lantus pen on my nightstand all the time so I will remember to take it at bedtime." C. "I take my metformin every morning, even if I will be skipping breakfast." D. "I throw away the Novolog (aspart) vial of insulin I am using after four weeks, even if it is half full." - ANSWER-A. "When I had to skip breakfast and lunch the day of my procedure, I took my Diabeta (glyburide) but skipped my Levemir (determir) Glyburide is a sulfonylurea, an insulin secretogogue with a comparatively high rate of hypglycemia and should not be taken if the person does not intend to eat. Additionally, basal insulin should be taken and full or reduced amount even when pts are NPO. Which of the following pt statements would be least important to note in the health history section of the initial DSME assessment? A. "My mother believes I got diabetes from eating too much candy as a kid." B. "I was hospitalized 8 months ago for DKA." C. "I experience low bg episodes about twice a month." D. "I have had diabetes for 4 years, ut I am not sure what type I have." - ANSWER-A. "My mother believes I got diabetes from eating too much candy as a kid." Which of the following choices is NOT information to be gathered as part of the initial individual DSME assessment, accord to the ADA National Standards for DSME (2013)? A. Financial status B. Emotional response to diabetes C. Cultural and religious practices that could affect diabetes D. Sexual orientation - ANSWER-D. Sexual orientation Which of the following pts would be classified as morbidly obese? A. 50 year old white male who is 22 kg (about 49 lbs) overweight and has already suffered one heart attack B. 26 year old Hispanic female with BMI of 41 C. 48 year old African American male who is consulting a specialist for possible bariatric surgery D. 60 year old white male who weighs 225 lbs - ANSWER-B. 26 year old Hispanic female with BMI of 41 Which of the following choices would be the MOST appropriate method for screening for pt numeracy challenges? A. Ask the pt about the highest grade he or she completed and how well the pt did in math B. Ask the pt if he or she has any trouble doing math problems C. Give the pt a standardized assessment test to be completed at home and have the pt bring it the next appt. D. Present applicable hypothetical situations, such as choosing a menu with specified total grams of carbs or calculating a mealtime insulin dose using a correction scale - ANSWER-D. Present applicable hypothetical situations, such as choosing a menu with specified total grams of carbs or calculating a mealtime insulin dose using a correction scale Which of the following items are considered Standards of Care (2013) for adults with T1DM or T2DM? A. Annual eye exam and annual echocardiogram B. Annual influenza vaccination and dilated eye exam every 6 months (more often if needed) C. Hepatitis B vaccination for adults less than 60 years and annual influenza vaccination for all pts D. Annual C peptide lab and A1C lab test every 6 months (more often if not at goal) - ANSWER-C. Hepatitis B vaccination for adults less than 60 years and annual influenza vaccination for all pts According to Medicare guidelines, which of the following pt characteristics or situations is NOT justification for individual sessions of diabetes education (over group sessions)? A. The pt prefers one-on-one education because he does not get along with others B. No group classes are available within 2 months of the referral C. The pt has visual and or language limitations D. The physician has a document request for individual education, based on the educator's assessment and recommendation - ANSWER-A. The pt prefers one-on-one education because he does not get along with others A 59 year old single female with T2DM admits that she only takes half of her recommended Januvia (sitagliptin) tablet, but does take her full metformin tablet. She later tells you that she has added more vegetables to her meals, but only canned vegetables. Based on these brief statements, what barrier do you believe is MOST likely a concern for this pt? A. Transportation B. Cultural C. Cognitive ability D. Financial - ANSWER-D. Financial A pt who is reluctant to attend DSME class states the reason as, "I already know all this stuff." In light of his learning readiness, what would be the MOST appropriate action?" A. Tell him that if he changes his mind, he may call you at anytime. Document his refusal to participate. B. Give him a pop quiz with challenging diabetes knowledge questions to help him see that he does not know everything C. Acknowledge his reluctance and ask if he might be willing to share some of his knowledge and experiences with the other class members D. Change the subject to minimize conflict and then speak with his wife to see if she might have better luck convincing him - ANSWER-C. Acknowledge his reluctance and ask if he might be willing to share some of his knowledge and experiences with the other class members Which of the following pt statements should alert you to a lack of understanding about the purpose of self-monitoring of bg? A. "I test my bg whenever I feel bad, even if it is not my regularly scheduled time to test." B. "I test 2-3x per day and schedule my testing times for when I think my numbers will be the best." C. "I wake up at 3am and test for a couple of days whenever my doctor changes my dose of basal insulin." D. "I try to test a couple of hours after a meal to see if my mealtime insulin dose was too little or too much." - ANSWER-B. "I test 2-3x per day and schedule my testing times for when I think my numbers will be the best." Which of the following is NOT considered a critical skill needed by the diabetes educator to assess pt's abilities to plan goals? A. Interpret information Gathering (ie assesses attitude, knowledge, and skill related to goal setting ability) B. Facilitating Engagement (ie uses skill to build a trusting relationship) C. Reporting Progress (ie documenting past and present progress, or lack thereof, in achieving set goals) D. Problem Analysis (ie develops an understanding of factors related to a pt's self management problems) - ANSWER-C. Reporting Progress (ie documenting past and present progress, or lack thereof, in achieving set goals) A pt comes into your clinic to sign up for diabetes education classes. He tells you that he has had diabetes for 12 years but did not want to face his diagnosis. Now, after seeing how he is unable to keep up with his grandchildren, he has realized the need to make some changes and control his bg. What stage of change most accurately describes the pt's state? A. Precontemplation B. Contemplation C. Preparation D. Action - ANSWER-C. Preparation Which of the following is NOT among the top treatment fears for pts who are being prescribed insulin? A. Nausea and subsequent weight loss B. Worsening of their diabetes C. Needles D. Hypoglycemia - ANSWER-A. Nausea and subsequent weight loss An older pt is not completing her assessment paperwork along with other group members. She moves slowly and squints at the signs on the door. Her hands shakes as she retrieves an item from her handbag. Based on what you have briefly observed, which fo the following learning barriers do you MOST likely suspect may be present? A. Visual and tactile/dexterity B. Hearing and literacy C. Financial and visual D. Mobility and cultural - ANSWER-A. Visual and tactile/dexterity A pt in your DSME group asks why a person cannot use oral medication to treat T1DM. Which is the most accurate and appropriate response? A. "Because T2DM is brought on by wt, and weight gain is a side effect of insulin, we avoid using insulin in those with T2DM while we prefer it for those with T1DM, who are typically underweight." B. "Everyone needs insulin to live. In T2DM, the insulin producing cells (beta cells) may still be working somewhat but not well enough to keep bg normal. Oral medications help the body's insulin to work better. In T1DM, the body has destroyed its own beta cells and so we must use insulin from an outside source." C. "T1DM is a more severe form of diabetes, and therefore, we go straight for the most potent medication. T2DM, on the other hand, is less severe and can be minimized by lifestyle changes, and so there are "less drastic" medication options." D. "Because T2DM is characterized by in - ANSWER-B. "Everyone needs insulin to live. In T2DM, the insulin producing cells (beta cells) may still be working somewhat but not well enough to keep bg normal. Oral medications help the body's insulin to work better. In T1DM, the body has destroyed its own beta cells and so we must use insulin from an outside source." In relation to safe driving, which for the following advice would the clinician least likely recommend? A. Always wear medical distances, stop every one to two hours to check bg B. When driving long distances, stop every one to two hours to check bg C. Always eat something with carbohydrates within the hour before you drive D. Keep some form of glucose or quick carb handy in the vehicle at all times - ANSWER-C. Always eat something with carbohydrates within the hour before you drive Which active-learning instructional strategy listed is one in which the educator has the MOST control over content? A. Group discussion B. Conversation maps C. Lecture with visual aids (ie slides) D. Demonstration - ANSWER-D. Demonstration For how long following intense, extended exercise should a person be concerned with the possibility of activity related hypoglycemia (assuming the person uses insulin)? A. Up to 24 hours after the activity B. Up to 8 hours after the activity C. Up to 4 hours after the activity D. Up to 2 hours after the activity - ANSWER-A. Up to 24 hours after the activity The provider for your pt added pioglitazone (Actos) to the pt's regimen one month ago. Your pt visits you today and says that he is dissatisfied with the new medicine, as it "has not done one thing to help my bg." After acknowledging his frustration how would you respond to his complaint? A. Suggest that he discontinue the medication and ask the provider to try something else B. Suggest that a higher dose may be needed and offer to consult with the provider to authorize a higher dose C. Suggest that the medicine may not be working because he is likely eating more, as evidenced by his wt gain since last visit D. Explain the medications in this class can take up to 12 weeks to work - ANSWER-D. Explain the medications in this class can take up to 12 weeks to work "I just can't stand testing my bg, although I have to admit that when I do and the number is high, I act on it right away." Which of the following is the best example of "developing discrepancy" by the educator? A. "Just be glad that we have the meters we do today. Back in the day, it took more than a minute to get the result and you needed a much bigger drop of blood, which meant a much more painful finger poke!" B. "It sounds like you are dealing with some serious obstacles when it comes to self monitoring, yet I also sense that when you do test, you are able to use the information to help you correct high bg when needed. What effect do you think those corrections will have on your health in the long run?" C. "It is just one of those things that people with diabetes have to deal with. Trust me, you are not alone - almost none of my pts enjoy testing their bg, and I tell them the same thing I'm telling you." D. " Gr - ANSWER-B. "It sounds like you are dealing with some serious obstacles when it comes to self monitoring, yet I also sense that when you do test, you are able to use the information to help you correct high bg when needed. What effect do you think those corrections will have on your health in the long run?" Which of the following mental health conditions that are commonly associated with diabetes can be addressed primarily by the diabetes educator and may not necessarily require a referral to a mental health professional? A. Depression B. Behavioral lapse C. Eating disorder D. Anxiety - ANSWER-B. Behavioral lapse Which of the following exercise precautions applies specifically to pts with unstable proliferative retinopathy? A. Exercise beyond only what is needed for activities of daily living is not advised as increased blood flow may exacerbate retinal problems B. Swimming and other prone physical activities should be avoided as they increase pressure in the retinas C. Resistance training should not be included in the exercise regimen because the resulting excessive systolic bp response may further damage the eyes D. Before beginning a moderate intensity exercise program consisting of both aerobic and strength training exercises, pts should have a. stress test and cleared by a cardiologist - ANSWER-C. Resistance training should not be included in the exercise regimen because the resulting excessive systolic bp response may further damage the eyes Which of the following medications may react with glipizide (Glucotrol) in a way that may result in an increased risk of hypoglycemia? A. Corticosteroids (Deltasone) B. Protease inhibitors (indinavir) C. Estrogen products (Premarin) D. Sulfonamides (Bactrim) - ANSWER-D. Sulfonamides (Bactrim) Sulfonamide medications compete with sulfonylurea medications, such as glipizide, for protein binding sites, thereby keeping more of the glipizide acting in the blood stream. Which diabetes medication classes are generally contraindicated for pts with CHF? A. DPP-4 inhibitors (ie sitagliptin) and alpha glucosidase inhibitors (starch blockers) B. Biguanides (ie metformin) and TZDs (ie pioglitazone) C. Sulfonulureas (ie glipizide) and meglitinides (ie nateglinide) D. GLP-1 receptor agonists (ie exenatide) and amylin analogs (ie pramlintide) - ANSWER-B. Biguanides (ie metformin) and TZDs (ie pioglitazone) A pt states that he has a goal of getting his A1C to below 7% by the end of the year. He worries that having is high as it is now (7.9%) puts him at risk for complications. You notice his weight has been increasing. He admits that with his new job, he has not had time to work out at the gym and has been snacking a lot, due to stress. Which of the following actions would be a BEST next step with this pt? A. Discuss the increased risks of having an A1C above 7% B. Ask open-ended questions that may help the pt identify some short-term goals that will help lower his A1C C. Lay out a daily schedule for the pt that facilitates his return to exercising, which will be sufficient to lower bg w/o increasing his medication D. Explore why he eats when stressed and suggest some stress reduction exercises that he can do at work - ANSWER-B. Ask open-ended questions that may help the pt identify some short-term goals that will help lower his A1C Acute sensory neuropathy and chronic sensorimotor distal polyneuropathy is characterized by sever burning pain in the lower extremities that is often worse at night. For tx of these conditions, what is considered the key to effective mgmt? A. Confirmation of diagnosis and ruling out other causes through neurologic testing B. Pain mgmt with medication and referral to a pain mgmt specialist C. Graded supervised aerobic exercise to safely improve circulation D. BG control and stabilization - ANSWER-D. BG control and stabilization Which of the following is an accurate association between celiac disease and diabetes? A. Celiac disease is associated with insulin resistance, and therefore has a greater prevalence among those with T2DM when compared with the general population B. Because celiac disease is an immune mediated disorder, there is a greater prevalence among those with T1DM when compared to the general population C. Because wheat-free diets are naturally lower in carbohydrates, the celiac diet is a recommended meal plan option for those with T2DM, even w/o diagnosed celiac disease D. Because celiac disease occurs with much greater frequency in the diabetic population, screening for celiac disease is recommended for all persons with diabetes - ANSWER-B. Because celiac disease is an immune mediated disorder, there is a greater prevalence among those with T1DM when compared to the general population Which explanation best describes how steroid use MOST affects bg? A. Steroid use induces insulin resistance and affects glucose metabolism, which is manifested especially in post-prandial glucose levels B. Steroid use decreases the rate of insulin metabolism and therefore increases the risk for hypoglycemia C. Steroid use increases insulin resistance and is specifically manifested in fasting glucose levels D. Steroids suppress the immune system and deactivate a portion of both endogenous and exogenous insulin. Therefore, bg typically rises with steroid use - ANSWER-A. Steroid use induces insulin resistance and affects glucose metabolism, which is manifested especially in post-prandial glucose levels You call to f/u with your pt, who was diagnosed with diabetes 6 weeks ago. She admits that after she used all her bg test strips, she quit checking her bg because she has no insurance and they are too expensive for her very limited income. Which of the following resources would be LEAST helpful to this pt? A. Partnership for Prescription Assistance (a national program sponsored by pharmaceutical research companies) B. A low-interest medical loan from her local bank C. The local or state health dept. low-income prescription program D. N (a non-profit organization that centralizes information and applications for pharmaceutical drug assistance programs) - ANSWER-B. A low-interest medical loan from her local bank The DPP demonstrated that progression from prediabetes to T2DM can be delayed or even prevented through lifestyle modifications and wt reduction. Based on the results of this large-scale study, what does the ADA recommend as a target weight reduction for those with prediabetes? A. 10-20 lbs B. 7% of body weight C. Wt loss to within 10 lbs of ideal body weight D. BMI of 22 or less - ANSWER-B. 7% of body weight Which two risk factors have the strongest correlation with a pt's risk for development and progression of diabetic retinopathy? A. Type of diabetes and A1C B. BG control and BP control C. BG variability and smoking status D. BP control and family hx of eye disease - ANSWER-B. BG control and BP control What is the recommended breakdown of macronutrients, according to the current American Diabetes Association Nutrition Recommendations (2013)? A. Approximately 70% of total calories should come from carbohydrates, 20% protein, and 10% fat B. Approximately 45-55% of total calories should come from carbohydrates, 25-40% protein, and 15-20% fat C. Approximately 35-40% of total calories should come from carbohydrates, 20-30% protein, and 30-35% fat D. Theres is no specific mix of macronutrients recommended by the ADA. The best mix of macronutrients depends on individual circumstances - ANSWER-D. Theres is no specific mix of macronutrients recommended by the ADA. The best mix of macronutrients depends on individual circumstances Which dietary strategy is the primary recommendation for those with prediabetes? A. A meal plan that focuses on moderate carbs, including carb monitoring/counting B. A low-carbohydrate diet (Atkins or similar) C. A calorie-reduced diet with reduced intake of dietary fat D. A low glycemic index/glycemic load diet - ANSWER-C. A calorie-reduced diet with reduced intake of dietary fat Not only has this strategy been shown effective at modest weight loss, but the reduction in fat may also improve insulin sensitivity. Which of the following food options would be the best example of an appropriate tx option for a bg level of 58 mg/dL? A. 8 oz whole milk B. 15 grapes C. 2 T pb D. 2 T pb and a slice of bread - ANSWER-B. 15 grapes Lipohypertrophy is described as "thickened tumor like swelling of the subcutaneous tissue or a mild swelling or lump under the skin at injection sites." When insulin is injected into theses spots, insulin absorption is significantly decreased. What counsel should be given to a pt who exhibits signs of lipohypertrophy? A. Begin antibiotic therapy under the direction of a dermatologist to reduce the swelling B. Apply warm compress twice daily until the swelling is significantly reduced C. Avoid injecting insulin into those areas until the swelling is gone; rotate injection sites to prevent recurrence D. These swollen masses must be removed surgically, but this can typically be done as an outpatient procedure in a dermatology office - ANSWER-C. Avoid injecting insulin into those areas until the swelling is gone; rotate injection sites to prevent recurrence You have a pt with T1DM (on MDI) who tells you that for religious reasons, he would like to fast one day each month (from after dinner until about 3 PM the next day - about 20 hours). Which response and action would be most appropriate? A. Discuss possible changes and the best way to address them, such as more frequent monitoring, consideration of insulin pump therapy, and plan to address high or low bgs. B. Readdress the hazards of fasting with the pt, including hypoglycemia and DKA. Warn the pt that fasting is not advised for those with T1DM. C. Offer to explain the health concerns to the pt's pastor in hopes that an alternative arrangement can be made for this pt. D. Tell the pt that if he chooses to fast, he should take only half his basal insulin and no bolus insulin. For hypoglycemia, he should use a glucagon injection - ANSWER-A. Discuss possible changes and the best way to address them, such as more frequent monitoring, consideration of insulin pump therapy, and plan to address high or low bgs. During a visit with your pt, a 68 year old man with T2DM, you discuss his physical activity goal that was set 6 months ago. His goal was to begin a walking program starting at 10 minutes per day and advance until he is walking 30 minutes per day at the 6 month point. He rates his progress towards his goal at a "0" and says that he has not done anything since he set the goal at his visit 6 months ago. What is the next best step to take with this pt? A. Suggest the he not dwell on this failed goal and focus on a different aspect of self mgmt B. Offer the pt more time to work on his goal C. Discuss with the pt his motivation and barriers to achieving the goal D. Suggest that the goal be revised to begin with less time walking and increase the time at a slower rate - ANSWER-C. Discuss with the pt his motivation and barriers to achieving the goal In a multidisciplinary team care approach to diabetes mgmt, which of the individuals below is "central to the team," according to the National Standards for DSME/DSMS? A. The pt B. The diabetes educator C. The case manager D. The PCP - ANSWER-A. The pt You are teaching a group class on diabetes and healthy meal planning. All 4 participants have provided an example of what they consider a healthy, well-balanced meal for someone who has diabetes. Which example would you site as the best example of an appropriate meal choice? A. A turkey and cheese, lettuce, and tomato sandwich with an apple, a small serving of baked chips, and a diet soda B. A bowl of chicken broth, pickle, sugar-free jello, 2 celery sticks, water, and a multiple vitamin C. A medium chef salad with lettuce, eggs, cheese, chicken, celery, and Italian dressing, and a glass of water D. Whole grain pasta (about 2 cups) with low fat cream sauce, 1 slice of garlic bread, 1 cup of cooked green peas, and skim milk - ANSWER-A. A turkey and cheese, lettuce, and tomato sandwich with an apple, a small serving of baked chips, and a diet soda BP readings fora. pregnant pt (26 weeks gestation) with gestational diabetes at her last three visits were as follows: 134/92, 144/90, and 142/96. She is already on a low-salt diet and says she follows it consistently. Which, if any, of the tx options would be appropriate for this pt? A. Methlydopa B. A low dose of an ACE inhibitor (ie lisinopril) C. A low to moderate dose of a diuretic (ie furosemide) D. No medical tx is necessary, as these levels are mostly within target for pregnancy. Reinforce lifestyle modification, including a low salt diet and regular walking - ANSWER-A. Methlydopa Methyldopa is one of the recommended medications for treating a hypertensive disorder during pregnancy. Other suggested medications include: labetalol, dilitazem, clonidine, and prazosin. The prescribed meal plan for your pt is based on a 2000 calorie requirement. The number of calories coming from saturated fat should not exceed what amount? A. Calories from saturated fat for this pt should not exceed 40 calories per day B. Calories for saturated fat for this pt should not exceed 140-200 calories per day C. Saturated fat, in all persons with diabetes, should not exceed 200 mg per day, regardless of total calorie need D. There is no recommendation for saturated fat, but total fat calories for this patient should not exceed 700 calories - ANSWER-B. Calories for saturated fat for this pt should not exceed 140-200 calories per day Mrs. M is a 65 year old Hispanic female with T2DM and a dx of CHF. At this time, she takes no medication for her diabetes, and states that she follows a fairly strict carb-consistent diet. Her A1c values have steadily increased over the past year and have not reached 8.4%. In addition, her serum creatinine has also been increasing and is now at 2.1 mg/dL. She states she is not willing to consider insulin at this time. Which medication would you recommend her proved prescribe? A. Glucophage (metformin) B. Actos (pioglitazone) C. Lantus insulin (insulin glargine) D. Januvia (sitagliptin) - ANSWER-D. Januvia (sitagliptin) Due to increased creatinine levels, the pt would not be a candidate for metformin, as metformin relies on appropriate kidney function to metabolize appropriately. Metformin use in renal impaired pts may lead to lactic acidosis and is therefore contraindicated for pts with serum creatinine above 1.4 mg/dL. Likewise, pioglitazone is not a first-line drug and is not recommended for those with CHF. While basal insulin is generally a safe choice, it is not usually used as a first line tx and the pt is not willing to consider it. Sitagliptin has been shown to be both effective and safe as a first line diabetes medication and can be used in pts with impaired renal function and hx of heart disease, although a reduced dose may be needed. Which of the following statements below is a recent evidence-based practice recommendation and an example of translating research into practice? A. Low-carbohydrate diets are recommended for persons with T2DM because of results showing greater wt loss and improvements in lipid levels B. Unvaccinated adults with diabetes who are aged 19 through 59 years should receive hepatitis B vaccination C. Routine antioxidant supplementation, including vitamin A and C and carotene, is recommended for adults with T2DM D. Glycemic goals for critical care hospitalized pts with diabetes should not exceed 120 mg/dL and should not be less than 80 mg/dL - ANSWER-B. Unvaccinated adults with diabetes who are aged 19 through 59 years should receive hepatitis B vaccination A pt with uncontrolled T2DM, a sedentary lifestyle, and multiple co-morbidiites tells you that she wishes to begin an exercise program to lose weight and improve her overall health. She states she wants to start slowly (walking and mild weight training), but eventually work up to where she can run a mile with her husband. Her co-morbidities include, "severe non-proliferative retinopathy" (according to ophthalmologist notes from 7 months ago), stage 2 renal disease with microalbuminuria, cardiac autonomic neuropathy, and peripheral neuropathy that is manifested by reduced sensation in her feet. Which of the following statements is most accurate and compete, regarding pre-exercise evaluation and referrals? A. Because the pt is starting slowly (ie walking and mild wt training), no referral or extensive pre-exercise physical evaluation is needed B. The pt should receive an electrocardiogram stress test since she is curre - ANSWER-C. This pt should be referred for an ECG stress test and a retinopathy exam. In addition, the provider should perform a thorough physical exam and the pt may need to modify the exercise regimen to prevent exacerbation of her complications You have been asked to provide a 90 minutes diabetes education activity at a senior center for 6-12 residents, all of who have diabetes. Group members will have different levels of preexisting diabetes knowledge. Which instructional strategy below would be most appropriate? (Assume that you have access to or will be provided any equipment and furniture that may be needed and that you are equally comfortable with all strategies.) A. Conversation maps B. Computer/web based DSME (you have access to 6 laptops) C. Providing printed diabetes materials to address a variety of topics; use activity time to go over what each publication addresses D. PowerPoint lecture addressing basic diabetes principles - ANSWER-A. Conversation maps Group interaction actives, such as conversation maps, have proven to facilitate learning to a greater extent than passive learning strategies. In all likelihood, most of the residents can still participate in a discussion type activity w/o too much trouble, even with deficits in sight, mobility, or dexterity. A strategy such as this allows those with varying amounts of knowledge/experience to participate equally. Listed below are types of teaching strategies. Each has attributes and limitations. If you were choosing appropriate strategies based solely upon group size (from individual to large group), select the series that makes the most sense. A. Games, printed materials, demonstration, case studies B. Web-based activities, role-playing, group discussion, lecture C. Printed materials, lecture, demonstration, Web-based activites D. Games, lectures, printed material, group discussion - ANSWER-B. Web-based activities, role-playing, group discussion, lecture In speaking with a group of new inpatient nurses, you discuss the American Association of Clinical Endocrinologist (AACE) and ADA consensus statement (2009) recommendations of inpatient bg targets. Which of the following statements accurately reflects those recommendations? A. Pre-meal bg target for non-critically ill pts: <100 mg/dL B. Random bg target for non-critically ill pts: <140 mg/dL C. Target (all times) bg for non-critically ill pts: 100-130 mg/dL D. Target (all times) bg for critically ill pts: 140-180 mg/dL - ANSWER-D. Target (all times) bg for critically ill pts: 140-180 mg/dL Your pt with T2DM is committed to exercising faithfully to both improve her glycemic control as well as lose wt. However, whenever she exercises beyond 30 minutes (at moderate intensity), her bg drops below 80 mg/dL and she has to consume some type of sugary snack to bring it up. She is very discouraged that she is not able to lose weight due to having to supplest with extra sugar and calories when she exercises. Which of the following possible adjustments would be the best choice to make to the pt's regimen to prevent hypoglycemia and address her concern with wt loss? A. She might consume a small amount of fat free fruits before the activity (ie half a glass of OJ) B. She could omit her breakfast dose of repaglinide (Prandin) on the mornings she will exercise C. She could skip her morning dose of metformin on mornings she will exercise D. She should not be concerned about the weight at this point as exercise has man - ANSWER-B. She could omit her breakfast dose of repaglinide (Prandin) on the mornings she will exercise Your pt has had T2DM for the past 12 years. He controls his diabetes with diet, exercise, and oral medication. Similarly, he watches his fat intake because of occasional borderline LDL (currently WNL). His last three A1C labs were all less than 7%. He has no apparent co-morbidities. According to the ADA Standards of Practice (2013), which fo the following is not indicated annually for this pt? A. A1C B. Comprehensive foot exam C. Dilated eye exam D. Fasting lipid profile - ANSWER-A. A1C The A1C screening is recommended at least twice annually for pts who meet glycemic guidelines, in this case, less than 7%. The other screenings are indicated once yearly for a pt with these characteristics. Lipid profile may be done every two years for those with very low risk, but since this pt has a borderline LDL level, the screening should be done annually. Your pt arrives late for his appt. You notice that his A1c is higher and that his adherence to self care skills (specifically monitoring, exercise, and taking meds) has decreased since his last visit 6 months ago. When you ask, "Over the last month or so, have you lost interest in doing things that usually bring you pleasure?" He replies, "Yes, I have to admit that I have," What implication does this have and what should your response be? A. His answer suggests that the pt is in a "slump" (or "burnout"), which many people with diabetes experience. Assure him it is normal and encourage him to think back to how he felt when he was faithfully performing self care behaviors B. His answer is expected, for when a person neglects self care behaviors, it negatively affects glucose levels, which then decreases one's ability to participate in pleasurable activities C. The pt's answers suggest that he may be experiencing diabet - ANSWER-D. His response is a strong indicator for depression. Encourage the pt to meet with a mental health professional; then make the referral and offer to help schedule the appt. F/u with the pt by phone to ensure that he attended the appt. and schedule a f/u visit for diabetes care in one month You are meeting with your pt who has T2DM and is 26 weeks pregnant. She reports that her fasting and post-prandial bg values have been within target range and that she is taking insulin before each meal as advised. However, she also reports that almost everyday of the last two weeks, she has had a small to moderate amount of ketones present in her urine. Of the options, which management plan would best address this problem? A. As long as ketones are not consistently larger and her bg values are within range, there is no need to adjust her regimen B. The pt's bedtime long acting insulin dose should be increased to eliminate the ketones C. Since ketones are the byproduct of the breakdown of fat, the pt should increase the amount of fat eaten throughout the day so that she will gain wt instead of lose it D. The pt should add a substantial snack at bedtime, coupled with a dose of prandial insulin to cover the snack - ANSWER-D. The pt should add a substantial snack at bedtime, coupled with a dose of prandial insulin to cover the snack Which of the following statements concerning treatment for peripheral arterial disease is true? A. Reduction of BP (by about 10/5 mmHg) has been shown to reduce the risk of amputation in PAD by 30% B. Control of bg at an A1c of 7% or lower has been shown to significantly slow the progression of existing PAD C. Lipid lowering has been associated with nearly 40% reduction in new or worsening symptoms of PAD D. Casual (unsupervised) exercise programs have been shown to have excellent benefits for those with PAD, including reduction of PAD symptoms, increased circulation, and improved balance - ANSWER-C. Lipid lowering has been associated with nearly 40% reduction in new or worsening symptoms of PAD Despite attending all classes as well as one on one visits with the educator, a pt performs only the bare minimum self care skills. Beyond basic survival skills education, he has not been receptive to any additional information about his diabetes. Which explanation is the most likely, and what is the logical course of action for the education? A. He did not fully understand the information in the classes; he would likely benefit from a review of the self mgmt material B. His personality is more introspective; he likely uses the "problem focused coping style." This pt should be presented with printed information that he can process privately and provided with contact info, should he need help C. The pt is likely experiencing the "depression and frustration" emotional stage of a chronic disease. The educator should emphasize positive changes and accomplishments, but recognize the sense of loss that comes with facing a - ANSWER-D. The pt's actions represent an "avoidant coping style," commonly associated with emotional discomfort. The educator should initiate a frank, honest discussion on what he is feeling, including validating his feelings. "Pushing," additional, more "in-depth" diabetes education at this point would not be helpful. Jeff is a 26 year old with T1DM and wears an insulin pump. He reports that he has noticed a pattern of hypoglycemia two to three hours after lunch and dinner. When asked, he states that before meals, and even after fast, he seems to have no problem. Which of the following pump setting changes would you recommend? A. Reducing his basal rate by 10% b/w lunch and bedtime B. Changing his insulin to carb ratio from 10 to 12 for lunch and dinner only C. Modifying his correction/sensitivity factor to give less insulin D. Changing insulin to carb ratio form 10 to 8 for lunch and dinner only - ANSWER-B. Changing his insulin to carb ratio from 10 to 12 for lunch and dinner only Assuming each of the pts below are currently consuming an average amount of daily protein (about 0.8 to 1.0 g/kg body wt/day), which of the pts may need to reduce his or her daily protein intake? A. A pregnant woman, normal wt, in the second trimester B. A 60 year old male with stage 4 kidney disease, normal BMI C. A female, T2DM with a slow-healing lower extremity wound D. None of the above should be switched to low protein diet - ANSWER-D. None of the above should be switched to low protein diet Which fo the following behavioral objectives below is an example of an immediate outcome? A. Demonstrating proper technique for self monitoring bg B. Reducing the number of missed doses of medication C. Improving HDL to target level D. Being 100% compliant on all recommended screenings - ANSWER-A. Demonstrating proper technique for self monitoring bg Some dietary supplements are packaged in containers with a "USP-verified make." What is the role of the US Pharmacopoeia (USP) and thus indicated by this label? A. To verify that the products listed on the label are accurate and pure B. To market herbal products the have been FDA approved C. To verify that the clinical claims made by the product are accurate D. To ensure that herbal supplements will not interact with other medications - ANSWER-A. To verify that the products listed on the label are accurate and pure Which of the following accurately describes the policy on disposing of sharps, such as insulin syringes, lancets, and infusion set needles? A. Used sharps should only ever be put into official biohazard (sharps) containers, which can be purchased at a pharmacy B. It is okay to put the sharps in a hard plastic container (such as a laundry detergent container) and when full, tape the lip and throw it away in the garbage C. Sharps may be put in a hard, non permeable container, but should be taken to the pharmacy for final disposal, and never put in the regular garbage collection D. Since medical waste disposal laws vary from state to state, pts and educators need to determine specific policy for their areas - ANSWER-D. Since medical waste disposal laws vary from state to state, pts and educators need to determine specific policy for their areas You pt takes basal insulin with a sulfonylurea. You meet with him to consider adjustment to his current regimen, at the pt's request. His recent A1c was 8.9%. At the appt, he states that he is not sure where the problem lies, and he expresses frustration that his insurance will only cover 4 bottles of test strips (200 test strips) every two months. Which self monitoring regimen below would be the most appropriate for this pt? A. Right before and two hours after a single meal day, rotating the meal. Do this for two to three weeks and bring in results B. Fasting morning monitoring every morning and then again just before bed every night, for one month C. Because this pt takes insulin, he needs to test before each meal, every day, indefinitely D. Due to his limitation on test strips, he should save them for when he feels his bg may be high or low, and rely on other records, such as food and exercise logs to pinpoint the - ANSWER-A. Right before and two hours after a single meal day, rotating the meal. Do this for two to three weeks and bring in results After exhausting other medical options, a pt's physician prescribes insulin for his hospitalized pt, and recommends the regimen be continued at home after discharge. The pt has a very limited income as well as very poor eyesight; the pt is unable to drive to f/u visits or to pick up prescriptions at the pharmacy. Which healthcare (hospital staff) team member should you most likely consult to assist the pt? A. Pharmacist B. Registered dietitian C. Inpatient social worker D. Ordering physician - ANSWER-C. Inpatient social worker What is the ultimate goal of diabetes self mgmt education and support? A. Optimal glycemic control B. Imparting knowledge and skills needed to make important lifestyle (behavioral) changes C. Reduction of diabetes related complications D. Reduced incidence, cost, and effects of diabetes through improved prevention, diagnosis, and mgmt - ANSWER-B. Imparting knowledge and skills needed to make important lifestyle (behavioral) changes Which of the following is a difference b/w medication administration using a disposable insulin pen device to inject insulin and a pen device to inject a GLP-1 analog medication, such as exenatide (Byetta)? A. Insulin pen devices require a new pen needle each time, but with GLP-1 receptor agonist pen devices, the same needle can be used repeatedly B. Insulin injections require site rotation, but GLP-1 receptor agonist injections can be given in the same spot since they are typically given less frequently C. When using an insulin pen device, the pt should prime the pen before each use, whereas with a GLP-1 receptor agonist medication, the priming is only done as part of new pen set up D. GLP-1 receptor agonist medication must be kept refrigerated until immediately before use, whereas an in use insulin pen may be kept at room temp until the time of use - ANSWER-C. When using an i