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CDCES study practice questions
What is the first step in the process of diabetes self management education? a. assessment b. goal setting c. diagnosis d. referral - ✅a. assessment the steps in order are: assessment, goal setting, planning, implementation, evaluation/monitoring Which option is an outcome of personal record keeping in relation to physical activity, according to recent studies? a. those who keep logs of PA are more adherent to other elements of tx (ie diet, meds) b. those who keep PA logs are more likely to enroll in organized exercise programs (ie classes, gym memberships) c. keeping a PA log is associated w/ higher level of self efficacy d. the obligation of record keeping has been identified as a barrier to exercise - ✅c. keeping a PA log is associated w/ higher level of self efficacy consider the following pt- male, 46 yo, prev sedentary, mild HTN and HLD (both controlled w/ meds), T2DM, BMI 26. If this pt wishes to start a moderate intensity exercise regimen, what additional assessment may be warranted? a. stress test w/ ECG b. DEXA scan to assess bone density and strength c. ankle-brachial index to rule out PAD d. none as BP and chol are controlled and exercise is only mod intensity - ✅a. stress test w/ ECG stress test is not mandated prior to exercise for pt's w/ dm, clinical judgement recommended based on hx and comorbidities. Stress test may be warranted in this case d/t pt being >40 yo w/ prev hx of sedentary, cvd risk factors, and beginning a program that is more intense than brisk walking. a diabetes educator assess and instructs pts on a variety of of self care skills. Which teaching strategy provides the best opportunity to both assess and instruct on self administration of insulin? a. written quiz in which the pt puts insulin admin steps in order. b. demonstration and return demonstration of insulin admin c. video viewed and reviewed on proper insulin technique d. printed handout w/ pics depicting steps of insulin admin, followed by verbal acknowledgement of understanding. - ✅b. demonstration and return demonstration of insulin admin
The following policies are apart of a DSME program: asking pt's if there are any dietary restrictions or preferences, inviting family members to participate, being sensitive to ones rate of speech and tone of voice. These policies address which specific type of consideration? a. readiness for change variation among pt's b. potential low literacy/numeracy levels c. cultural characteristics/barriers of the population d. poor family and social support - ✅c. cultural characteristics/barriers of the population according to the ADA consensus statement on managing preexisting dm for pregnancy, what is the optimal glycemic target for pregnant women w/ preexisting dm (assuming target may be reached w/o excessive hypoglycemia)? a. premeal fasting <90 and either 1 hr pp <120 OR 2 hr pp <100; hbA1c <5.5% b. premeal fasting <95 and either 1 hr pp <140 OR 2 hr pp <120; hbA1c <6% c. premeal fasting <90 and either 1 hr pp <120 OR 2 hr pp <100; hbA1c <6% d. premeal fasting <100 and either 1 hr pp <140 OR 2 hr pp <120; hbA1c <7% - ✅b. premeal fasting <95 and either 1 hr pp <140 OR 2 hr pp <120; hbA1c <6% also note for pregnancy, BG not considered hypoglycemia until < during the initial assessment process, the patient answers the question "how important is it for you to make this change right now?" with a 9 out 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. In customizing her DSME plan, what should the focus be? a. providing materials and experiences that enhance her knowledge and skills b. addressing psychosocial needs, such as accepting her dx c. highlighting benefits of good dm mngmnt to encourage behavior change d. explaining the questions further to confirm understanding - ✅a. providing materials and experiences that enhance her knowledge and skills it is important to address potential barriers to self monitoring of BG, esp for patients who are not adhering to their plan of care. Which of the following barriers was not one cited by patients in recent studies? a. cost of testing supplies b. discomfort of fingersticks c. lack of instruction and support d. misplacement of small items - ✅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 patient's typical s/s w/ hypos b. current pt physical/glycemic status (wt, BMI, A1c) c. timing and content of meals (ie carbs) in relation to activity d. med regimen- types, dosing, timing -
d. small group discussion around a table where pt's teach each other a skill after seeing it explained and demo'ed by the educator - ✅d. small group discussion around a table where pt's teach each other a skill after seeing it explained and demo'ed by the educator a pt w/ GDM is convinced she developed GDM from eating to much popcorn early in her pregnancy. She insists that if she does not eat any again she will not have to start insulin and her BG will return to normal. What emotional stage associated w/ chronic disease dx does the educator assess in this pt? a. denial b. anger c. bargaining d. frustration and depression - ✅c. bargaining of the choices below, what is the strongest predictor of health status? a. ethnic group b. literacy skill c. income level d. age - ✅b. literacy skill determines their ability to understand health related topics a 29 yo hispanic female pt tells her dm educator that her goal is to lose 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 (pro/fat vs CHO) b. energy balance (cal intake vs expenditure) c. type and amounts of cho consumed d. total g fiber/day - ✅b. energy balance (cal intake 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. prev DSME d. all of the above should be noted - ✅b. level of family support which of the following does not need to be noted on the medication regimen portion of the inital DSME assessment? a. daily MVi w/ iron b. 2 cinnamon capsules w/ each meal c. emergency albuterol inhaler for asthma (but hasnt been used in 3 yrs)
d. all of the above should be noted - ✅d. all of the above should be noted an adult male pt who is 6'1" 215 lb w/ T2DM completes a 24 hr diet recall. Which of his meals reported below does the educator assess to be the one most in need of modifications? a. Bfast- 1 c raisin bran w/ 1 c skim milk, 12 oz OJ, 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 w/ light italian dressing, 1 c green beans, black coffee d. all need mods - ✅a. Bfast- 1 c raisin bran w/ 1 c skim milk, 12 oz OJ, 1/2 bagel When asked about his personal goal for diabetes education, a pt's reply is "I dont know what you mean." What would be an appropriate response? a. "what do you mean you dont know what I mean?" b. "How do you hope that learning more about diabetes will help you?" c. dont say anything and allow them to think longer d. "well, for example, would you like to achieve your ideal weight, or reach your target BG?" - ✅b. "How do you hope that learning more about diabetes will help you?" a pt who has identified themselves as a visual learner would likely most prefer which method of instruction? a. role playing 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 BG d. group discussion on challenges r/t dealing w/ stress of dm - ✅b. seeing pictures of food portions followed by booklets on meal planning a dm educator is reading the pt chart of a 30 yo african american female, newly dx w/ dm. BMI is 17.5. What BMI category is this? a. underwt b. normal c. overwt d. obese - ✅a. underwt What is the main purpose of personal record keeping w/ regards to dietary habits? a. pt is able to look back and feel proud for positive changes, promoting pt empowerment b. food record allows the pt and educator to review, eval, and reassess food choices which can be used to set or modify goals c. insurance providers need to see evidence of the impact of MNT d. food record forces the pt to pay attention to what they're eating and promotes life skills of recording daily activities -
a. low level of health literacy b. food insecurity c. limited time to see provider d. homelessness - ✅c. limited time to see provider Which pt statement represents a situation in which specialty care provider resources are not being used according to ADA recommendations? a. "I see a dentist 2 x yr even though I do not have and have never had gum disease" b. "I see my ophthalmologist every 1-2 yrs even tho he says I have no signs of retinopathy c. "I had my chol checked when I was dx w/ dm, and bc I did not require meds, I will have a lipid profile taken every 5 yrs" d. "I see a nephrologist annually even tho my BP is WNL and I have no dx kidney problems" - ✅d. "I see a nephrologist annually even tho my BP is WNL and I have no dx kidney problems" how frequently should a dm educator assess a pt's tobacco use status and readiness to quit status? a. at every visit for those who smoke and only at the initial visit for those who do not b. annually unless the pt brings it up c. at every visit d. whenever educator notes signs that indicate possible change in status - ✅c. at every visit Which of the following assessment items is most likely to indicate poor circulation in the lower extremities? a. substantial hair on tops of toes b. ankle brachial index of 1. c. diminished dorsalis pedal pulses d. positive pinprick sensation at level of the ankle - ✅c. diminished dorsalis pedal pulses an older man w/ T2DM reports the following exercise plan 6 days per week: 40 mins jogging MWF and 40 mins strength training T/Th/Sa. As part of the educators assessment, they should consider whether which type of PA recs is being addressed? a. aerobic exercise b. toning exercise c. flexibility exercise d. resistance exercise - ✅c. flexibility exercise Stretching should be including in the exercise plan which of the following examples would the dm educator assess to be the most appropriate example of individual BGM record keeping?
a. pt records BG w/ time, date, meds, food intake, and other activities in spiral notebook instead of log sheet provided by MD. Book is tattered and stained w/ blood and food b. pt allows meter to record all readings which he then brings to clinic for each visit c. pt does not bring meter to visits but writes BGs on log sheet. Lists only values (no food, activity, etc) d. pt writes BGs in logbook that came with meter. Includes time, activity level, illnesses but no dates, food, or meds. States he picks any blank page to start the week and some are out of order - ✅a. pt records BG w/ time, date, meds, food intake, and other activities in spiral notebook instead of log sheet provided by MD. Book is tattered and stained w/ blood and food as part of the initial comprehensive DSME assessment, the educator asks their pt to describe his meals and snacks from the past 24 hrs. He states he cant recall what he ate. What action/response would be most appropriate? a. Note "pt does not recall" and move onto next question b. invite his wife who has accompanied him to help recall what he ate c. give them a 24 hr diet log sheet and ask him to return it completed by next week d. encourage him by prompting "now honey, I cant believe that a man as smart as you cant come up with anything" - ✅b. invite his wife who has accompanied him to help recall what he ate the educator is reviewing recent lab data for a new pt w/ dm but no other documented co- morbidities. Which lab value is of greatest concern? a. HbA1c 7.8% b. LDL 101 mg/dl c. HDL 88 mg/dl d. serum Cr 2.8 mg/dl - ✅d. serum Cr 2.8 mg/dl This value is out of range and likely indicates renal impairment. Other values are slightly elevated but dont raise immediate concern when asked to explain why he takes a specific oral dm med, the pt does not look at the label. Instead he opens the bottle and takes out a pill. Which possible barrier should the educator investigate further? a. financial b. cognitive c. health literacy d. fear of side effects - ✅c. health literacy What is acanthosis nigricans and what does it suggest? a. a darkening and thickening of the skin, typically on back/side of neck or axillae, indicative of insulin resistance b. pattern of deep labored breathing indicative of acidosis common in DKA c. darkening of toe nails indicative of poor pedal circulation
d. 60 yo white male 225 lb - ✅b. 26 yo hispanic female w/ BMI 41 Which of the following choices would be the most appropriate method for screening for pt numeracy challenges? a. ask pt the highest grade they completed and how well they did in math b. ask if they have any trouble doing math problems c. give them a standardized assessment to complete at home and bring back to next appt d. present applicable hypothetical situations such as calculate meal time insulin dose - ✅d. present applicable hypothetical situations such as calculate meal time insulin dose Which is considered standards of care for adults with T1 or T2DM? a. annual eye exam and annual ECG b. annual flu vax and dilated eye exam every 6 mon (more often if needed) c. hep B vax for adults <60 yo and annual flu vax for all pt's d. annual c peptide lab and hba1c every 6 months (more oftenif not at goal) - ✅c. hep B vax for adults <60 yo and annual flu vax for all pt's According to medicare guidelines, which pt characteristics or situations is not justification for individual sessions of diabetes education (vs group setting)? a. pt prefers 1:1 education because they do not get along w/ others b. no group classes are available within 2 months of referral c. pt has visual and/or language barriers d. physician has document request for individual education, based on the educators assessment and recommendations - ✅a. pt prefers 1:1 education because they do not get along w/ others a 59 yo single female w/ T2DM admits that she only takes 1/2 of her recommended januvia, but does take the full metformin dose. Later she tells the educator that shes added more veggies to her meals but only canned veg. Based on these statements, what barrier does the educator believe is most likely a concern for this pt? a. transportation b. cultural c. cognitive ability d. financial - ✅d. financial a pt who is reluctant to attend DSME class states the reason "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 can call anytime. Document his refusal b. give him a pop quiz w/ challenging dm knowledge questions to help him see 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 other class members d. change the subject to minimize conflict then speak w/ his wife to see if she can convince him -
✅c. acknowledge his reluctance and ask if he might be willing to share some of his knowledge and experiences with other class members which of the following statements should alert the educator to a lack of understanding about the purpose of self monitoring BG? a. "I test my BG whenever I feel bad, even it is not my regularly scheduled time to check" b. "I test 2-3 x day and sched my testing for when I think my numbers will be the best" c. "I wake up at 3 in the am and test for a couple of days whenever my dr changes my basal insulin dose" 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" - ✅b. "I test 2-3 x day and sched my testing for when I think my numbers will be the best" Which of the following is not considered a critical skill needed by the educator to asses the pt's abilities to plan goals? a. interpret info gathering (assess attitude, knowledge and skill r/t goal setting ability) b. facilitating engagement (uses skills to build trusting relationship) c. reporting progress (documenting past and present progress or lack thereof) d. problem analysis (develops understanding of factors r/t pt's self mngmnt problems) - ✅c. reporting progress (documenting past and present progress or lack thereof) 4 critical skills for educators to assess pt's planning skills are: interpret info gathering, facilitating engagement, hypothesis testing, problem analysis Pt comes into office to sign up for DSME classes. He tells the educator that hes had dm for 12 yrs but did not want to face his dx. Now after seeing he cant keep up w/ his grandkids he realized the need to change and control BGs. What stage of change in the transtheoretical model most accurately describes his state? a. precontemplation b. contemplation c. preparation d. action - ✅c. preparation Hasnt made change yet but has recognized need to make changes and working towards it Which of the following is not among top tx fears for pt's who are being prescribed insulin? a. nausea and subsequent wt loss b. worsening of diabetes c. needles d. hypoglycemia - ✅a. nausea and subsequent wt loss an older pt is not completing her assessment ppw along w/ other group mates. She moves slowly and squints at the signs on the door. Her hands shake as she gets an item from her bag. Based on
the provider for a patient added pioglitazone (actos) to the pt's regimen one month ago. The pt visits his dm educator today and says that he is dissatisfied w/ the new med bc it has not done one thing to his bg. After acknowledging his frustration, how should the educator respond? a. suggest he dc the med and ask the provider to try something else b. suggest that a higher dose may be needed and offer to consult w/ provider to authorize dose inc c. suggest that the med may not be working bc he is likely eating more, as evidenced by his wt gain since lov d. explain that meds in this class can take up to 12 weeks to work - ✅d. explain that meds in this class can take up to 12 weeks to work TZDs can take up to 12-16 weeks to reach full effect Look at the pt statements and determine the choice that is the best example of "developing discrepancy" in MI Patient- "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" a. Educator: "be glad that we have the meters that we do today. back in the day it took more than a min to get the results and required a more painful poke" b. Educator: "it sounds like yu are dealing with serious obstacles w/ self monitoring; yet I also sense that when you do test you use the info to help you correct your BG. What affect do you think those corrections have on your health in the long run?" c. Educator: "it is just one of those things ppl w/ dm have to deal with. You are not alone" d. Educator: "Great job coming in with your meter and log today. Lets see how you did correcting for highs and lows recently" - ✅b. Educator: "it sounds like yu are dealing with serious obstacles w/ self monitoring; yet I also sense that when you do test you use the info to help you correct your BG. What affect do you think those corrections have on your health in the long run?" This response is the best example of developing discrepancy in MI. Idea is that the inconsistency bt behavior/belief and desired outcome will spur the pt to conclude that it is worth the struggle to make changes. Educator acknowledges the struggles bt both sides of thew argument and helps pt focus on LT outcomes of fewer complications. Which mental health condition that is commonly associated with diabetes can be addressed primarily by the dm educator and may not necessarily require referral to mental health professional? a. depression b. behavioral relapse c. eating disorder (ex. bulimia) d. anxiety - ✅b. behavioral relapse Which of the following exercise precautions applies specifically to pt's w/ proliferative retinopathy? a. exercise beyond only what is needed for ADL's (slow walking) is 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 exercise regimen bc resulting excessive systolic BP response may further damage to the eyes d. before beginning mod intensity exercise program w/ strength and aerobic exercise, pt should have a stress test cleared by a cardiologist - ✅c. resistance training should not be included in exercise regimen bc resulting excessive systolic BP response may further damage to the eyes Which of the following meds may react w/ glipizide (glucotrol) in a way that may result in an increased risk for hypos? a. corticosteroids (ie Deltasone) b. protease inhibitors (indinavir) c. estrogen products (premarin) d. sulfonamides (bactrim) - ✅d. sulfonamides (bactrim) Which DM med class is generally contraindicated for pt's w/ CHF? a. DPP-4 inhibitors (sitaglipitin) b. TZD's (pioglitazone) c. sulfonylureas (glipizide) d. GLP-1 receptor antagonists (exenatide) - ✅b. TZD's (pioglitazone) pt states his goal is to get A1c <7% by end of the year. He worries that having it as high as it is now (7.9%) puts him at risk of complications. Educator notices his wt has been increasing. He admits that w/ his new job he has dec time to exercise and snacking has increased d/t stress. Which action would be the best next step for this pt? a. discussed inc risk of high A1c b. ask open ended questions that may help him identify short term goals that will help lower A1c c. lay out a daily schedule for him that will facilitate his return to exercise d. explore why he eats when stressed and suggest stress reduction exercises - ✅b. ask open ended questions that may help him identify short term goals that will help lower A1c Acute sensory neuropathy and chronic sensorimotor distal neuropathy (DPN) is characterized by severe burning pain in the lower extremities that is often worse at night. For tx, what is considered the key to effective mngmnt? a. confirmation of dx and ruling out other causes thru neurologic testing b. pain mngmnt w/ meds and referral to a pain mngmnt specialist c. graded supervised aerobic exercise to safely improve circulation d. BG control and stabilization - ✅d. BG control and stabilization Which of the following is an accurate association bt celiac and dm?
What is the recommended breakdown of macros according to the current ADA nutrition recs? a. ~ 70% total cals from CHO, 20% protein, 10% fat b. ~45-55% of total cals from CHO, 25-40% from protein, 15-20% fat c. ~35-40% total cals from CHO, 20-30%, 30-35% fat d. there is no specific mix of macros recommended by ADA, based on individual circumstances - ✅d. there is no specific mix of macros recommended by ADA, based on individual circumstances Which dietary strategy is the primary recommendation for those w/ prediabetes? a. meal plan that focuses on moderate CHO, including carb monitoring/counting b. a low carb diet (ie atkins) c. a calorie reduced diet w/ reduced intake of dietary fat d. a low glycemic index/glycemic load diet - ✅c. a calorie reduced diet w/ reduced intake of dietary fat Which of the following food options would be the best example of an appropriate tx option for a BG level of 58? a. 8 oz whole milk b. 15 grapes c. 2 tbsp peanut butter d. 2 tbsp peanut butter on slice of bread - ✅b. 15 grapes Lipohypertrophy is described as "thickened tumor like swelling of the subQ tissue or a mild swelling or lump under the skin at injection sites." When insulin is injected into these spots, insulin absorption is significantly decreased. What counsel should be given to a pt who exhibits signs of lipohypertrophy? a. begin antibiotic tx under the direction of a dermatologist to reduce swelling b. apply warm compresses BID until swelling decreases c. avoid injecting into those areas until swelling is gone; rotate injection sites d. masses should be removed surgically - ✅c. avoid injecting into those areas until swelling is gone; rotate injection sites a pt w/ T1DM on MDI tells educator that for religious reasons they would like to fast 1 day each month (from after dinner until 3 pm the next day, about 20 hrs). Which response and action would be most appropriate? a. discuss possible challenges and best ways to address them, such as inc monitoring, consider pump, plan to address highs and lows b. readdress the hazards of fasting, including hypos and DKA. Warn that fasting is not advised c. offer to explain health concerns to the patients pastor d. tell him if he chooses to fast, he should only take 1/2 basal and no bolus insulin. use glucagon for hypo - ✅a. discuss possible challenges and best ways to address them, such as inc monitoring, consider pump, plan to address highs and lows
68 yo pt w/ T2DM set goal to walk 10 mins/day and inc until walking 30 mins/day over a 6 month period. At the 6 month f/u, he rates his progress a 0 and states he never started. What is the next best step? a. suggest he not dwell on this failed goal and focus on a different aspect of self care b. offer more time to work on his goal c. discuss his motivations and barriers to achieving the goal d. suggest the goal be revised to begin w/ less time walking and inc the time at a slower rate - ✅c. discuss his motivations and barriers to achieving the goal In a multidisciplinary team care approach to dm mngmnt, which of the following individuals is "central to the team" according to the national standards for DSMES? a. the patient b. the educator c. case manager d. the PCP - ✅a. the patient The educator is teaching a group class on dm and healthy meal planning. All 4 participants have provided an example of what they consider a healthy, well balanced meal for a diabetic. Which example would be sited as the best example of an appropriate meal choice? a. sandwich w/ turkey, lettuce, cheese, tomato w/ an apple, small serving baked chips, diet soda b. bowl of chicken broth, pickle, SF jello, 2 celery sticks, water, MVi c. med chef salad w/ lettuce, eggs, cheese, chicken, celery, italian dressing, glass of water d. 2 c whole grain pasta w/ LF cream sauce, 1 slice garlic bread, 1 c cooked green peas, skim milk - ✅a. sandwich w/ turkey, lettuce, cheese, tomato w/ an apple, small serving baked chips, diet soda BP readings for a pregnant pt (26 weeks gestation) w/ GDM at her last 3 visits were: 134/92, 144/90, 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 her? a. methyldopa b. low dose of ACE inhibitor (lisinopril) c. low to moderate dose diuretic (ie. furosemide) d. no medical tx necessary, as these levels are mostly within target for pregnancy. Reinforce lifestyle mods, including low salt diet and reg exercise - ✅a. methyldopa other options for pregnancy- labetalol, diltiazem, clonidine, prazosin This pt meets criteria for preeclampsia- systolic >140, diastolic >90, dx after 29th week of pregnancy The prescribed meal plan for a pt is based on a 2,000 cal requirement, the # of cals coming from sat fat should not exceed what amount?
Educator has been asked to provide a 90 min dm education activity at a senior center for 6- residents w/ dm. Group members will have different levels of pre-existing dm knowledge. Which instructional strategy would be most appropriate? a. convo maps b. computer/web based programs (w/ access to laptops) c. printed materials to address variety of topics, use activity time to review d. slide show lecture addressing basic diabetes principles - ✅a. convo maps Listed are types of teaching strategies. Each has attributes and limitations. If choosing appropriate strategies based solely on group size (from individual to large), select the option 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, demos, web based activities d. games, lecture, printed material, group discussion - ✅b. web based activities, role playing, group discussion, lecture In speaking w/ a group of new inpatient nurses, the educator discusses the AACE and ADA consensus statement recommendations of inpatient BG targets. Which accurately reflects those recs? a. pre-meal BG for non critically ill pts: < b. random BG target for noncritically ill pts: < c. target (all times) for critically ill pts: 100- d. target (all times) for critically ill pts: 140-180 - ✅d. target (all times) for critically ill pts: 140- lower BG targets in critically ill resulted in higher mortality. for non critically ill, recommended target pre meal is <140. target for random BG non critically ill is < pt w/ t2dm is committed to exercising faithfully to both improve BGs and lose wt. However whenever she exercises >30 mins at mod intensity, her BG drops <80and she has to consume some type of sugary snack to inc it. She is discouraged that she is not able to lose wt d/t this. Which of the following possible adjustments would be the best choice to make to the pt's regimen to prevent hypos and address wt concerns? a. consume small amount of fat free fruit before the activity (ie 1/2 glass OJ) b. omit her bfast dose of repaglinide (prandin) on the mornings she will exercise c. skip her am dose of metformin on mornings of exercise d. she should not be concerned about the wt at this point as exercise has many other benefits, and she needs to treat low BG - ✅b. omit her bfast dose of repaglinide (prandin) on the mornings she will exercise this will reduce the amount of insulin released by her pancreas on the day of exercise a pt has had t2dm for 12 yrs. He controls it w/ diet, exercise, and oral meds. Similarly he watches his fat intake bc of occ borderline LDL (currently WNL). His last 3 A1c labs were all <7%. He has
no comorbidities. According to the ADA standards of practice, which of the following screenings is not indicated annually for this pt? a. A1c b. comprehensive foot exam c. dilated eye exam d. fasting lipid profile - ✅a. A1c A1c should be taken twice yearly for people meeting target (<7) a pt arrives late for his appt. You notice his A1c is higher and his adherence to self care skills (specifically SMBG, exercise, taking meds) has dec since his LOV 6 months ago. When you ask "over the last month, have you lost interest in doing things that usually bring you pleasure?" he replies "yes, I admit that I have." What implication does this have and what should the response be? a. suggests he is in a slump. assure him this is normal and encourage him to reflect on how he felt when he performed self care b. His answer is expected. Discuss this cycle w/ him and encourage to be more diligent w/ his self care c. suggests he is experiencing dm anxiety. Discuss ways to reduce stress/anxiety d. indicator of depression. Encourage to meet w/ a professional. f/u by phone then schedule visit 1 mon out - ✅d. indicator of depression. Encourage to meet w/ a professional. f/u by phone then schedule visit 1 mon out When meeting w/ a pt who has t2dm and is 26 weeks pregnant, she reports her fasting and pp BG have been within target and she is taking insulin prior to meals as advised. However she also reports that almost everyday over the last 2 weeks, she has had a small to moderate amount of ketones in the urine. Of the options, which mngmnt plan would best address this? a. as long as ketones are not consistently large and her BG is within rnage, there is no need to adjust regimen b. her bedtime basal dose should be inc to eliminate ketones c. since the ketones are a byproduct of the breakdown of fat, she should inc the amount of fat eaten so that she will gain wt instead of lose it d. she should add a substantial snack at bedtime, coupled w/ a dose of prandial insulin to cover the snack - ✅d. she should add a substantial snack at bedtime, coupled w/ a dose of prandial insulin to cover the snack maternal ketosis should be avoided as ketones cross the placenta and can harm the placenta Which statement concerning tx for PAD is true? a. reduction of BP (by about 10/5) has been shown to reduce risk of amputation in PAD by ~30% b. control of BG at A1c <7% has been shown to sig slow progression of PAD c. lipid lowering has been associated w/ nearly 40% dec in new or worsening s/s of PAD d. casual (unsupervised) exercise programs have been shown to have excellent benefits for PAD , including dec of s/s, inc circulation, and improved balance -
