糖尿に関する理解度をチェキ！

ぽっくり参った〜（略してポクッター）ファウンダーの◯◯◯ッチででん！

ちな、集めたネタについて語らくマガジンもあるんで見逃しチェキっちょw

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When assessing for risk of hypoglycemia in relation to exercise, which element of the patient record is most important to consider?

⭕️ Medication regimen: types, dose, and timing

❎ The patient’s typical signs and symptoms with hypoglycemia

❎ Timing and content (i.e. carb content) of meals in relation to the activity

❎ Current patient physical/glycemic status (wt., BMI, A1c)

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Which of the following behaviors is the most likely indication that the patient is at a very low level of readiness to change?

❎ The patient volunteers to answer a review question at the end of class but gets the answer totally wrong

❎ The patient watches your demonstration but does not say anything

❎ The patient becomes tearful as you explain how to keep a food diary

⭕️ The patient denies that she has diabetes and disagrees with the doctor’s referral for DSME

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According to ADA Standards, which statement is not true regarding medical nutrition therapy and diabetes?

⭕️ Medical nutrition therapy is recommended for only those persons with diabetes who are underweight, overweight, or obese

❎ Because nutrition in the hospital setting is complex, a registered dietitian should be part of the inpatient diabetes care team to provide medical nutrition therapy

❎ Medical nutrition therapy is recommended for anyone who has diabetes, regardless of nutritional status

❎ Children with diabetes and celiac disease should consult with a registered dietitian familiar with both conditions

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You are assessing a patient’s blood glucose monitoring technique by having her demonstrate a blood glucose test. Which of the following actions is indicative of improper technique?

⭕️ Milking the lanced finger at the tip to acquire a sufficient blood sample

❎ Recording the reading in her notebook rather than on the clinic-provided sheet

❎ Setting the lancet device to her preference

❎ Cleaning her hands with warm water and soap instead of alcohol

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Your patient suffers from obesity, type 2 diabetes, hypertension, 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 patient’s conditions is at greatest risk due to his food choices?

⭕️ Hypertension

❎ Type 2 diabetes

❎ Obesity

❎ Hyperlipidemia

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A patient with gestational diabetes (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 blood glucose 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 patient?

❎ Frustration & depression

❎ Denial

❎ Anger

⭕️ Bargaining

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Which instructional strategy is likely to be most effective in terms of patient retention?

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

❎ Current, well-referenced booklets with colorful diagrams, written at a patient’s optimal reading level, that can be reviewed as desired

❎ One-on-one conversation over the phone where the educator presents information and then rephrases the information using analogies to ensure understanding

❎ PowerPoint presentation with funny visuals and bullet list of main points

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What is the first step in the process of diabetes self-management education?

❎ Referral

❎ Diagnosis

❎ Goal setting

⭕️ Assessment

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Which of the following options is an outcome of personal record keeping in relation to physical activity, according to recent studies?

❎ Those who keep logs of physical activity are more adherent to other elements of therapy (i.e. diet, medication)

❎ Those who keep exercise logs are more likely to enroll in organized exercise programs (i.e. gym memberships, classes, etc.)

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

❎ The obligation of record keeping has been identified as a barrier to exercise by study participants

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Consider the following patient: male, age 46, previously sedentary, mild hypertension and hyperlipidemia (both adequately controlled with medication), type 2 diabetes, and a BMI of 26. If this patient wishes to begin a moderate-intensity exercise regimen, what additional assessment may be warranted?

⭕️ Stress test with ECG (electrocardiogram)

❎ DEXA scan to assess bone density and strength

❎ Ankle-brachial index to rule out peripheral arterial disease

❎ None, as BP and cholesterol are being controlled and exercise is only moderate intensity

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In your role as diabetes educator for a clinic, you both assess and instruct patients 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 written quiz in which the patient puts insulin administration steps in order

❎ A video that can be viewed and reviewed on proper insulin administration technique

⭕️ A demonstration and return demonstration of insulin administration

❎ A printed handout with pictures depicting steps of insulin administration, followed by verbal acknowledgement of understanding

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The following policies are part of your DSME program: asking patients 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?

❎ Potential low literacy/numeracy levels among your patients

❎ Readiness for change variation among your patients

⭕️ Cultural characteristics/barriers of your population

❎ Poor family and social support

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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)?

❎ Pre-meal/fasting glucose: 70 to 110 mg/dL; peak postprandial: <140 mg/dL; A1c <7%

❎ Pre-meal/fasting glucose: 60 to 90 mg/dL; peak postprandial: <120 mg/dL; A1c <5.5%

❎ Pre-meal/fasting glucose: 70 to 100 mg/dL; peak postprandial: <120 mg/dL; A1c <6.5%

⭕️ Pre-meal/fasting glucose: 60 to 99 mg/dL; peak postprandial: <129 mg/dL; A1c <6%

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During the initial assessment process, your patient answers the question, “How important is it for you to make this change right now?” with a 9 out of 10 (very important) and answers the question, “How confident are you that you will be able to make this change?” with a 2 out of 10 (not very important). In customizing her DSME plan, what should your focus be?

❎ Highlighting the benefits of good diabetes management as a way to encourage behavior change

⭕️ Providing materials and experiences to enhance her knowledge and skills

❎ Explaining the two questions further to confirm understanding, as it is very uncommon for a patient to rate the readiness-to-change elements this far apart

❎ Addressing psychosocial needs, such as accepting her diagnosis and managing stress levels

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It is important to assess potential barriers to self-monitoring of blood glucose, especially for patients who are not adhering to their plan of care recommendations. Which of the following barriers was not one cited by patients in recent studies?

❎ Cost of testing supplies

❎ Discomfort of finger sticks

❎ Lack of instruction and support

⭕️ Misplacement of small items

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