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Management of Type 2 Diabetes: Implications for the Home Healthcare Clinician

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional: February 2009 - Volume 27 - Issue 2 - p 102–103
doi: 10.1097/01.NHH.0000346312.64380.93
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CE TEST QUESTIONS

GENERAL PURPOSE

To provide registered professional nurses with an understanding of evidence-based quality care for persons with diabetes (PWD).

LEARNING OBJECTIVES

After reading this article and taking this test, you should be able to:

  1. Explain the pathophysiology of Type 2 diabetes mellitus (T2DM) and outline the recommended diabetic screenings.
  2. Discuss the medical management of the PWD and the psychosocial impact of the disease.

1. Typical pathophysiology of T2DM may include

a. beta-cell abnormalities.

b. increased glucose tolerance.

c. biliary changes.

d. increased cellular responsiveness to insulin.

2. What condition worsens insulin resistance?

a. marked confusion.

b. obesity

c. overexertion

d. younger age

3. What laboratory test result shows a positive correlation with insulin resistance?

a. albumin

b. B-type natriuretic peptide

c. C-reactive protein

d. mean corpuscular volume

4. What factor is key to reducing the risk of developing T2DM?

a. lifestyle changes

b. taking a “statin” medication

c. receiving appropriate vaccines

d. taking a daily aspirin

5. An adult patient with which of the following conditions should be screened for T2DM?

a. chronic obstructive pulmonary disease

b. hyperthyroidism

c. irritable bowel syndrome

d. hypertension (HTN)

6. According to the American Diabetes Association (ADA), the fasting plasma glucose test (FPG) is the best screening test for

a. patients with thyroid disease.

b. pregnant adults.

c. children.

d. patients with hepatitis.

7. What result on the FPG indicates a state of pre-diabetes?

a. 80 to 100 mg/dl

b. 100 to 125 mg/dl

c. 125 to 150 mg/dl

d. 150 to 180 mg/dl

8. The ADA recommends screening for pre-diabetes in person

a. younger than 45 years with a body mass index (BMI) ≥ 22 kg/m2.

b. over 45 years with a BMI > 22 kg/m2.

c. younger than 40 years with a BMI > 25 kg/m2 without additional risk factors.

d. over 45 years with a BMI > 25 kg/m2.

9. The ADA recommends what type of screening at every visit for the PWD?

a. visual foot exam

b. assessment of activity tolerance

c. blood glucose test

d. retinal exam

10. The recommended hemoglobin A1C level for nonpregnant adults is

a. > 4%.

b. ≥ 5%.

c. < 7%.

d. < 8%.

11. Patients not meeting the A1C goal should have their A1C levels checked

a. every month.

b. every other month.

c. every 3 months.

d. twice a year.

12. The BP goal for the PWD with HTN after initiation of an ACE inhibitor is less than

a. 120/60.

b. 130/80.

c. 140/70.

d. 145/80.

13. A benefit of using ACE inhibitors in PWD is that they

a. help to normalize the patient's lipid profile.

b. promote insulin resistance.

c. prevent glucose intolerance.

d. slow the progression of microalbuminemia.

14. According to the ADA, the lipid profile goals for PWD without coronary disease are

a. LDL < 100 mg/dl, HDL > 50 mg/dl, triglycerides < 150 mg/dl.

b. LDL < 100 mg/dl, HDL > 60 mg/dl, triglycerides < 70 mg/dl.

c. LDL < 70 mg/dl, HDL > 70 mg/dl, triglycerides < 100 mg/dl.

d. LDL < 50 mg/dl, HDL > 100 mg/dl, triglycerides < 100 mg/dl

15. PWD over 40 years of age with overt cardiovascular disease should receive

a. calcium channel blockers.

b. acetaminophen 1 Gm daily.

c. digitalis.

d. statins and fibrates.

16. Which statement is true regarding painful peripheral neuropathy (PDN)?

a. Generally the pain is in the fingers and hands.

b. Pain is typically worse at night.

c. PDN affects up to 20% of PWD with long-standing disease.

d. Glycemic control may decrease the risk of developing neuropathy by 90%.

17. Which of the following is not generally included in Medical Nutrition Therapy?

a. cost management techniques

b. diabetes self-care

c. physical exercise

d. weight management

18. An example of a micro level intervention for the clinician is to

a. become active in organizations that promote improved health outcomes for PWD.

b. encourage policy change to promote better understanding of diabetes.

c. educate the public on diabetes.

d. assist the client to deal with trouble shooting daily issues.

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© 2009 Lippincott Williams & Wilkins, Inc.