CDE Practice Exam #1 Questions with complete Solutions., Exams of Laboratory Practices and Management

Download CDE Practice Exam #1 Questions with complete Solutions. and more Exams Laboratory Practices and Management in PDF only on Docsity! CDE Practice Exam #1 Questions with complete Solutions. A community pharmacy wants to offer a fee-for-service diabetes patient education program to its customers. Which of the following is the MOST appropriate way to market this new program? A. Place an ad in the regional paper B. Place flyers in every prescription bag C. Send out letters to local hospital administrators D. Contact the top 3 insurance companies in the state - Correct Answer B. Place flyers in every prescription bag In a fee-for-service environment, where patients pay out-of-pocket, the most efficient advertising needs to be directly to the consumer. A 35 year-old woman with T1DM present to the clinic for f/u of self monitoring blood glucose. Her A1c is 12%, and during the interview she reports that she thinks her boyfriend is interested in a younger, thinner woman. Which of the following is the best f/u question related to this patient's concerns? A. Do you think that your boyfriend might stay with you if you become blind? B. Are you afraid that insulin might cause you to gain weight? C. Do your parents know that your blood glucose levels are poorly controlled? D. What time of the day do you check your glucose? - Correct Answer B. Are you afraid that insulin might cause you to gain weight? The question's focus is on assessment and screening for eating disorders, of which intentional insulin omission is one. Effective assessments reveal lifestyle issues and facts, are patient centered, and facilitate honest self-disclosure. Routine labs for a patient with a history of normal glucose tolerance revealed a fasting glucose level of 113 mg/dL. What does the result indicate? A. Normal blood glucose B. Impaired fasting glucose C. Diabetes D. Gestational diabetes - Correct Answer B. Impaired fasting glucose A blood glucose level between 100 and 125 mg/dL indicates impaired fasting glucose. A normal fasting glucose is <100 gm/dL and diabetes is indicated by a fasting blood glucose of >126 mg/dL. SQ presents for a routine visit. While performing a foot exam you note "dependent rubber" (swelling and redness) when his feet are in a dependent position and pallor on elevation. You suspect: A. diabetic neuropathy B. peripheral arterial disease C. varicose veins D. Charcot joint - Correct Answer B. peripheral arterial disease Swelling and redness when the feet hang down are signs of poor circulation and peripheral vascular disease. Diabetic neuropathy may accompany peripheral vascular disease; however these visually observable changes are not usually present. Varicose veins and Charcot joint are also not usual causes of foot swelling and redness. An individual newly diagnosed with T2DM presents for education. What should the educator do first? A. Provide a detailed overview of the pathophysiology of T2DM. B. Assess the individual's interests, needs, and problems C. Discuss chronic complication risk D. Review a carbohydrate counting meal plan - Correct Answer B. Assess the individual's interests, needs, and problems Assessment is the first step in the process of providing diabetes education. By understanding what the interests, needs, and problems of the person with diabetes are, the educator is more likely to provide appropriate and useful information that will assist the individual to meet desired outcomes. The other choices may well become part of the education plan, but this follows assessment. Which of the following medications should NOT be used in pregnancy? A. Human insulin B. Metformin C. Methlydopa D. HMG-CoA reducates inhibitors - Correct Answer D. HMG-CoA reductase inhibitors C. Contact her daughter at work D. Have the patient identity drug pictures in the Physician's Desk Reference - Correct Answer A. Contact the local pharmacy that fills her prescription The local pharmacy will be able to provide objective data and estimates of long-term adherence. A 45 year old Hispanic man with T2DM for 10 years refuses to start insulin after failing oral agents. Which of the following is the MOST appropriate response for the educator? A. Educate the patient on the increased risk of microvascular complications B. Ask the patient why he does not want to start insulin C. Reassure the patient that insulin injections won't hurt D. Ask the patient if he has any family members with diabetes complications - Correct Answer B. Ask the patient why he does not want to start insulin The educational process always begins with assessment, ie, in this case understanding why the patient does not want to start insulin. The other choice assumed what the problem - lack of knowledge, fear of pain, and experienced of family members - may be without involving the patient in the process and therefore are not correct choices. A spotless blood glucose log from the past 2 months reveals twice daily checks, with all results neatly written in blue ink and falling between 80 mg/dL and 125 mg/dL. An A1C drawn the week prior was 9.8%. Which of the following best summarizes the findings? A. The results correlate as expected B. The A1C is lower than expected C. The blood glucose values are not accurate D. The A1C was not fasting - Correct Answer C. The blood glucose values are not accurate Clues to fabricated home blood glucose values include daily testing at exactly the same time without missed days, absence of blood smears on the pages with neatly written numbers in the same ink, frequently repeated values, and values all with the desired range. Sad mood, lack of interest or pleasure, unintentional weight or appetite changes, fatigue, and worsening blood glucose control indicate the need for further evaluation of which of the following? A. An eating disorder B. Depression C. An anxiety disorder D. Anger management - Correct Answer B. Depression These are all symptoms of depression. Weight loss with an eating disorder would be intentional, major symptoms of anxiety disorder include sweating, tremulousness, weakness, lack of concentration, irritability, and restlessness; anger would be characterized by outbursts. A 60 year-old man with cognitive deficits and dominant handed weakness from a past cerebral vascular accident presents to learn how to inject insulin. Which of the following is the MOST appropriate method to assess insulin education successfulness? A. Ask the patient to describe the injection steps B. Have the patient write out the procedure C. Provide the patient with a pamphlet to take home D. Have the patient demonstrate an injection - Correct Answer D. Have the patient demonstrate an injection The focus of this question is assessment of psychomotor skills. Demonstration of an injection by the educator, then return demonstration by the patient, allows for active learning. Which of the following is the MOST effective way to determine the health literacy level of a person with diabetes who has been referred to you? A. Ask the patient how well he or she reads B. Obtain information about the patient's education level C. Gauge the reading level based on the newspapers and magazines the individual reads D. Ask the patient to read an educational pamphlet on diabetes and explain its meaning - Correct Answer D. Ask the patient to read an educational pamphlet on diabetes and explain its meaning Most adults who are illiterate have learned to hide their literacy deficit and manage to compensate for this deficit and function in society. People do not tend to reveal that they are illiterate, number of years of schooling is not an indicator, and neither is types of magazines or books read. At the end of a nutrition counseling session, the diabetes educator asks the patient to pretend that the educator is a waitress and the patient is ordering a meal that would fit into her meal plan. This teaching format is called: A. games B. discussion C. role-playing D. demonstration - Correct Answer C. role-playing By definition, role-playing is a form of active learning that allows the learner to practice, express, explore, discuss, and share. The prioritization of learning objectives should be based on: A. review of the medical record B. recommendations of the referring physician C. diabetes education curriculum D. patient's identified interests or needs - Correct Answer D. patient's identified interests or needs According to adult learning theory, adults learn best when they feel the need to know, when it is personally relevant, and when it is active. A 24 year-old college student with T1DM presents to the pharmacist educator for insulin dose adjustments. She reports injecting the same amount of rapid-acting insulin with each meal and never making any changes. Her recent A1c was 8.7%. Which of the following is the most appropriate approach for this patient? A. Advise the patient to search the internet for information on meal planning B. Consult a registered dietitian to educate the patient about carbohydrate counting C. Telephone the patient's family to enlist their help and support D. Provide the patient with written materials to take home - Correct Answer B. Consult a RD to educate the patient on carbohydrate counting This patient could benefit from a consult with an RD for education on carbohydrate counting and using insulin to carbohydrate ratios. Which of the following is the most appropriate sick-day management guideline? A. Omit insulin when vomiting occurs After 2 previous cancellations, a 67 year-old man with diabetes presents for bg monitoring education. He states several times that he's only at the appointment to satisfy his doctor; however, he is fairly attentive and engaged until the blood glucose monitor is removed from the package. At this point, he begins to fidget and appears agitated. Based on this information, what would be the educator's best assessment of this man's behavior? A. Hypoglycemia B. Hyperglycemia C. Needle panic D. Short attention span - Correct Answer C. Needle panic Needle anxiety occurs in almost everyone to varying degrees. If severe or persistent and left unresolved, diabetes control can suffer because of missed injections, inadequate testing, and avoidance of healthcare follow-up visits. A skilled diabetes educator will learn to match and individualize the presentation of the BG monitoring so that the fears of the person with diabetes may be alleviated. Which teaching method is particularly effective in a group education setting? A. Lecture B. Use of computer programs C. Distribution of print materials D. Role-playing - Correct Answer D. Role-playing Role-playing is an active form of learning that facilitates the sharing of information and therefore works well in a group setting. A 19 year-old patient complains of unexplained weight loss and extreme hunger over the past month. Which of the following is the MOST useful information to confirm diagnosis of diabetes? A. Reports of polyuria B. An A1C of 5.1-6.4% C. Fasting plasma glucose 100-125 mg/dL D. Random plasma glucose >200 mg/dL with polyuria - Correct Answer D. Random plasma glucose >200 mg/dL with polyuria According to the ADA's 2015 Clinical Practice Recommendations: Diagnosis and Classification of DM, the criteria for diagnosis of diabetes are as follows: Fasting plasma glucose >126 mg/dL OR Symptoms of hyperglycemia and a casual plasma glucose >200 mg/dL OR 2-hour plasma glucose >200 mg/dL during a 75g oral GTT. Polyuria is a symptom of hyperglycemia, but cannot be used as diagnostic criteria, A1C 5.1-6.4% would be prediabetes, and a fasting plasma glucose of 100-125 mg/dL would indicate impaired fasting glucose. A 53 year old man whose mother and brother have T2DM presents at a health screening. He asks, "How does the doctor know if I have diabetes?" What is the MOST appropriate response to this question? A. Your doctor may use an A1C test of 6.0% or greater to diagnose diabetes B. T2DM must be diagnosed by HLA sub typing C. Your doctor may use 2 fasting bg values over 126 mg/dL D. T1DM can be diagnosed only if you are admitted with ketoacidosis - Correct Answer C. Your doctor may use 2 fasting bg values over 126 mg/dL Diabetes can be diagnosed by acute symptoms plus casual plasma glucose >200 mg/dL or by OGTT testing (2 hr >200 mg/dL). The HLA genotype is strongly associated with the occurrence of T1DM but again is not diagnostic. Although some individuals are diagnosed with T1DM when they develop DKA, it is not a criterion for diagnosis. In a post absorptive state (4 to 15.9 hours after food consumption) A. plasma insulin levels decrease and glucagon levels begin to rise B. insulin inhibits breakdown of glycogen and triglyceride reservoirs C. counter-regulatory hormone secretion is stimulated D. excess glucose is stored in hepatic, muscle, adipose, and other tissue reservoirs - Correct Answer A. plasma insulin levels decrease and glucagon levels begin to rise The focus of this question is normal fuel homeostasis, which occurs in 5 phases. Phase II of fuel homeostasis, is the post absorptive state. During this phase, blood glucose originates from glycogen breakdown and hepatic gluconeogenesis. Plasma insulin levels decrease and glucagon levels begin to rise. Energy storage ends and energy production begins. Carbohydrate and lipid stores are mobilized. Hepatic glycogen breakdown provides maintenance of plasma glucose and ensures an adequate supply of glucose for the brain and other tissues. Adipocyte triglyceride begins to breakdown and free fatty acids are released into circulation and used by the liver and skeletal muscle as a primary energy sources and as a substrate for gluconeogenesis. The brain continues to use glucose, provided mainly by gluconeogenesis, because of its inability to use free fatty acids as fuel. Insulin inhibits breakdown of glycogen and triglyceride reservoirs during Phase I; counter- regulatory hormone secretion is stimulated during Phase IV; and excess glucose is stored in hepatic, muscle, adipose, and other tissue reservoirs in Phase I. LT comes to you for counseling. Her bg levels are poorly controlled, she has stopped monitoring her bg levels, and she reports sleep disturbances and difficulty concentrating. You should first: A. screen her for depression B. encourage her to enroll in a diabetes self-mgmt program C. reinforce the importance of self-monitoring bg D. work with her to set realistic self-care goals - Correct Answer A. screen her for depression LT displays several common symptoms of depression including lack of interest, sleep disturbances, and difficulty concentrating. Mental health issues such as depression may interfere with diabetes self-mgmt and diabetes control and therefore should be addressed first. Which of the following islet cell antibodies is the best predictor of future T1DM? A. Heat shock protein 65 B. Islet antigen A2 and A2 beta C. Glutamic acid decarboxylase D. Insulin autoantibodies - Correct Answer C. Glutamic acid decarboxylase Early T1Dm is first identified by the appearance of active autoimmunity direct against pancreatic beta cells and their products. Glutamic acid decarboxylase appears to be the best immunologic predictor for the future development of T1DM. These islet cell antibodies may play a permissive or pathologic role in the causation of T1DM, but are not the best predictor. An overweight 52 year-old man presents complaining of polyuria, polydipsia, and fatigue. His fasting blood glucose is 326 mg/dL and his urine is negative for ketones. Which fo the following best describes the clinical presentation of this patient? A. Impaired fasting glucose C. Planning foods to be consumed at each meal/snack D. Perform blood glucose checks - Correct Answer B. Providing physical and mental support The question focuses on assessment of diabetes self-care considering age-related traits of youth and delegation of diabetes care responsibilities. Youth ages 12-15 are increasingly independent. The caregiver's responsibility is to continue delegation of diabetes self-mgmt tasks and to provide physical and mental support as needed. How often should individuals with diabetes have a dental checkup? A. Every 3 months B. Every 6 months C. Every 6 months and more often if periodontal disease is present D. Once a year - Correct Answer C. Every 6 months and more often if periodontal disease is present You are seeing AK for counseling. She has a 10-year history of T1DM and a 1% increase in her A1C since her last medical visit. She tells you that she became divorced 2 months ago and has been having difficulty functioning at work and following her self-management plan for several weeks now. Which of the following is the MOST likely diagnosis to accompany these symptoms? A. Major depressive disorder B. Adjustment disorder with depressed mood C. Dysthymic disorder D. Adjustment disorder with anxiety - Correct Answer B. Adjustment disorder with depressed mood This patient reports an identifiable cause of her depression. Major depressive disorder and dysthymic disorder are not associated with an identifiable cause of the psychological response. This patient's adjustment disorder is characterized by tearfulness, which is consistent with depression, rather than nervousness, worry, or jitteriness expected with anxiety. An individual with intense fear of becoming fat, even though he or she may be at normal weight or underweight, is characteristically of A. anorexia nervosa B. bulimia nervosa C. binge-eating disorder D. purging - Correct Answer A. anorexia nervosa Intense fear of gaining weight or becoming fat, even though underweight is one fo the criteria for anorexia nervosa. Bulimia is characertized by repeated episodes of binge- eating and involving a loss of control and compensatory behaviors to prevent weight gain, eg, self-induced vomiting, fasting. Binge-eating disorder is characterized by repeated episodes of binge-eating as in bulimia, but in the absence of compensatory behaviors to prevent weight gain. Purging is a compensatory behavior often used to prevent weight gain. A woman taking glipizide before breakfast and supper feels shaky, weak, and sweaty after walking for 30 minutes before lunch. She does not check her bg routinely. She returns to the office, eats, and feels better after lunch. Which of the following is the MOST likely explanation of the symptoms? A. Hyperglycemia B. Hypoglycemia C. Overexertion D. Ketoacidosis - Correct Answer B. Hypoglycemia The combination of exercise, delayed eating, and a sulfonylurea increases the likelihood of hypoglycemia. A patient on metformin mono therapy complains to his pharmacist about the high cost of the bg test strips and asks why he needs to test his bg at home. Which of the following is the most appropriate response? A. All patients with diabetes should test their bg at least twice daily. B. Self-monitored bg is only useful for patients on insulin C. Self-monitored bg lets patients see how food affects their glycemic control D. Urine testing is more appropriate for patients on oral agents for diabetes - Correct Answer C. Self-monitored bg lets patients see how food affects their glycemic control Patients who reach their glycemic control on oral drug therapy only need to test their bg a few times each week. Patients who are poorly controlled, changing therapy, or on insulin should test their bg levels at least 1 or 2 times daily. Which of the following is the MOST frequent cause of inaccurate results from self monitoring of blood glucose? A. Operator technique B. Improper calibration C. Expired or defective test strips D. Inadequate blood sample - Correct Answer A. Operator technique Inaccurate results from self-monitoring of bg can come from a variety of sources; however, the most common is operator technique. Many newer bg meters are self- calibrating and do not start the test until an adequate sample is applied. Using expired or defective test strips may also cause inaccurate results; however, newer testing methodologies make this error less significant. MP was recently diagnosed with T2DM. Her doctor placed her on thiazolidinediones (TZDs) 1 month ago. MP is discouraged because, despite taking the TZDs as prescribed, her glucose levels remain elevated. Which of the following choices would be the best first step for a diabetes educator to do? A. Review her diet and exercise programs B. Remind her that it can take as long as 8 to 12 weeks of TZD use to see an effect C. Refer her back to her doctor for an addition of another oral agent D. Reduce the calories in her meal plan - Correct Answer B. Remind her that it can take as long as 8 to 12 weeks of TZD use to see an effect Persons taking a TZD should be told that the maximum glucose-lowering effect of these medications may not be apparent until 8 to 12 weeks of use. Since the patient only has been on the TZD for a month, it is a logical first step to wait to see if the medications have an effect on glucose levels before looking to make changes in diet and exercise or referring to the doctor for additional medication. You are counseling NZ, who is on a basal/bolus insulin regimen. When evaluating her blood glucose records, which of the following would be MOST helpful to evaluate her basal insulin doses? A. 1-hour postprandial glucose B. Fasting and premeal glucose C. 2-hour postprandial glucose D. 4-hour postprandial glucose - Correct Answer B. Fasting and premeal glucose The basal insulin dose controls bg levels in between meals when the individual is not eating. Therefore premeal glucose and fasting glucose data are the best indicators of the A pedometer records steps/day, a lifestyle activity. An overweight 11 year-old Hispanic boy with T2DM presents to the registered dietitian for meal planning. His mother and father accompany him. Both are obese and have type 2 diabetes. Which of the following is the MOST appropriate advice for this patient? A. Avoid eating fast food B. Eliminate high-fat, calorie dense foods C. Get involved in a soccer, basketball, or baseball league D. Aim for at least 60 minutes of moderate intensity physical activity daily - Correct Answer D. Aim for at least 60 minutes of moderate intensity physical activity daily The Dietary Guidelines for Americans recommend at least 60 minutes of moderate intensity physical activity daily for children and adolescents. When addressing lifestyle intervention in children and adolescents, the focus must be one of substitution and reduction rather than elimination. Instead of recommending avoidance of fast-food, the suggestion might be to learn to make healthier choices; reduce consumption of fatty, calorie-dense foods; competitive sports may not be appropriate. The Nutrition Facts panel on a food package revels 16g of total carbohydrates per serving. How many carbohydrate choices (servings) do 2 servings of the food item contain? A. 1/2 B. 1 C. 2 D. 3 - Correct Answer C. 2 You wish to conduct an evaluation of your diabetes self-management education program. Your major outcomes of interest are program sustainability and its long-term effects on individual outcomes. Which of the following tools/frameworks would best meet your needs? A. Continuous Quality Improvement (CQI) B. Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) C. Penetration, Implementation, Participation, and Effectiveness (PIPE) D. National Diabetes Education Outcomes System (NDEOS) - Correct Answer B. Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) RE-AIM is the one evaluation tool that includes the dimensions of effectiveness (in terms of the primary outcome) and maintenance (or program sustainability). CQI is incorrect because it is a management approach that attempts to correct program shortcomings. The PIPE model provides a global estimate of impact and influence of the program. This evaluation framework does address effectiveness but most sustainability. The NDEOS is incorrect because it is a system that gathers, tracks, and aggregates outcomes measures unique to diabetes education and supports its integration into care. Olive oil and canola oil are sources of A. monounsaturated fat B. polyunsaturated fat C. saturated fat D. trans fat - Correct Answer A. monounsaturated fat Other sources of monounsaturated fats include avocados, almonds, pecans, and peanuts. When substituted for saturated fats, monounsaturated fats can decrease LDL, triglycerides without decreasing HDL. When developing a diabetes self-management program, assessment of the target population should include assessment of educational needs, ethic background, formal education level, reading ability, and A. knowledge about diabetes B. attendance at medical appointments C. social or family support D. barriers to participation in education - Correct Answer D. barriers to participation in education Assessment of the target population should not be limited to individuals who frequently attend medical appointments, but encompass all individuals with diabetes. Knowledge about diabetes or social support is not an assessment criteria. An 62 year old woman with a history of T2DM and cardiovascular disease contacts the diabetes educator for advise on exercise. Her physician advised her to begin a resistance program following a recent diagosis of osteopenia. Which of the following is the most appropriate exercise recommendation for the patient? Advise her to A. check her blood pressure and pulse frequently B. focus on aerobic exercise to strengthen her bones C. hold her breath while lifting to stimulate coronary perfusion D. complete repetitions as quickly as possible - Correct Answer A. check her blood pressure and pulse frequently Individuals with cardiovascular disease must focus particular attention on blood pressure and heart rate response during resistance training. The heart rate and bp need to remain within the limits established by an exercise stress test, and, therefore, need to be monitored throughout the training session. Starting with lighter resistance and choosing exercises that use a smaller amount of muscle mass help decrease the myocardial oxygen demand on the heart. In the absence of contraindications, all patients with diabetes should be encouraged to engage in resistance training at least twice per week. Recommended duration of resistance training is 1 to 3 sets of 8-20 repetitions. An educator is hired to develop a new diabetes education program for an inner-city, hospital based clinic. Which of the following is the MOST appropriate first step for this educator? A. Contact local drug industry representatives for education material B. Post flyers in the hospital waiting rooms announcing the education program C. Send out a memo to all hospital staff asking for referrals to the program D. Contact the hospital billing office to review patient demographic information - Correct Answer D. Contact the hospital billing office to review patient demographic information One of the first steps in the development of a new education program is to assess the target population and determine their educational needs. An obese 45 yearly patient expresses an interest in losing weight and asks for advice on exercise. Which of the following is the MOST appropriate exercise recommendation for this patient? A. Advise him that the real focus should be on meal planning, not exercise B. Encourage the patient to work up to walking 45 to 60 minutes for 5 to 7 days weekly C. Advise the patient that swimming is the best method to induce weight loss D. Recommend high-intensity exercise, such as running, for maximum weight loss - Correct Answer B. Encourage the patient to work up to walking 45 to 60 minutes for 5 to 7 days weekly B. American Diabetes Association (ADA) C. Health Insurance Portability and Accountability Act (HIPPA) D. Centers for Medicare and Medicaid Services (CMS) - Correct Answer C. Health Insurance Portability and Accountability Act (HIPPA) A physician is considering adding metformin to a patient's regimen, but is unsure of how it improves glycemic control. Which of the following is the most appropriate description of the primary mechanism of action for metformin? A. Increased insulin sensitivity B. Inhibition of hepatic glucose release C. Delated absorption fo carbohydrates form the GI tract D. Enhanced insulin secretion from the islet cells of the pancreas - Correct Answer B. Inhibition of hepatic glucose release Thiazolidinediones improve insulin sensitivity in skeletal muscle. Alpha-glucosidase inhiibitors delay absorption of carbohydrates from the GI tract. Sulphonylureas and meglitinides enhance insulin secretion from the islet cells of the pancreas. A postal worker who walks a route every day is newly diagnosed with T2DM. Which of the following is MOST likely to cause hypoglycemic symptoms while he is delivering mail? A. Meglitinides B. Thiazolidinediones C. Biguanides D. DPP-IV inhibitors - Correct Answer A. Meglitinides Although less likely than longer-acting insulin secretagogues, meglitinides are more likely to cause hypoglycemia than other oral agents. TZDs, biguanides, and DPP-IV inhibitors are not likely to cause hypoglycemia and would be better choices for this patient. Quality improvement in a diabetes education program A. is a systemic review of process and outcome data to measure the effectiveness of the education and support and to correct program shortcomings B. is conducted by management staff only C. focuses exclusively on patient outcomes D. is not a process recommended in the National Standards for Diabetes Self- Management Education and Support - Correct Answer A. is a systemic review of process and outcome data to measure the effectiveness of the education and support and to correct program shortcomings A QI process is a systemic review of process and outcome data to measure the effectiveness of the education and support and looks for ways to improve any identified gaps in service or service quality. The process includes staff from a variety of levels and department that are relevant to the specific QI project. A QI project can select a number of groups as the customer, including patients with diabetes, third-party mayors, regulatory agencies, etc. Implementing a QI process in a DSME program is recommended in Standard 10 of the National Standards. A 32 year-old woman with polycystic ovarian syndrome and newly diagnosed T2DM begins pioglitazone plus metformin. Which of the following should be included in her initial medication counseling? A. Use of contraception B. Hypoglycemia risk C. Risk for diabetic ketoacidosis D. Potential for disulfiram-like reaction - Correct Answer A. Use of contraception Resolution of hyperglycemia with metformin in patents with PCOS often restores menstruation and ability to become pregnant. TZDs and biguanides are not associated with hypoglycemia. Disulfiram-like reactions are associated with first generation sulfonylureas, bot not with the patient's regimen. Marked dawn phenomenon or frequent, unpredictable hypoglycemia in a patient on multiple daily injections warrants considerations of A. carbohydrate counting B. increased basal dose C. more frequent bg monitoring D. insulin pump therapy - Correct Answer D. insulin pump therapy With insulin pump therapy the dawn phenomenon effects are easier to manage because a variable basal rate can be set to accommodate fluctuations in insulin requirements overnight. Basal rates can be lowered during periods of low physiological requirements, which can minimize nocturnal or daytime hypoglycemia. Serum glucose of 734 mg/dL, loss of 13% body weight, lethargy, mild confusion, and negative ketones are indicative of A. hyperosmolar hyperglycemia nonketonic syndrome (HHNS) B. diabetic ketoacidosis (DKA) C. insufficient insulin in T1DM D. steptococcus infection - Correct Answer A. hyperosmolar hyperglycemia nonketonic syndrome (HHNS) A bg greater than 600 mg/dL, without significant ketones, characterizes hyperosmolar hyperglycemic nonketonic syndrome (HHNS). Extreme dehydration, more than profound insulin deficiency, is the primary precipitating factor. HHNS develops slowly and does not cause the GI pain and Kussmaul respirations associated with DKA. A middle school principal is concerned about the apparent rise in the number of obese children at her school. She has heard the reports in the media lately about the increasing incidence of T2DM in overweight children, so she contacts the local diabetes educator for recommendations. Which of the following is the MOST appropriate recommendation to prevent diabetes in the children? A. Organize a school assembly with presentations by a dialysis nurse and patient B. Encourage daily physical education and modify cafeteria food choices C. Write a letter to the parents of the children linking obesity and diabetes D. Offer a plasma glucose screening of parents at the school - Correct Answer B. Encourage daily physical education and modify cafeteria food choices This question addresses lifestyle interventions to help prevent T2DM in overweight children. Schools are organizations that are especially pertinent to diabetes prevention. Successful school-based interventions have focused on multiple levels of intervention including environmental change (such as cafeteria food choices), encouraging daily physical activity, classroom instruction by teachers, and family involvement. The absence of warning signs of impending neuroglycopenia is known as A. servere hypoglycemia B. hypoglycemia unawareness C. multifocal neuropathy D. amyotrophy - Correct Answer B. hypoglycemia unawareness