CDE Practice Exam Questions #3

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."

B. "How do you hope that learning more about diabetes will help you?"

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."

B. "I test 2-3x per day and schedule my testing times for when I think my numbers will be the best."

"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. " Great job coming in with your meter and log book today. Let's see how you did over the last two weeks on correcting for highs and treating lows."

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 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

B. 15 grapes

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

B. 26 year old Hispanic female with BMI of 41

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

B. 7% of body weight

Which of the following A1c targets would be most appropriate for a 69 year old woman with long standing T1DM who has cardiovascular disease, advanced kidney disease, retinopathy, and autonomic neuropathy? A. <9.5% B. <8% C. <7% D. <6.5%

B. <8% Although the general ADA rec is <7%, higher targets should be set for pts with hx of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, and those with long standing diabetes in whom the general goal is difficult to attain.

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

B. Ask open-ended questions that may help the pt identify some short-term goals that will help lower his A1C

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

B. BG control and BP control

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

B. Because celiac disease is an immune mediated disorder, there is a greater prevalence among those with T1DM when compared to the general population

All of the following suggestions are appropriate strategies to address financial barriers associated with self-monitoring of bg, except one. Which is not a recommended cost cutting strategy? A. Obtain a generic meter with corresponding test strips form a department store such as Walmart, where test strips are only about half the cost B. If possible, back date the meter so that it will accept recently expired test strips C. Select a monitoring schedule/strategy that conserves test strips but still provides information to recognize trends D/ Regardless of the meter the clinic prefers, contact the insurance carrier to determine which meter/strips is preferred and therefore least expensive to the pt

B. If possible, back date the meter so that it will accept recently expired test strips

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

B. Lack of interest on the part of the pts

The American Association of Diabetes Educators' Policy and Advocacy group has identified six goals. Which is not one fo the identified goals? A. Influencing the future of diabetes education and the role of the diabetes educator in health care B. Limiting the specialized skill of providing evidence based diabetes education to health care professionals who are certified as diabetes educators C. Advocating for policies that improve access to diabetes self mgmt training D. Attaining and maintaining reasonable reimbursement for diabetes educators

B. Limiting the specialized skill of providing evidence based diabetes education to health care professionals who are certified as diabetes educators

Regarding communication among all members of a pt's healthcare team, which of the following statements is true, according to the National Standards for Diabetes Self Management and Support (2013)? A. Because of HIPAA restrictions, providers and educators are limited in sharing pt's health information with team members w/o permission from the pts B. Sharing information among healthcare team members increases the likelihood that all the members will work in collaboration C. Pts report greater satisfaction when their information is shared among team members, and it saves them the time of having to repeat assessments D. Communicating with members of a pt's healthcare team under recent guidelines has resulted in additional cost in terms of time, money, and work burden

B. Sharing information among healthcare team members increases the likelihood that all the members will work in collaboration

More than 50% of men notice the onset of erectile dysfunction within ten years of the diagnosis of diabetes. Various treatment options are available. Which pt would not be a candidate for phosphodiesterase type 5 inhibitor (PDE5 inhibitor) such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis)? A. A man with stage 3 CKD B. A man with moderate liver impairment C. A man with mild ischemic heart disease who uses nitroglycerine spray PRN for chest pain D. All of the above

C. A man with mild ischemic heart disease who uses nitroglycerine spray PRN for chest pain

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

C. Acknowledge his reluctance and ask if he might be willing to share some of his knowledge and experiences with the other class members

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

C. Always eat something with carbohydrates within the hour before you drive

Which of the following examples violates infection control principles? A. A pt uses soap and water instead of alcohol to clean the skin before administering insulin injection B. A clinic uses one bg meter to perform all point of care glucose tests for pts C. An inpatient diabetes educator trains all pts on pen use with a single demo pen, but changes the pen needle each time D. Parents who have two children with T1DM withdrawal insulin from the same insulin vial but with a separate and new sterile insulin syringe for each child's dose

C. An inpatient diabetes educator trains all pts on pen use with a single demo pen, but changes the pen needle each time

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

C. At every visit

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

C. Cultural characteristics/barriers of your population

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

C. Diminished dorsals pedal pulses

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

C. Discuss with the pt his motivation and barriers to achieving the goal

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

C. Flexibility exercise

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

C. Health literacy

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)

C. Hepatitis B vaccination for adults less than 60 years and annual influenza vaccination for all pts

Which of the following is least likely to result in low bg? A. Decreased food intake B. Increased insulin C. Increased level of stress D. Increased intake of alcohol without carbohydrates

C. Increased level of stress

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

C. Inpatient social worker

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

C. Keeping a physical activity log is associated with a higher level of self efficacy

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

C. Lipid lowering has been associated with nearly 40% reduction in new or worsening symptoms of PAD

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

C. Preparation

As of 2013, the ADA recommends that bariatric surgery be considered only for those pts with T2DM who meet which of the following criteria? A. Pt has tried numerous dietary and/or behavioral options to lose wt w/o measurable success B. Pt presents with weight related comorbidities that are potentially life threatening C. Pt's BMI >35 and glycemic control through other means has proven difficult D. There is no criteria at this time, as the ADA does recommend bariatric surgery as a treatment option, due to cost and associated risks

C. Pt's BMI >35 and glycemic control through other means has proven difficult

Which of the following behavioral goals is measurable? A. Improve diabetes control by managing portion size B. Increase cardiovascular endurance by Jan 1 C. Run 20 minutes at least three times a week D. Minimize the risk of diabetic eye disease by keeping my ophthalmology appts

C. Run 20 minutes at least three times a week

Which class of medications for T2DM has a mechanism of action that relies on the kidneys to excrete glucose through the urine, and should therefore not be used in those with eGFR less than 30 mL/min or by those on dialysis? A. Sulfonylureas (ie glyburide) B. Biguanides (ie metformin) C. SGLT2 inhibitors (ie canagliflozin) D. DPP-4 inhibitors (ie sitagliptin)

C. SGLT2 inhibitors (ie canagliflozin)

You are conducting a seminar for family members and significant others of those with diabetes. In your advice for this group, what would you describe as the primary question a support person should ask him/her self? A. What will help this person with diabetes gain greater control of his/her chronic disease? B. What can I do that will result in better bg for this person with diabetes C. What does this person with diabetes want in the way of support? D. What can I do or say that will result in longer, complication-free life for this person with diabetes?

C. What does this person with diabetes want in the way of support?

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."

D. "I see a nephrologist annually even though my BP is normal and I have no diagnosis of kidney problems."

According to the 2017 ADA Standards of Care, what is the recommended maximum BP target for most adults with diabetes who are being treated for HTN? A. 120/80 B. 130/90 C. 120/90 D. 140/90

D. 140/90

What is the BP threshold at which pts with diabetes should be advised on lifestyle changes to reduce BP? A. >150/90 B. >140/80 C. >130/80 D. >120/80

D. >120/80

In the last few years, professional diabetes organizations including the ADA have adopted the A1c test as a diagnostic tool. In order for a valid diagnosis to be made using the A1c of >6.5%, which of the following stipulations or qualifiers must also be present? A. A1c must be accompanied by a fasting bg of over 126 mg/dL B. The pt must also have symptoms of hyperglycemia C. The pt must also have at least one episode of random plasma glucose >180 mg/dL D. A1c must be NGSP-certified and standardized to the Diabetes Complications and Control Trial (DCCT); repeat test is recommended

D. A1c must be NGSP-certified and standardized to the Diabetes Complications and Control Trial (DCCT); repeat test is recommended

The FDA has approved six nonnutritive sweeteners for use in moderation: acesulfame-K, aspartame, Neotame, saccharin, Sucralose, and Stevia. Which of these should be avoided by women who are pregnant or breastfeeding? A. Aspartame B. Saccharin C. Neotame D. All have been shown to be safe, even for pregnant and breastfeeding women

D. All have been shown to be safe, even for pregnant and breastfeeding women

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

D. Demonstration

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

D. Financial

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

D. HTN

You receive a referral for a pt, Mr B., from his primary care provider, for "medication consult and education related to history of non-compliance." Which of the following strategies would provide you with the most accurate and comprehensive assessment on Mr. B's medication knowledge, habits, and associated challenges? A. Prepare a written knowledge assessment on which he will match the name of a medication he takes with the appropriate common side effect B. Spend extra time reading through the pt's chart notes by the referring provider to get a better sense of the diabetes medication, education, and adherence history C. Ask the pt to bring a written list of what he is taking and when. Then compare it to the list of what is currently prescribed D. Have the pt bring all the medication he currently takes, in the original container. Then have him describe to you for what purpose, when, and how he takes each medication.

D. Have the pt bring all the medication he currently takes, in the original container. Then have him describe to you for what purpose, when, and how he takes each medication.

Your pt comes in for a return visit one month after starting basal bolus insulin therapy. She tells you that she will have to stop taking half of her insulin because her insurance does not pay for Apidra inslulin, only Lantus, and she cannot afford to pay out of pocket for it. Assuming that there may be other insulin brands in this class that her insurance does cover, which of the following would be the most appropriate replacement for Apridra that you might suggest to this pt's provider? A. NPH/regular (Novolin 70/30) B. Insulin detemir (Levemir) C. NPH insulin (Humulin-N) D. Insulin lisper (Humalog)

D. Insulin lisper (Humalog)

Which diabetes medication should not be omitted for a pt who is fasting in preparation for surgery? A. Metformin B. Sulfonylurea C. Short-acting insulin D. Long-acting insulin

D. Long-acting insulin

National Diabetes Awareness month presents an annual opportunity to promote diabetes advocacy through community outreach activities. What month is National Diabetes Awareness month? A. January B. April C. September D. November

D. November

Which of the following statements relating to barriers to diabetes education is true? A. Most PCP do not agree that their pts need more education and support for diabetes B. Pts over 65 are more likely to seek diabetes education than their middle aged counterparts C. Reflecting the makeup of the diabetes population, the majority of participants in DSME programs are minorities D. Tension and disagreement between PCPs and diabetes educators regarding self care recs has been found to be a barrier to pt's access to diabetes education

D. Tension and disagreement between PCPs and diabetes educators regarding self care recs has been found to be a barrier to pt's access to diabetes education

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."

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.

Standard 10 of National Standards for Diabetes Self Mgmt and Support (2013) states that DMSE providers "will measure the effectiveness of the education and support and look for ways to improve any identified gaps in services or service quality." As a first step in the continuous quality improvement process, the educator should ask which one of the following questions? A. Are the methods used to provide pts with the services they need and want effective? B. What programs or initiatives should be implemented to improve outcomes? C. How will we measure the effectiveness of change or initiative? D. What resources will be needed to implement changes to current practice?

A. Are the methods used to provide pts with the services they need and want effective?

For hospitalized pts with diabetes, discharge planning, including appropriate diabetes education (ie survival skills education) should begin when? A. As soon as the pt is admitted B. As soon as the provider has written the discharge order C. As soon as the pt stated that he or she is ready for instruction D. As soon as the appropriate diabetes treatment plan (ie diet recs, meds, SMBG schedule, and targets) has been decided

A. As soon as the pt is admitted

What is the first step in the process of diabetes self management education? A. Assessment B. Goal setting C. Diagnosis D. Referral

A. Assessment

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

A. Breakfast: 1 cup of Raisin Bran with 1 cup skim milk, 12 oz orange juice, 1/2 bagel

Which foot care recommendation is not appropriate for a person with diabetes, assuming there are no physical limitations, severe neuropathy, or lower extremity injuries or infections? A. If foot odor is noticed, soak feet in a warm Epsom bath for 15 to 20 minutes per day B. If you notice dry skin, moisturize the area daily with lotion, except between the toes C. Wash your feet frequently. Pat skin dry and dry between the toes thoroughly D. If toenails are long enough to bump the inside of the shoe, trim straight across and file any sharp corners

A. If foot odor is noticed, soak feet in a warm Epsom bath for 15 to 20 minutes per day

Which of the following nutrition modifications is not recommended for pts who suffer from gastroparaesis? A. Increased dietary fiber B. Frequent small meals C. Decreased dietary fat D. Soft or liquid foods

A. Increased dietary fiber

What are the ADA recommended cholesterol goals (2013) for adults with diabetes and no hx of cardiovascular disease? A. LDL <100 mg/dL, HDL >40 mg/dL (men) and >50 mg/dL (women), triglycerides <150 mg/dL B. LDL <150 mg/dL, HDL >40 mg/dL (men) and >50 mg/dL (women), triglycerides <180 mg/dL C. Total cholesterol <200, HDL >40 mg/dL,triglycerides <100 mg/dL D. LDL <150 mg/dL, HDL >50 mg/dL (men) and >40 mg/dL (women), triglycerides <100 mg/dL

A. LDL <100 mg/dL, HDL >40 mg/dL (men) and >50 mg/dL (women), triglycerides <150 mg/dL

Which of the following options is the most appropriate example of a learning objective for your class? A. Learner will select an appropriate, balanced meal choice from a restaurant menu B. Learner will know what it means to eat healthily C. Learner will improve A1c through better food choices D. Learner will understand the difference between glycemic index and glycemic load

A. Learner will select an appropriate, balanced meal choice from a restaurant menu

Which of the following labs require the pt to fast? A. Lipid profile B. A1c C. Microalbumin D. ALT/AST

A. Lipid profile

Which electrolyte level, frequently masked and appearing as normal, can be life threatening if not immediately corrected in DKA? A. Potassium B. Phosphate C. Sodium bicarbonate D. Sodium

A. Potassium

Which stage of diabetic retinopathy is characterized by neovascularization (new vessel growth) and/or vitreous or preretinal hemorrhage? A. Proliferative diabetic retinopathy B. Severe nonproliferation diabetic retinopathy C. Moderate nonproliferation diabetic retinopathy D. Mild nonproliferation diabetic retinopathy

A. Proliferative diabetic retinopathy

Your pt, who uses insulin, is planning to travel. In terms of health and safety, which item would be the least important for the pt to include in his carry-on luggage? A. Snacks, such as nuts and string cheese B. Insulin and syringes C. Bg meter and extra testing supplies D. Diabetic ID and provider contact information

A. Snacks, such as nuts and string cheese

Which of the following entities is not an organization that accredits or officially "recognizes" diabetes self-mgmt education programs - a necessary requirement for Medicare reimbursement? A. The National Certification Board for Diabetes Educators (NCBDE) B. The American Diabetes Association (ADA) C. The American Association of Diabetes Educators (AADE) D. All of the above are organizations that can recognize or accredit DSME programs

A. The National Certification Board for Diabetes Educators (NCBDE)

According to the ADA Nutrition Therapy Recommendations 2013, which of the following statements regarding outcomes of low-carbohydrate diets is true? A. The glycemic effects of low carb diet is mixed, therefore, no definite conclusions can be drawn regarding the effects of low carb diets on A1c B. Low carb diets were found to raise LDL and triglyceride levels in most studies C. Studies suggest that low carb diets are effective because retention of these diets is high D. Low carb diets are the safest option for a pt with renal disease

A. The glycemic effects of low carb diet is mixed, therefore, no definite conclusions can be drawn regarding the effects of low carb diets on A1c

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

A. The pt prefers one-on-one education because he does not get along with others

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

A. Up to 24 hours after the activity

Which of the following options is a modifiable risk factor for T2DM? A. Weight/obesity B. Family hx C. Race/ethnicity D. Age

A. Weight/obesity

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."

A. "My mother believes I got diabetes from eating too much candy as a kid."

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

A. A darkening and thickening of the skin, typically on the back/sides of the neck or the axillae; indicative of insulin resistance

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.

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.

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

A. A turkey and cheese, lettuce, and tomato sandwich with an apple, a small serving of baked chips, and a diet soda

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

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.

Which of the following elements is not part of the standard "exercise prescription"? A. Commencement (when will the pt begin the activity program) B. Intensity (how difficult and challenging the activity should be) C. Frequency (how often the activity should be performed) D. Duration (how long will the activity last each session)

A. Commencement (when will the pt begin the activity program)

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

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.

Which of the following is the best example of a behavioral goal/objective that is specific? A. Decrease intake of regular soda form three cans to one can per day by Dec. 1 B. Decrease the risk for diabetes related cardiovascular complications by 25% C. Improve glycemic control by the next diabetes care visit D. Improve overall health by eating better, moving more, and getting better rest

A. Decrease intake of regular soda form three cans to one can per day by Dec. 1

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

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.

Which of the following reasons is not listed as a rationale for documentation of pt encounters (including assessment, education plan, and outcomes) under Standard 7 (individualization) of the ADA National Standards for Diabetes Self Mgmt and Support (2013)? A. Documentation provides proof of services rendered by the educator, and can be used to verify practice hours for certification renewal B. Documentation is used to guide the education process C. Documentation provides evidence of communication among instructional staff and other members of the participant's health care team D. Documentation prevents duplication of services

A. Documentation provides proof of services rendered by the educator, and can be used to verify practice hours for certification renewal

In 2007, researchers observed community-based diabetes screenings at 12 separate health fairs in Harlem, NYC. The results, published in 2010, revealed several concerns, which may apply to community based diabetes screening fairs throughout the country. Which of the following statements was not a finding of the research (and likely not a common concern related to local diabetes health fairs)? A. Due to a general lack of trust in health care professionals, attendance in local health fairs is usually poor and therefore a deterrent to holding such events B. Screeners typically use equipment that is designed for home use only, and is not intended for diagnostic or screening purposes. C. Technique of screeners tends to vary, which can skew test results D. Screening rarely includes gathering diabetes risk assessment data or recent caloric intake (fasting status)

A. Due to a general lack of trust in health care professionals, attendance in local health fairs is usually poor and therefore a deterrent to holding such events

"The systematic process by which the worth or value of something, in the case of DSME teaching or learning is judged" is known as which of the following? A. Evaluation B. Documentation C. Planning D. Implementation

A. Evaluation

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

A. MNT is recommended for only those person with diabetes who are underweight, overweight, or obese

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

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.

For those who choose to consume alcoholic beverages, what guidelines do the ADA provide in the Diabetes Standards of Care (2013)? A. One drink per day or less for adult women and two drinks per day or less for adult men B. Two drinks per day or less for adult women and three drinks per day or less for adult men; abstaining from "hard liquor" is recommended C. Persons with diabetes should not consume alcohol due to the increased risk for hypoglycemia D. Persons with diabetes may consume alcohol without restriction as long as they account for carbohydrates and plan accordingly

A. One drink per day or less for adult women and two drinks per day or less for adult men

How frequently should most pts with diabetes receive a pneumonia vaccine (as recommended by the ADA, 2013) in order to reduce the risks associated with pneumonia? A. One time for those over age 2, then a one time revaccination for those age 65 and older B. Every year C. Every five years, unless the person has had pneumonia, and then the vaccination is unnecessary D. Every ten years until age 80, at which time revaccination is not recommended

A. One time for those over age 2, then a one time revaccination for those age 65 and older

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

A. Providing materials and experiences to enhance her knowledge and skills

Which of the following pt attributes (skills/experiences) is not considered a prerequisite for continuous subcutaneous insulin infusion (ie insulin pump) therapy? A. Pt must have a diagnosis of T1DM B. Pt must be proficient at counting carbohydrates C. Pt should have previous experience on multiple daily injection therapy D. Pt exhibits a pattern of consistent, frequent bg monitoring

A. Pt must have a diagnosis of T1DM

Which is not a standard recommendation for those with mild to moderate chronic kidney disease (stage 1 through 4)? A. Restricting foods high in vitamin K B. Good glycemic control (as tight as can be achieved without hypoglycemia) C. BP mgmt through the use of an ACE inhibitor or ARB medication D. Abstaining from use of nonsteroidial anti-inflammatory drugs

A. Restricting foods high in vitamin K

To determine a pt's level of mastery of self care skills such as insulin administration, which of the following evaluation methods should be used? A. Return demonstration B. Ask the pt to explain the process C. Ask the pt to verbally acknowledge understanding of the skill D. Completion of a short post test (which can be quantified or scored)

A. Return demonstration

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 problem

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

You pt, a 24 year old with T1DM for three years, manages his diabetes with multiple daily injections of basal and rapid acting insulin. He reports a trend of high morning bg and hypoglycemia just before meals during the day. The pt agrees to wear a CGM for three days. Upon examination of the report, you notice two occurrences where the pt's bg dropped below 60 mg/dL overnight. On the one night when this did not occur, fasting morning bgs were within target range. What is the likely explanation for what this pt is experiencing? A. Somogyi phenomenon B. Dawn phenomenon C. Inappropriate nutrient balance at night (needs more protein) D. Fluctuations in the honeymoon period

A. Somogyi phenomenon The Somogyi phenomenon, while rare, is a rebound form hypoglycemia that results in high morning glucose due to an exaggerated counter regulatory response. Dawn phenomenon is elevated fasting bg in the morning, likely due to overnight growth hormone and increased cortisol. It is not usually preceded by hypoglycemia.

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

A. Steroid use induces insulin resistance and affects glucose metabolism, which is manifested especially in post-prandial glucose levels

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

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.

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

A. Talking to the nurse of the referring provider and using the information to complete the assessment form

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

A. The pt

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

A. To verify that the products listed on the label are accurate and pure

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

A. Underweight <18.5 = underweight 18.5-24.9 normal 25-29.9 overweight 30+ obese 40+ morbidly obese

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

A. Visual and tactile/dexterity

You have been asked to teach a diabetes class to a small group of pts, all of whom are hearing impaired. You have secured an ASL translator to interpret for the class members. What other modification should be made to meet the needs of the particular audience? A. Write medication names and other "proper" nouns on the white board B. Modify some of the handouts to include more pictures and less text C. Arrange all chairs in the circle so class members can clearly see each other D. Provide each class member with a pad of paper and pen to facilitate written communication

A. Write medication names and other "proper" nouns on the white board

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 insulin resistance, most oral medications for T2DM work by improving a body's sensitivity to insulin. Those with T1DM are very sensitive to insulin. If some of these oral medications were used to treat someone who has T1DM, they would likely cause severe hypoglycemia."

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 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

B. A demonstration and return demonstration of insulin administration

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

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

Identify the statement that is true with regards to recommenced lab values. A. Someone with an HDL of 31 mg/dL is not at risk for CVD as long as the total cholesterol is not above 200 mg/dL B. A serum creatinine of 3.6 mg/dL in a 55 year old female indicates probable renal impairment C. Regardless of regular SMBG values, someone with T1DM with an A1c of 5.9% is well controlled D. A pt who has a creatinine level of less than 56 IU/L does not have fatty liver disease

B. A serum creatinine of 3.6 mg/dL in a 55 year old female indicates probable renal impairment Creatinine above 1.3 mg/dL for men or 1.1 mg/dL for women is considered out of normal range and should be examined further.

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

B. Behavioral lapse

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)

B. Biguanides (ie metformin) and TZDs (ie pioglitazone)

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

B. Calories for saturated fat for this pt should not exceed 140-200 calories per day

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

B. Changing his insulin to carb ratio from 10 to 12 for lunch and dinner only

Which statement regarding dental disease and diabetes is false? A. Treatment of periodontal disease has been shown to reduce A1c levels B. Children with diabetes have significantly more dental caries than their non-diabetic counterparts C. Elevated glucose increases the frequency, progression, and severity of periodontal disease D. Medications such as diuretics and antidepressants may contribute to tooth decay and periodontal disease

B. Children with diabetes have significantly more dental caries than their non-diabetic counterparts

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

B. Energy balance (total calorie vs. expenditure)

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

B. Imparting knowledge and skills needed to make important lifestyle (behavioral) changes

Physiologic changes in aging are associated with an increased risk for diabetes and many diabetes-related complications, which may warrant the need for adjustments to the diabetes mgmt plan. Which of the following changes is not commonly associated with advanced age? A. Reduced metabolic rate that can alter digestion B. Increase insulin resistance and decreased insulin effectiveness C. Altered pain perception D. Decreased renal function

B. Increase insulin resistance and decreased insulin effectiveness

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

B. Interpersonal barrier related to healthy eating

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..."

B. Invite his wife, who has accompanied him, to help recall what he ate yesterday

Hypoglycemia unawareness the decrease or absence of the typical counterregulatory responses to low bg. Which of the following options is the primary recommendation for addressing this phenomenon? A. More frequent bg monitoring, including use of CGM B. Less stringent bg targets, at least for several weeks C. More stringent bg control to restore autonomic responses to hypoglycemic D. Increased precautions, including cessation of driving and limits on high-risk activity

B. Less stringent bg targets, at least for several weeks

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

B. Level of family support

Which is the strongest predictor of health status? A. Ethnic group B. Literacy skill C. Income level D. Age

B. Literacy skill

You are preparing to teach an introductory course at a community center on nutrition intervention as part of diabetes care. Which of the following materials would be most appropriate for the class you will be teaching? A. Copies of ADA guidelines on nutrition B. Models of food, nutrition labels, and sample restaurant menus C. Graphs showing rates of diabetes complications for different A1c levels D. Props to demonstrate personal foot care (mirror, file, socks, types of shoes, etc)

B. Models of food, nutrition labels, and sample restaurant menus

Which of the following dietary interventions has not been shown to be an effective weight loss strategy? A. 4 to 5 small meals/snacks throughout the day B. Omitting beast to reduce total daily caloric intake C. Emphasis on portion control D. Meal replacements (such as liquid meals or pre-packaged wt loss meals)

B. Omitting beast to reduce total daily caloric intake

Which of the following marketing strategies has been found to be the most reliable and cost effective method of bringing new pts into a diabetes education program? A. Radio ads B. Personal outreach to referring providers C. Word of mouth (current participants, employees, etc) D. Finding and contacting pts who were previously hospitalized and experienced hyperglycemia

B. Personal outreach to referring providers

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%

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%

What is the first tx priority for a person experiencing a hyperosmolar hyperglycemic state (HHS)? A. Decrease bg by infusing insulin B. Rehydrate by providing adequate intravenous fluids C. Correct electrolyte imbalances by monitoring and providing supplementation when needed D. Address the background infection that precipitates the HHS

B. Rehydrate by providing adequate intravenous fluids

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

B. Seeing pictures of food portions followed by booklets on meal planning

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 many other benefits, and she needs to treat low bg

B. She could omit her breakfast dose of repaglinide (Prandin) on the mornings she will exercise

Why does the ADA recommend the "development of standardized procedures for documentation, training health professionals to document appropriately, and the use of structured standardized forms based on current practice guidelines" in the National Standards for Diabetes Self Mgmt and Support (2013)? A. Such documentation practices and attributes are required by TJC (The Joint Commission) B. Such documentation practices and attributes have been shown to improve documentation and may ultimately improve quality of care C. Such documentation practices and attributes will facilitate smoother clinic operations and reduce administrative costs D. Such documentation practices and attributes assist in the reimbursement process and are preferred by most insurance carriers

B. Such documentation practices and attributes have been shown to improve documentation and may ultimately improve quality of care

A member of the DMSE class group asks a specific question about food choices during session one. You typically address healthy eating in session two. What is the best way to handle the situation? A. In order to capitalize on the apparent interest, abandon the present order of classes. Talk about food today and discuss the session one material next time B. Take a few minutes to briefly answer the question; acknowledge that many in the group likely have questions about food, and promise that this will be addressed in greater detail as part of the next session C. Tell the client that if he will be patient and remember his question for next session, you will promise to address it first thing D. Politely explain that there is a specific order in which the information needs to be presented to make the most sense. Ask him to limit his questions to the topic at hand but let him know that he may ask you one on one after class if he needs an immediate answer

B. Take a few minutes to briefly answer the question; acknowledge that many in the group likely have questions about food, and promise that this will be addressed in greater detail as part of the next session

In response to low pt satisfaction scores for the class on meds, the diabetes educator redesigns the class content outline to contain more information on the mechanism of action of each class of oral medication. After receiving approval from the continuous quality improvement (CQI) team, the educator implements the new content. She is surprised when the pt satisfaction scores for the class are even lower the next month. What is the most likely explanation for the failure of this change to better satisfy participants? A. The educator most likely failed to thoroughly explain her idea to the CQI team B. The educator did not collect and analyze information on why the pts did not like the class before deciding on the change C. The evaluation method used to gauge pt satisfaction is most likely not a valid or reliable tool D. The educator was not creative in her solution to the problem

B. The educator did not collect and analyze information on why the pts did not like the class before deciding on the change

In a group class on nutrition, you show a sample breakfast menu and ask participants to modify the meals to measure about 60 grams of carbohydrate. One pt shares her modified menu: 1 scrambled egg, 2 oz ham, 2 pieces of wheat toast, 1/2 large grapefruit, 1 cup skim milk. Which evaluation best describes this meal? A. The meal has significantly too few grams of carbohydrates B. The meal has approximately 60 grams of carbohydrates C. The meal has significantly too many carbohydrates D. It is impossible to estimate the number of carbohydrates without seeing the grapefruit and the type of bread

B. The meal has approximately 60 grams of carbohydrates

What is the main difference between process evaluation (or process) and summative (or outcomes) evaluation? A. Process evaluation deals with its and summative evaluation deals with the organization B. The purpose of the process evaluation is to make needed adjustments to the educational process; the purpose of summative evaluation is to determine the effectiveness of the education process C. The scope of formative evaluation is small, as in a single session or class, where as the summative evaluation encompasses a period of time (usually one year) and includes statistics on an organization's productivity (ie number of pts served, classes taught, etc) D. The object of formative evaluation is to identify gaps or deficits and then make changes and adjustments as needed; the object of the summative evaluation is to compile and summarize data for reporting purposes

B. The purpose of the process evaluation is to make needed adjustments to the educational process; the purpose of summative evaluation is to determine the effectiveness of the education process

Which of these statements regarding obstructive sleep apnea is not accurate? A. Treatment of sleep apnea has been proven to significantly improve bp control B. Treatment of sleep apnea has been conclusively proven to improve glycemic control C. Treatment of sleep apnea has been shown conclusively to improve quality of life D. Persons who are obese are four to ten times more likely to have obstructive sleep apnea

B. Treatment of sleep apnea has been conclusively proven to improve glycemic control

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

B. Unvaccinated adults with diabetes who are aged 19 through 59 years should receive hepatitis B vaccination

What is the distinction between assessment and evaluation? A. Assessment is clinical in nature, whereas evaluation is typically administrative B. Assessment is always done at the beginning of a process or procedure, whereas evaluation is always done at the end C. Assessment implies gathering and interpreting data for the purpose of directing action, whereas evaluation is to determine the extent to which an action or process was successful D. In relation to diabetes program mgmt, there is no significant difference between assessment and evaluation, the two are used interchangeable

C. Assessment implies gathering and interpreting data for the purpose of directing action, whereas evaluation is to determine the extent to which an action or process was successful

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

C. Avoid injecting insulin into those areas until the swelling is gone; rotate injection sites to prevent recurrence

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

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.

You discover that the middle school your pt attends does not permit him to carry his bg meter or insulin with him. What step below would you take to advocate for your pt? A. Teach the pt how he should check his bg so as to stay within the school guidelines (ie before and after school) B. Show the pt ways he can hide his testing and insulin supplies and perform the necessary skills in the bathroom, so as to not get in trouble C. Contact the school principal, school nurse, and head district nurse to get clarification on the policy and explain the need for modification for your pt D. Encourage the mother of the pt to contact the school board or her legislator if necessary

C. Contact the school principal, school nurse, and head district nurse to get clarification on the policy and explain the need for modification for your pt

You are visiting with a pt who has T1DM and uses an insulin pump. She tells you she is confused about the sick day instructions she has been given and asks why she should increase her basal rate when she so rarely is able to eat anything when she feels sick. Which explanation below is most appropriate? A. You are correct to question these instructions. You should never take more insulin when you are not eating, as insulin will drop your bg. Instead of increasing the basal rate, you should actually decrease it. Once you are feeling better and eating normally again, you can resume your regular basal insulin schedule. B. Food is needed to fight the illness and prevent DKA. Extra basal insulin will slowly lower your bg. As your bg drops, you will begin to feel hungry. So in this case, the extra basal insulin actually fats as an appetite stimulant. C. During times of stress, such as illness, your liver puts extra glucose into your blood. Your basal insulin covers the glucose from the liver, as opposed to glucose from carbs you eat. Therefore, extra basal insulin is needed to address the extra liver sugar when you are sick. When you eat or drink something with carbohydrate, you would bolus accordingly. D. We know that because of dehydration, insulin dose not get absorbed as well when you are sick. Therefore, in addition to drinking at least 8 oz of fluid every hour, you must also increase the basal insulin rate to compensate for the decrease in insulin absorption.

C. During times of stress, such as illness, your liver puts extra glucose into your blood. Your basal insulin covers the glucose from the liver, as opposed to glucose from carbs you eat. Therefore, extra basal insulin is needed to address the extra liver sugar when you are sick. When you eat or drink something with carbohydrate, you would bolus accordingly.

A new pt reports that she is not sure what type of diabetes she has because no one has ever giver her a clear answer. She is 46 year old and Caucasian with a BMI of 20. She states that she has always been thin and active, and that no one in her family has diabetes that she knows of. With the exception of her father, who has rheumatoid arthritis and psoriasis, her family history is unremarkable. She was diagnosed with diabetes two years ago and claims she is able to keep her bg in the normal range with a careful low carb diet. When you check her labs, you see that her last A1c was 6.4% and her c-peptide level was on the low end of normal. Labs are also positive for GAD and islet cell antibodies. What type of diabetes does this pt most likely have? A. T2DM B. T1DM C. Latent autoimmune diabetes of adulthood (LADA) D. Maturity onset diabetes of the young

C. Latent autoimmune diabetes of adulthood (LADA) LADA is characterized by positive GAD/islet cell antibodies, a normal to low c-peptide level, and can often be managed with diet in the beginning months or years.

Which of the following lab findings is most closely associated with hypertriglyceridemia? A. High HDL B. Elevated fasting plasma glucose C. Low HDL D. Small sized LDL-C particles

C. Low HDL

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

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.

Which of the following personal characteristics has proven to positively affect behavioral outcomes through healthy coping to one's diabetes? A. Stubbornness B. Affluence C. Optimism D. Consistency

C. Optimism

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

C. Resistance training should not be included in the exercise regimen because the resulting excessive systolic bp response may further damage the eyes

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?

C. Say you are driving your car and you begin to feel shaky, sweaty, and confused. What would you do?

Which of the following is the primary role of the diabetes educator regarding depression and diabetes? A. Using a reliable, valid tool to diagnose its who exhibit symptoms B. Teaching pts depression prevention strategies, including stress mgmt techniques C. Screening pts and assisting them in getting access to care form a mental health professional D. Conferring with the mental health profession to know how to appropriately counsel depressed pts on diabetes self care

C. Screening pts and assisting them in getting access to care form a mental health professional

Using the AADE7 Self care Behaviors Goal Sheet, you and a pt are working on individualizing self care behavior goals. You document that he has checked the box saying, "make better food choices" under the "Health Eating" category. Which of the following statements is the best example of individualization of this goal? A. Make better food choices to reduce A1c less than 7.5% B. Make better food choices over the next 6 months (by Oct 31) C. Switch to diet soda and sugar free ice cream D. Report to educator each Monday on previous week's food choices

C. Switch to diet soda and sugar free ice cream

Which statement is characteristic of a "patient empowerment" approach to DSME/DSMS, as opposed to more traditional behavioral theories? A. Pts must rely only on themselves to deal with the challenges of a chronic disease, such as diabetes B. Pts learn from their own experiences and from observing the experiences of those around them C. The choices that have the greatest effect on diabetes outcomes are made by pts, not by healthcare professionals D. A pt's perception of how the community/society views a behavior will have a great impact on his or her intentions to adapt it

C. The choices that have the greatest effect on diabetes outcomes are made by pts, not by healthcare professionals

Your pt, who has just been prescribed two oral medications for T2DM, also takes many other meds for chronic conditions, including Crohn's disease, COPD, HTN, anemia, and vitamin deficiencies. She is very concerned about medication dose timing, contraindications, and side effects; she requests an educational appt to address her concerns. Which team member would be the best professional to meet with this pt? A. The doctor(s) who originally prescribed the medication B. A mental health professional to help her with anxiety C. The pharmacist assigned to the pt's healthcare team D. The RD, who is also a CDE

C. The pharmacist assigned to the pt's healthcare team

You receive the lab results fo your next pt and see the A1c is 9.6%. When the pt enters the room, she tells you that she forgot her meter but brought her log book. You see that for the past 2 months, she has not missed a single pre-meal or bedtime bg test. All numbers are within target range. What is the most likely explanation for the discrepancy? A. The pt likely has some type of anemia or hemoglobinopathy which results in her A1c not closely correlating with actual avg estimated bg B. The pt likely had a brand of bg meter that is inaccurate C. The pt is likely making up bg values D. The pt is probably using improper testing technique

C. The pt is likely making up bg values

Which of the following statements is true regarding preconception care and diabetes? A. Only about half of all female pts of childbearing age with diabetes receive preconception counseling B. Preconception care should include wt mgmt as a the first priority so that those women who become pregnant are as close to ideal body weight as possible C. The rate of congenital malformations for diabetic women whose A1c is less than 7% prior to and at conception is similar to rates for women without diabetes D. An important part of preconception counseling may be to initiate lipid mgmt medication (such as a statin), since lipid levels tend to increase during the first part of pregnancy

C. The rate of congenital malformations for diabetic women whose A1c is less than 7% prior to and at conception is similar to rates for women without diabetes

Most educators instruct pts to obtain a blood sample from the side of the finger when self monitoring. What is the reason for this advice? A. There are more capillaries on the sides of the fingers than the tip, and therefore, easier to get a sufficient sample B. The sides of the fingers have fewer germs, since they do not come in contact with surfaces as much as he tips C. There is less pain when lancing the sides of the fingers, compared to the tips D. Studies have shown that drops obtained from the sides of the fingers produce a more accurate whole blood sample result than alternative sites, including fingertips

C. There is less pain when lancing the sides of the fingers, compared to the tips

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 currently sedentary. No other referrals are warranted at this time. 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 D. This pt should have referrals to ophthalmology, neurology, cardiology, nephrology, and possibly to an exercise physiologist. All team members will need to confer on this pt to devise the best activity regimen; it is likely that exercise will be contraindicated due to the extensive high risk of comorbidities.

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 are instructing insulin-requiring pts on how to treat hypoglycemia. To treat hypoglycemia that occurs immediately before a meal, which of the following is the best course of action? A. Skip your insulin because your bg is already too low. If the glucose is normal or high before the next meal, then you may take the recommended dose at that time. B. Eat your meal now but take your dose of mealtime insulin about an hour later C. Treat the low bg as you would any low bg and then once it is in the normal range, take your regular dose of insulin and eat your regular meal D. Take the insulin right away, then prepare the meal and eat as you normally would

C. Treat the low bg as you would any low bg and then once it is in the normal range, take your regular dose of insulin and eat your regular meal

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

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

At a visit last month, your pt committed to quit smoking. When you call to see how he is doing 4 weeks later, he admits that he has had two relapses, but then "recommitted" to stop smoking each time. He asks if you have any tips to help him avoid theses relapses. Which suggestion is not a recommended relapse prevention strategy? A. Be aware of risky behavior or situations that may lead to a relapse and try to avoid them B. Have a plan to combat negative thoughts or temptations C. Employ stress mgmt techniques, such as cognitive reframing, turning to a support person, or others that the pt has used to help manage stress D. Acknowledge and repeat the mantra that the bad behavior is gone and will not come back (ie "I am not a smoker; I do not want or need to smoke)

D. Acknowledge and repeat the mantra that the bad behavior is gone and will not come back (ie "I am not a smoker; I do not want or need to smoke)

A pt tells you that she is very worried about "dropping too low" at night and therefore eats a bowl of ice cream every night and only takes a half dose of her nighttime basal insulin. Because this results in high fasting AM bgs, she has quit testing in the morning because she is not willing to increase her basal insulin anyway. What mental health issue does this pt exhibit? A. Depression B. Eating disorder C. Denial D. Anxiety

D. Anxiety Anxiety is manifested by taking extreme measures to avoid a feared outcome.

Which of the following methods is not recommended as an effective way to obtain information on tracking behavioral objectives? A. Group classes B. Email messaging C. Phone consultation D. Any of the above are legitimate ways to track pt progress of behavioral goals

D. Any of the above are legitimate ways to track pt progress of behavioral goals

You pt takes insulin glargine (Lantus) and has a treat to target self adjustment scale, with a fasting morning bg of <120 mg/dL. It has been three months since his last visit. Since then, his basal insulin dose has been self increased by 18 units (to 48 units QHS). Today, his BG meter shows that his fasting bg levels are still usually above target, sometimes within target, with an occasional hypoglycemic reading. Most bedtime glucose readings are well above target. You also notice that his weight has increased by 4 kg (about 9 lbs) since his last visit. What is the most likely explanation for these findings? A. The pt requires additional basal insulin since most of his fasting morning readings are still above target. He should increase his dose of according to the algorithm B. He requires additional basal insulin, but because he mistaking more than 40 units, he may benefit by having a split dose C. Because he has some low readings (although few), he should decrease the dose and add bolus insulin during the day D. As evidenced by his wt gain and continued high readings, the pt is likely overeating. Help the pt evaluate current eating patterns and make adjustments

D. As evidenced by his wt gain and continued high readings, the pt is likely overeating. Help the pt evaluate current eating patterns and make adjustments

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

D. Explain the medications in this class can take up to 12 weeks to work

What is the greatest risk for persons with small nerve fiber neuropathy (a sub category of chronic sensorimotor distal neuropathy)? A. Injury from falls d/t Charcot foot syndrome B. Decrease in overall wellness due to limited mobility C. Risk for sudden cardiac death d/t cardiac denervation D. Foot ulceration and subsequent gangrene and amputation

D. Foot ulceration and subsequent gangrene and amputation

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

D. He needed to prime the needle before dialing the dose

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 diabetes related anxiety. Stress, the body's response to the anxiety, is manifested in his increased A1c and neglect of self care behaviors. Discuss ways to reduce anxiety and stress, such as medication or breathing exercises 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

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

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)

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.

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

D. Medication regimen: types, dose, and timing

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

D. Misplacement of small items

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

D. None of the above should be switched to low protein diet

According to recently revised Medicare guidelines, a referral for medical nutrition therapy (MNT) by a RD can be made by whom? A. Any credentialed or certified member fo the diabetes care team, including the certified diabetes educator B. A member of the diabetes care team with any of the following credentials: physician, qualified non-physician practitioner (NP/PA), or pharmacist C. Only a primary care provider, including the treating physician or qualified non-physician practitioner (NP/PA) D. Only the treating physician

D. Only the treating physician DSMT referrals can be made by a physician or a qualified non-physician practitioner. DSMT and separate MNT services may not be provided or billed on the same day but may be performed by the same person (if the CDE is an RD) on separate days.

Your pt, a 22 year old female with T1DM (dx 3 years ago), visits with you while home on summer break from college. She reports enjoying college, but realizes that perhaps she has not been responsible with her diabetes self care as she really needs to be. Which of the following interventions below is the greatest priority for this pt? A. Referral to a nephrologist to check for kidney problems B. Referral to an ophthalmologist for an annual dilated eye exam C. Referral for MNT for a review of good eating practices, including alcohol consumption D. Pre-conception counseling to prevent unplanned pregnancy

D. Pre-conception counseling to prevent unplanned pregnancy

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

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

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

D. Serum creatinine 2.8 mg/dL

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

D. Sexual orientation

Mr. D drops by the clinic on his way home from work to obtain a copy of his wife's most recent lab results. You know that Mr. D comes to appointments with his wife and assists in her diabetes self mgmt. What is the appropriate action for you to take? A. Politely explain that it is a HIPAA violation to provide any private health information to anyone but the individual or personal representative (someone legally appointed to make healthcare decisions) B. Provide Mr. D with a blank copy of the Release of Information form and tell him that if his wife will sign it, only then will you be able to comply with his request C. Suggest that the lab is not needed at this time and that it can be discussed with the provider or educator in person at Mrs. D's next appt. D. Since Mrs. D has identified her husband as a participant in her care, you may provide Mr. D with a copy of the lab results, provided it does not violate the policies of your workplace

D. Since Mrs. D has identified her husband as a participant in her care, you may provide Mr. D with a copy of the lab results, provided it does not violate the policies of your workplace

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

D. Since medical waste disposal laws vary from state to state, pts and educators need to determine specific policy for their areas

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

D. Small group discussion around a table where pts teach each other a skill after seeing it explained and demonstrated by the educator

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)

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.

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

D. Target (all times) bg for critically ill pts: 140-180 mg/dL

Which of the following aggregate pt outcomes are required to be collected and reported as part of DSME program recognition and accreditation? A. Pt attendance rates for educational appts B. Overall change in pt A1c C. Percent of pts achieving behavioral goals D. The AADE and ADA do not specify which outcomes be tracked

D. The AADE and ADA do not specify which outcomes be tracked

Which of the following statements regarding A1c is accurate, in relation to persons with diabetes? A. Regardless of age or other factors, an A1c greater than 7% represents a medically unacceptable risk B. A1c was recently adopted by the ADA as a diagnostic tool for diabetes because there is almost no variation among race, gender, or age and it remains largely unaffected by other medical conditions C. Screening for diabetes by using the A1c has been shown to identify more cases of previously undiagnosed by diabetes than either the fasting plasma glucose or the 2 hour glucose tolerance test D. The ADA recommends that the A1c test should be performed at least twice annually, and more often in some cases

D. The ADA recommends that the A1c test should be performed at least twice annually, and more often in some cases

Your pt is beginning a physical activity regimen, to include moderate intensity exercise 5 days a week for 30 minutes each day. He wants to know how to tell if he is exercising at the right intensity. From previous encounters with the pt, you are aware that he has some literacy/numeracy challenges, and so you decide to suggest the original "Rating of Perceived Exertion" (RPE). How would you explain this intensity guide to your pt? A. The RPE lets you estimate how intense you physical activity is by counting the number of breaths per minute and comparing it to the number at rest. Moderate/vigorous intensity is equal to an increase in two to four breaths per minute. B. The RPE estimates intensity by how easy it is to have a. conversation during the activity. For moderate/vigorous intensity, you should be breathing harder but still able to talk while performing the activity. If you are breathing too heavily to talk, then the activity is too intense. C. The RPE has you estimate the intensity of your activity based on how much your heart rate has increased from resting. For every 10 beats per minute, you go up one number in the scale. You should be between a "5" and "8" (or 50 to 80 bpm increase) for moderate/vigorous intensity activity. D. The RPE helps you estimate the intensity of your activity by focusing on how tired you feel and how difficult the activity seems. It uses a scale of 6 (extremely light) to 20 (beyond extremely hard or maximum exertion). Moderate/vigorous intensity activity is about 12 to 16 (somewhat hard to hard) on the scale.

D. The RPE helps you estimate the intensity of your activity by focusing on how tired you feel and how difficult the activity seems. It uses a scale of 6 (extremely light) to 20 (beyond extremely hard or maximum exertion). Moderate/vigorous intensity activity is about 12 to 16 (somewhat hard to hard) on the scale.

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

D. The pt should add a substantial snack at bedtime, coupled with a dose of prandial insulin to cover the snack

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 lifetime disease 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.

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.

Eating disorders are more common in those with diabetes than in the general population, and are more prevalent in women. Recent studies have been focused on women with T1DM who restrict insulin in order to avoid wt gain. Which of the following statements is not a finding of these studies? A. Withholding insulin to prevent wt gain is associated with problems in other diabetes self care areas B. Withholding insulin to prevent wt gain is associated with higher levels of diabetes specific stress C. Those women who withheld insulin to prevent wt gain have higher mortality risk, which correlates with the frequency of withholding the insulin D. Those women who have had diabetes for shorter duration are more likely to restrict insulin than those who have had diabetes for longer durations

D. Those women who have had diabetes for shorter duration are more likely to restrict insulin than those who have had diabetes for longer durations

For a pt with T2DM, who is mostly sedentary and who has a BMI of 26 and no contraindicative comorbidities, which option is the best example of a goal that is realistic and attainable? A. Purchase a pair of walking shoes and walk to and from the mailbox everyday B. Participate in the half marathon at the end of the month C. Enroll and attend all the daily spin classes at my local health club D. Walk briskly for 25 minutes every day following dinner

D. Walk briskly for 25 minutes every day following dinner Positions statements and the ADA recommendations stipulate that 150 minutes (25 min 6x per week in this case) of moderate intensity, such as brisk walking, is the minimum goal for pts with T2DM.

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

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.

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. Needymeds.com (a non-profit organization that centralizes information and applications for pharmaceutical drug assistance programs)

B. A low-interest medical loan from her local bank

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

A. Nausea and subsequent weight loss

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

D. BG control and stabilization

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

B. Web-based activities, role-playing, group discussion, lecture

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

D. The pt denies that she has diabetes and disagrees with the doctor's referral to DSME

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

A. Demonstrating proper technique for self monitoring bg

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

A. Social Cognitive Theory

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)

C. Reporting Progress (ie documenting past and present progress, or lack thereof, in achieving set goals)

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

D. All of the above should be noted

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

D. Theres is no specific mix of macronutrients recommended by the ADA. The best mix of macronutrients depends on individual circumstances