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Adult diabetes mellitus: Thinking beyond type 2

doi: 10.1097/01.NPR.0000483075.07124.7d
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INSTRUCTIONS Adult diabetes mellitus: Thinking beyond type 2

TEST INSTRUCTIONS

  • To take the test online, go to our secure website at www.nursingcenter.com/ce/NP.
  • On the print form, record your answers in the test answer section of the CE enrollment form on page 46. Each question has only one correct answer. You may make copies of these forms.
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  • You will receive your CE certificate of earned contact hours and an answer key to review your results.There is no minimum passing grade.
  • Registration deadline is May 31, 2018
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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 2.0 contact hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223.

Your certificate is valid in all states. This activity has been assigned 0.5 pharmacology credits.

Adult diabetes mellitus: Thinking beyond type 2

General Purpose: To provide information about two atypical types of adult diabetes: KPD and LADA. Learning Objectives: After completing this continuing-education activity, you should be able to: 1. Explain the scope of the problem and the NP's role in diagnosing and treating adult diabetes mellitus. 2. Describe the clinical presentation, diagnostic classification, and glucose-lowering regimen for KPD and LADA.

  1. According to the CDC, what percentage of individuals in the United States age 20 and older has diabetes mellitus?
    1. 12.3%
    2. 16.2%
    3. 25.9%
  2. DesRoches and colleagues demonstrated that NPs were more likely than physician colleagues to care for populations that
    1. were older.
    2. were underserved.
    3. had more comorbidities.
  3. Mundinger and colleagues first demonstrated that, compared to primary care by their physician colleagues, primary care by NPs was
    1. less expensive.
    2. more accessible.
    3. equivalent.
  4. The author suggests that one result of the ACA has been the identification of
    1. previously undiagnosed diabetes.
    2. new diabetes treatments.
    3. new classifications of diabetes.
  5. Literature from Sweden has reported that approximately 25% of T1DM cases are
    1. secondary to exocrine pancreatic disease.
    2. drug induced.
    3. diagnosed as adults.
  6. The author points out that arriving at the best diabetes diagnostic classification will promote
    1. better scientific research.
    2. the most appropriate glucose-lowering regimen.
    3. lower overall costs.
  7. In the absence of unequivocal hyperglycemia, which of the following should prompt repeat testing to diagnose diabetes?
    1. fasting plasma glucose of 120 mg/dL
    2. A1C of 6.5%
    3. random plasma glucose of 180 mg/dL
  8. Which classification of diabetes is characterized by insulin resistance and progressive beta cell dysfunction?
    1. gestational
    2. T1DM
    3. T2DM
  9. Obesity is most closely associated with
    1. T1DM.
    2. T2DM.
    3. autoimmune diabetes.
  10. A common problem in T1DM is
    1. DKA.
    2. weight gain.
    3. advanced age at onset.
  11. Age of onset, body habitus, and presence/absence of ketones are
    1. diagnostic criteria for diabetes.
    2. modifiable risk factors for diabetes.
    3. clues to diabetes classification.
  12. Choukem and colleagues' study of patients with KPD showed that after normoglycemia was achieved,
    1. impaired insulin secretion persisted.
    2. beta cell function normalized.
    3. glucagon suppression normalized.
  13. Which of the following is a diagnostic criterion for ketosis-prone atypical diabetes?
    1. glucose toxicity
    2. positive diabetes-related autoantibodies
    3. elevated C-peptide
  14. The most appropriate long-term pharmaceutical treatment for KPD would likely consist of
    1. exogenous insulin administration.
    2. metformin alone.
    3. metformin plus sulfonylureas.
  15. One of the three criteria for LADA as suggested by the Immunology of Diabetes Society is
    1. age of at least 50.
    2. positive for at least 1 antibody.
    3. initial requirement of insulin for glucose control.
  16. Which of the following is a sign of significant beta cell destruction?
    1. hypothyroidism
    2. ketosis
    3. hypoglycemia
  17. Clues to diagnosing LADA might include
    1. positive response to T2DM therapies.
    2. obesity.
    3. history of celiac disease.
  18. Typically, patients with LADA will eventually require treatment with
    1. basal and prandial insulin.
    2. metformin with prandial insulin.
    3. metformin plus sulfonylureas.
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