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BC-ADM practice questions

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Question 1Clinical assessment and diagnosis

Which hemoglobin A1c value is the standard diagnostic threshold for diabetes mellitus in a nonpregnant adult?

  1. 7.0%
  2. 5.7%
  3. 6.0%
  4. 6.5% Correct answer.

Explanation

An A1c of 6.5% or higher meets the diagnostic criterion for diabetes when confirmed or accompanied by classic symptoms, per widely accepted standards. Values between 5.7% and 6.4% define prediabetes, and 7.0% is a common glycemic treatment target rather than a diagnostic cutoff.

Question 2Clinical assessment and diagnosis

A fasting plasma glucose of 118 mg/dL in an asymptomatic adult is best classified as which of the following?

  1. Diabetes mellitus
  2. Hypoglycemia
  3. Normal glucose tolerance
  4. Prediabetes Correct answer.

Explanation

Fasting plasma glucose between 100 and 125 mg/dL defines impaired fasting glucose, a prediabetes category. Values below 100 mg/dL are normal and 126 mg/dL or higher on repeat testing supports diabetes.

Question 3Clinical assessment and diagnosis

Which test is preferred for diagnosing diabetes in a patient with sickle cell trait?

  1. Glycated albumin
  2. Fructosamine
  3. Hemoglobin A1c
  4. Fasting plasma glucose Correct answer.

Explanation

Hemoglobin variants such as sickle cell trait can interfere with A1c measurement and make results unreliable. Plasma glucose-based tests, including fasting glucose or an oral glucose tolerance test, are therefore preferred for diagnosis in this population.

Question 4Clinical assessment and diagnosis

A random plasma glucose of 230 mg/dL is drawn from a patient reporting polyuria, polydipsia, and unintentional weight loss. What is the correct interpretation?

  1. Consistent with stress hyperglycemia only
  2. Requires a confirmatory repeat test before diagnosis
  3. Diagnostic of diabetes Correct answer.
  4. Indeterminate and requires an A1c

Explanation

A random plasma glucose of 200 mg/dL or higher accompanied by classic hyperglycemic symptoms is sufficient to diagnose diabetes without a confirmatory repeat. The presence of polyuria, polydipsia, and weight loss satisfies the symptom criterion.

Question 5Clinical assessment and diagnosis

Which finding is most characteristic of diabetic ketoacidosis rather than hyperosmolar hyperglycemic state?

  1. Arterial pH of 7.15 Correct answer.
  2. Serum glucose of 700 mg/dL
  3. Effective serum osmolality of 340 mOsm/kg
  4. Serum bicarbonate of 24 mEq/L

Explanation

Diabetic ketoacidosis is defined by a metabolic acidosis, typically with arterial pH below 7.30 and low bicarbonate, driven by ketone accumulation. Hyperosmolar hyperglycemic state generally lacks significant acidosis and ketosis but shows marked hyperosmolality.

Question 6Clinical assessment and diagnosis

Which laboratory pattern best supports a diagnosis of diabetic ketoacidosis?

  1. pH 7.30, bicarbonate 26 mEq/L, negative ketones
  2. pH 7.25, bicarbonate 12 mEq/L, positive beta-hydroxybutyrate Correct answer.
  3. pH 7.38, bicarbonate 22 mEq/L, trace ketones
  4. pH 7.45, bicarbonate 28 mEq/L, negative ketones

Explanation

Ketoacidosis produces a high anion gap metabolic acidosis with low pH and low bicarbonate plus elevated ketones. A pH of 7.25 with bicarbonate of 12 mEq/L and positive beta-hydroxybutyrate fits this profile.

Question 7Clinical assessment and diagnosis

In a patient with type 2 diabetes and an eGFR of 25 mL/min/1.73 m2, which finding most strongly suggests diabetic kidney disease rather than a non-diabetic cause?

  1. Rapid decline in eGFR over weeks
  2. Hematuria with red cell casts
  3. Normal-sized kidneys on imaging
  4. Persistent albuminuria with diabetic retinopathy Correct answer.

Explanation

Persistent albuminuria accompanied by diabetic retinopathy strongly supports diabetic kidney disease, since retinopathy usually coexists with diabetic nephropathy. Features such as active urinary sediment, rapid decline, or absent retinopathy raise suspicion for another renal diagnosis.

Question 8Clinical assessment and diagnosis

Which urinalysis finding is most consistent with a urinary tract infection in a patient with diabetes?

  1. Isolated glucosuria
  2. Uric acid crystals
  3. Microalbuminuria
  4. Positive nitrite and leukocyte esterase Correct answer.

Explanation

Nitrite reflects nitrate-reducing bacteria and leukocyte esterase indicates pyuria, so both together support urinary tract infection. Glucosuria and microalbuminuria reflect glycemia and kidney damage rather than infection.

Question 9Clinical assessment and diagnosis

A patient with type 2 diabetes reports burning pain and hypersensitivity in both feet with normal vibration and monofilament sensation. Which diagnosis is most likely?

  1. Peripheral arterial disease
  2. Large-fiber sensory loss
  3. Lumbar radiculopathy
  4. Small-fiber painful neuropathy Correct answer.

Explanation

Burning pain and allodynia with preserved large-fiber modalities such as vibration and monofilament point to small-fiber neuropathy. Large-fiber disease would blunt vibration and protective sensation, and radiculopathy is usually asymmetric and dermatomal.

Question 10Clinical assessment and diagnosis

Which assessment best detects loss of protective sensation in a patient with diabetes?

  1. Ankle-brachial index
  2. Vibration threshold only
  3. 10-g monofilament testing Correct answer.
  4. Capillary refill time

Explanation

The 10-g monofilament assesses pressure perception and is a standard screen for loss of protective sensation and ulcer risk. Ankle-brachial index evaluates arterial perfusion, not sensory function.

Question 11Clinical assessment and diagnosis

Which finding on dilated eye examination is most specific for diabetic retinopathy?

  1. Drusen at the macula
  2. Retinal venous pulsation
  3. Optic disc cupping
  4. Microaneurysms with dot-blot hemorrhages Correct answer.

Explanation

Microaneurysms and dot-blot hemorrhages are hallmark early features of diabetic retinopathy reflecting capillary damage. Drusen suggest age-related macular degeneration and cupping suggests glaucoma.

Question 12Clinical assessment and diagnosis

A patient with type 2 diabetes has an A1c of 9.2%, blood pressure of 152/94 mm Hg, and LDL cholesterol of 145 mg/dL. Which conclusion best reflects a comprehensive risk assessment?

  1. LDL is at goal for a patient with diabetes
  2. Multiple modifiable cardiovascular risk factors require treatment Correct answer.
  3. Blood pressure is at goal for this patient
  4. Only glycemic control requires intervention

Explanation

Elevated A1c, uncontrolled blood pressure, and elevated LDL all exceed recommended targets and each independently raises cardiovascular risk. Comprehensive assessment therefore identifies several simultaneous targets for intervention rather than glucose alone.

Question 13Clinical assessment and diagnosis

Which finding most suggests an underlying secondary cause of diabetes in a newly diagnosed adult?

  1. Central obesity with acanthosis nigricans
  2. A1c of 7.1% at diagnosis
  3. Age 55 years with gradual onset
  4. Weight loss with new-onset diabetes and a family history of MEN1 Correct answer.

Explanation

New-onset diabetes with weight loss and a family history of multiple endocrine neoplasia type 1 raises concern for a glucagonoma or other endocrine cause. Typical type 2 diabetes presents gradually with obesity and insulin resistance features.

Question 14Clinical assessment and diagnosis

Which antibody is most commonly associated with type 1 diabetes and useful in confirming autoimmune etiology?

  1. Antinuclear antibody
  2. Rheumatoid factor
  3. Glutamic acid decarboxylase antibody Correct answer.
  4. Antimitochondrial antibody

Explanation

Glutamic acid decarboxylase antibodies are among the most frequently detected islet autoantibodies in type 1 diabetes. The other antibodies are markers of rheumatologic or hepatic autoimmune disease and do not confirm diabetes etiology.

Question 15Clinical assessment and diagnosis

Which presentation most suggests latent autoimmune diabetes in adults rather than typical type 2 diabetes?

  1. Strong family history of type 2 diabetes and gradual onset
  2. Onset at age 45 with obesity and acanthosis nigricans
  3. Normal BMI with rapid progression to insulin requirement and positive GAD antibody Correct answer.
  4. Metabolic syndrome with fatty liver

Explanation

Latent autoimmune diabetes in adults features adult onset with autoimmune markers such as GAD antibody and earlier insulin dependence, often without obesity. Classic type 2 diabetes presents gradually with obesity and insulin resistance.

Question 16Clinical assessment and diagnosis

Which statement about screening for prediabetes and type 2 diabetes in asymptomatic adults is correct?

  1. Screening should never be repeated once normal
  2. Screening is recommended only for adults over 65 years
  3. Screening applies only to those with a BMI above 40
  4. Screening should begin at age 35 years for all adults Correct answer.

Explanation

Current guidance recommends beginning screening for prediabetes and type 2 diabetes at age 35 years for all adults, with earlier screening for those who have risk factors. Repeat intervals are typically every three years when results are normal.

Question 17Clinical assessment and diagnosis

A 42-year-old with a BMI of 31 kg/m2 has no symptoms and a normal fasting glucose. Which factor would most justify earlier diabetes screening?

  1. Occasional alcohol use
  2. First-degree relative with type 2 diabetes Correct answer.
  3. Sedentary desk job
  4. Seasonal allergies

Explanation

A first-degree relative with diabetes is a recognized risk factor that supports earlier or more frequent screening. Alcohol use, occupation type, and allergies do not independently trigger earlier screening.

Question 18Clinical assessment and diagnosis

Which blood pressure value meets the commonly recommended target for most adults with diabetes?

  1. 142/92 mm Hg
  2. 128/78 mm Hg Correct answer.
  3. 150/95 mm Hg
  4. 138/88 mm Hg

Explanation

A target of less than 130/80 mm Hg is generally recommended for most adults with diabetes when it can be achieved safely. Values of 140/90 mm Hg or higher exceed the target.

Question 19Clinical assessment and diagnosis

Which lipid finding is most typical of poorly controlled type 2 diabetes?

  1. Low LDL with high HDL
  2. High triglycerides with low HDL cholesterol Correct answer.
  3. High HDL with low triglycerides
  4. Isolated high LDL with normal triglycerides

Explanation

Insulin resistance produces a dyslipidemia pattern of elevated triglycerides and low HDL cholesterol, often with small dense LDL particles. Isolated LDL elevation or high HDL with low triglycerides is not typical of this pattern.

Question 20Clinical assessment and diagnosis

A patient with diabetes has an eGFR of 28 mL/min/1.73 m2 and a urine albumin-to-creatinine ratio of 450 mg/g. How should the chronic kidney disease be staged?

  1. G3b with severely increased albuminuria Correct answer.
  2. G4 with moderately increased albuminuria
  3. G1 with normal albuminuria
  4. G2 with mildly increased albuminuria

Explanation

An eGFR of 28 falls in category G3b (30 to 44 is G3b, and 15 to 29 is G4), so the value sits at the G3b/G4 boundary and the A3 albuminuria category applies because the ratio exceeds 300 mg/g. Among the choices, G3b with severely increased albuminuria best fits the reported values.

Question 21Clinical assessment and diagnosis

Which symptom pattern most suggests gastroparesis in a patient with longstanding diabetes?

  1. Early satiety, nausea, and vomiting after meals Correct answer.
  2. Nocturnal diarrhea with fecal incontinence
  3. Postural dizziness on standing
  4. Burning pain in the feet at night

Explanation

Diabetic gastroparesis typically presents with early satiety, bloating, nausea, and postprandial vomiting due to delayed gastric emptying. Nocturnal diarrhea suggests enteropathy and postural dizziness suggests autonomic neuropathy.

Question 22Clinical assessment and diagnosis

Which finding on history most strongly suggests cardiac autonomic neuropathy in a patient with diabetes?

  1. Claudication after walking two blocks
  2. Burning pain in both hands
  3. Resting tachycardia with orthostatic hypotension Correct answer.
  4. Early satiety after meals

Explanation

Cardiac autonomic neuropathy can produce resting tachycardia and orthostatic hypotension from impaired autonomic regulation. Burning hand pain reflects peripheral neuropathy and claudication reflects peripheral arterial disease.

Question 23Clinical assessment and diagnosis

A patient with type 1 diabetes has an A1c of 6.8% but reports frequent hypoglycemia and wide glucose variability. Which interpretation is most accurate?

  1. The A1c confirms excellent stable control
  2. The A1c should be replaced by fasting glucose
  3. The A1c alone may overestimate glycemic control quality Correct answer.
  4. The A1c is invalid in type 1 diabetes

Explanation

A1c reflects average glycemia but can mask frequent hypoglycemia and high variability, so a near-target value may overstate control quality. Continuous glucose monitoring metrics add information about time in range and hypoglycemia burden.

Question 24Clinical assessment and diagnosis

Which condition should be considered when a patient with diabetes develops a painful, swollen foot with erythema but no break in the skin?

  1. Gout of the first metatarsophalangeal joint
  2. Deep vein thrombosis
  3. Charcot neuroarthropathy Correct answer.
  4. Cellulitis from an ulcer

Explanation

Charcot neuroarthropathy presents with a warm, swollen, erythematous foot in a patient with neuropathy, often without an obvious skin break. Prompt recognition matters because continued weight bearing worsens deformity.

Question 25Clinical assessment and diagnosis

Which assessment is essential before diagnosing a foot ulcer as neuropathic rather than ischemic?

  1. Fasting lipid panel
  2. Urine albumin-to-creatinine ratio
  3. Palpation of pedal pulses and ankle-brachial index Correct answer.
  4. Measurement of hemoglobin A1c

Explanation

Ischemia must be excluded because it changes ulcer management and healing potential, so pulse examination and ankle-brachial index are essential. Glycemic and kidney markers inform overall care but do not distinguish neuropathic from ischemic ulcers.

Question 26Clinical assessment and diagnosis

Which hemoglobin A1c value is the minimum threshold that the American Diabetes Association accepts as diagnostic for diabetes when confirmed by repeat testing?

  1. 6.5% Correct answer.
  2. 5.7%
  3. 6.0%
  4. 7.0%

Explanation

The ADA accepts an A1c of 6.5% or higher as a diagnostic criterion for diabetes, provided it is confirmed by a repeat test unless the patient is clearly symptomatic with glucose above 200 mg/dL. Values between 5.7% and 6.4% define prediabetes rather than diabetes.

Question 27Clinical assessment and diagnosis

A symptomatic patient presents with a random plasma glucose of 245 mg/dL. According to standard diagnostic criteria, what is required before this value can confirm diabetes?

  1. Nothing further; symptoms plus a random glucose of 200 mg/dL or higher is diagnostic Correct answer.
  2. A hemoglobin A1c drawn the same day
  3. A repeat fasting glucose on a different day
  4. An oral glucose tolerance test within one week

Explanation

Classic hyperglycemic symptoms combined with a random plasma glucose of 200 mg/dL or higher establish the diagnosis without additional confirmatory testing. Repeat testing is only needed when the patient is asymptomatic and the result is borderline or incidental.

Question 28Clinical assessment and diagnosis

Which fasting plasma glucose range defines impaired fasting glucose (prediabetes) in a nonpregnant adult?

  1. 70 to 99 mg/dL
  2. 126 to 139 mg/dL
  3. 100 to 125 mg/dL Correct answer.
  4. 140 to 199 mg/dL

Explanation

Impaired fasting glucose is defined as a fasting plasma glucose of 100 to 125 mg/dL. A value of 126 mg/dL or higher meets the threshold for diabetes, and below 100 mg/dL is considered normal.

Question 29Clinical assessment and diagnosis

A 58-year-old with type 2 diabetes reports early satiety, postprandial fullness, nausea, and vomiting of undigested food several hours after meals. Which test is most appropriate to confirm delayed gastric emptying?

  1. Gastric emptying scintigraphy Correct answer.
  2. Upper gastrointestinal endoscopy
  3. Hydrogen breath test
  4. Serum pancreatic polypeptide level

Explanation

Gastric emptying scintigraphy is the standard test for confirming gastroparesis by demonstrating delayed emptying of a radiolabeled meal. Endoscopy is used to exclude obstruction but does not measure emptying rate.

Question 30Clinical assessment and diagnosis

A patient with type 1 diabetes has no symptoms of coronary disease and a normal resting electrocardiogram. Which statement best reflects current guidance on routine exercise stress testing for silent ischemia?

  1. It should replace assessment of traditional cardiovascular risk factors
  2. It is required before starting any moderate-intensity walking program
  3. It is not routinely recommended because it has not been shown to improve outcomes Correct answer.
  4. It should be performed annually in all adults with type 1 diabetes

Explanation

Routine screening stress testing in asymptomatic patients with diabetes is not recommended, because it has not been shown to improve cardiovascular outcomes and can produce false-positive results. Risk is instead addressed by assessing and treating traditional risk factors.

Question 31Clinical assessment and diagnosis

A patient with type 2 diabetes has an A1c of 8.1% and a fasting glucose consistently near 100 mg/dL. Which measure would best clarify whether postprandial hyperglycemia is driving the elevated A1c?

  1. A repeat fasting glucose
  2. A serum fructosamine level
  3. A random glucose drawn at midday
  4. Two-hour postprandial glucose measurements Correct answer.

Explanation

When fasting values are near target but A1c remains elevated, postprandial excursions are the likely contributor. Paired premeal and 2-hour postprandial testing identifies the timing and magnitude of those excursions and guides therapy.

Question 32Clinical assessment and diagnosis

A patient with diabetes has a foot ulcer, and pulses are palpable with a normal ankle-brachial index. Which additional test is most useful to exclude clinically significant peripheral arterial disease before labeling the ulcer purely neuropathic?

  1. Repeat ankle-brachial index after exercise only
  2. Toe-brachial index or transcutaneous oxygen measurement Correct answer.
  3. Venous duplex ultrasonography
  4. Capillary blood glucose measurement

Explanation

A normal ankle-brachial index can be falsely reassuring in diabetes because medial arterial calcification makes vessels incompressible. Toe pressures or transcutaneous oxygen measurement assess the distal microcirculation and better detect ischemia in this setting.

Question 33Clinical assessment and diagnosis

A patient with type 2 diabetes develops a hot, swollen, erythematous foot without a break in the skin and with preserved pulses. Which diagnosis should be considered first when infection and fracture have been excluded?

  1. Gout
  2. Diabetic amyotrophy
  3. Charcot neuroarthropathy Correct answer.
  4. Cellulitis

Explanation

Charcot neuroarthropathy presents as a warm, swollen, erythematous foot in a patient with neuropathy, often without skin breakdown and with palpable pulses. Prompt recognition matters because early offloading prevents deformity.

Question 34Clinical assessment and diagnosis

Which finding on history most strongly supports a diagnosis of autonomic neuropathy affecting blood pressure regulation in a patient with long-standing diabetes?

  1. Orthostatic drop in systolic pressure without a compensatory heart rate rise Correct answer.
  2. Resting heart rate of 68 beats per minute
  3. Nocturnal diarrhea alternating with constipation
  4. Postprandial bloating and early satiety

Explanation

Orthostatic hypotension with blunted heart rate response indicates impaired baroreflex-mediated sympathetic function, a hallmark of cardiovascular autonomic neuropathy. The absence of a compensatory tachycardia distinguishes it from volume depletion.

Question 35Diabetes self-management education and support

A patient newly diagnosed with type 2 diabetes asks how often they should check their blood glucose at home when using a basal insulin regimen. Which teaching point best reflects standard self-management education?

  1. Check fasting glucose daily and periodically add paired pre- and post-meal checks. Correct answer.
  2. Discontinue home monitoring once the A1C is below 9 percent.
  3. Check glucose only when symptoms of hypoglycemia are felt.
  4. Check glucose once weekly at bedtime regardless of regimen.

Explanation

Basal insulin users benefit from daily fasting readings plus intermittent paired pre- and post-meal checks to reveal postprandial patterns and guide titration. Monitoring driven only by symptoms misses asymptomatic excursions, and a fixed weekly bedtime check cannot reveal fasting trends.

Question 36Diabetes self-management education and support

Which statement correctly describes the recommended timing of a postprandial self-monitoring blood glucose check?

  1. Immediately before eating the meal
  2. At the midpoint of the meal
  3. Four to five hours after finishing the meal
  4. One to two hours after the first bite of the meal Correct answer.

Explanation

Postprandial testing is conventionally timed from the start of the meal, with readings taken one to two hours afterward to capture the peak glucose rise. This timing lets patients and educators link specific foods or portions to glucose excursions.

Question 37Diabetes self-management education and support

A patient with type 1 diabetes reports frequent morning hyperglycemia. Overnight glucose checks at 2 a.m. and 4 a.m. are low, and glucose rises by 7 a.m. Which pattern should the educator recognize?

  1. Somogyi effect Correct answer.
  2. Dawn phenomenon
  3. Insulin under-basilization at dinner
  4. Injection site lipohypertrophy

Explanation

Nocturnal hypoglycemia followed by rebound morning hyperglycemia characterizes the Somogyi effect, driven by counter-regulatory hormone release. The dawn phenomenon instead shows rising glucose without preceding lows, and lipohypertrophy causes erratic absorption rather than a consistent nocturnal pattern.

Question 38Diabetes self-management education and support

Which dietary teaching approach best supports a patient learning carbohydrate consistency for fixed mealtime insulin doses?

  1. Keep carbohydrate amounts similar at each meal and match them to the prescribed insulin dose. Correct answer.
  2. Increase fat intake to replace carbohydrates at every meal.
  3. Skip meals on days when glucose readings are above target.
  4. Count only sugary foods as carbohydrates and eat other starches freely.

Explanation

With fixed mealtime insulin, consistent carbohydrate portions at each meal reduce mismatch between insulin action and glucose load. Skipping meals while taking fixed insulin raises hypoglycemia risk, and counting only sweets ignores starches that also raise glucose.

Question 39Diabetes self-management education and support

A patient using intensive insulin therapy wants to learn carbohydrate counting. Which skill is the most essential first step for accurate counting?

  1. Estimating portion sizes and identifying carbohydrate content of foods Correct answer.
  2. Reading food labels only for sodium content
  3. Calculating total daily energy expenditure
  4. Memorizing glycemic index values for all fruits

Explanation

Accurate carbohydrate counting depends on estimating portion size and knowing which foods contain carbohydrate and in what amounts. Glycemic index knowledge is secondary, and neither energy expenditure nor sodium labeling addresses carbohydrate quantity.

Question 40Diabetes self-management education and support

A patient with type 2 diabetes reports eating large restaurant meals and asks for a simple portion strategy. Which advice aligns with plate-method teaching?

  1. Fill the entire plate with fruit to increase fiber.
  2. Fill half the plate with non-starchy vegetables, one quarter with lean protein, and one quarter with carbohydrate foods. Correct answer.
  3. Fill half the plate with grains and half with protein.
  4. Fill half the plate with starchy vegetables and one quarter with cheese.

Explanation

The plate method divides the plate into half non-starchy vegetables, one quarter lean protein, and one quarter carbohydrate-rich foods to control portions without weighing food. This visual approach helps patients manage both carbohydrate load and overall energy intake.

Question 41Diabetes self-management education and support

Which statement about hypoglycemia recognition is most accurate for patient education?

  1. Symptoms such as shakiness and sweating may be blunted in people with long-standing diabetes or autonomic neuropathy. Correct answer.
  2. Hypoglycemia can be excluded if the patient feels well.
  3. Hypoglycemia always produces obvious symptoms until glucose falls below 40 mg/dL.
  4. Only patients using insulin can experience hypoglycemia.

Explanation

Long-standing diabetes and autonomic neuropathy can impair counter-regulation and blunt warning symptoms, increasing risk of severe hypoglycemia. Because symptoms may be absent, patients should be taught to check glucose when in doubt rather than rely solely on how they feel.

Question 42Diabetes self-management education and support

A conscious adult with diabetes has a glucose of 58 mg/dL and can swallow safely. Which action should the educator teach as first-line treatment?

  1. Inject rapid-acting insulin to stabilize glucose.
  2. Take 15 grams of carbohydrate with added fat to slow absorption.
  3. Take 15 grams of fast-acting carbohydrate and recheck glucose in about 15 minutes. Correct answer.
  4. Wait 60 minutes to see whether symptoms resolve.

Explanation

The rule of 15 calls for about 15 grams of fast-acting carbohydrate, followed by a glucose recheck in roughly 15 minutes and repeat treatment if still low. Adding fat slows absorption, and insulin would worsen hypoglycemia.

Question 43Diabetes self-management education and support

A patient with type 1 diabetes has a glucose of 52 mg/dL and is confused, unable to swallow safely. A glucagon kit is available and a family member is present. What should the educator teach the family member to do?

  1. Administer glucagon as prescribed and call emergency services. Correct answer.
  2. Give a glass of orange juice and recheck in 15 minutes.
  3. Wait for the patient to become alert before giving any treatment.
  4. Give oral glucose gel by spoon while the patient is confused.

Explanation

When a person cannot safely swallow, glucagon is the appropriate emergency treatment, followed by calling for emergency help. Oral carbohydrate is unsafe during impaired consciousness because of aspiration risk.

Question 44Diabetes self-management education and support

Which statement about sick-day management is most appropriate for a patient with diabetes?

  1. Check glucose only once daily during illness.
  2. Continue taking insulin or diabetes medication as prescribed and check glucose more frequently. Correct answer.
  3. Reduce fluid intake to prevent frequent urination.
  4. Stop all diabetes medications until appetite returns.

Explanation

Illness raises glucose through stress hormones, so patients generally continue diabetes medication, monitor glucose more often, and maintain hydration. Stopping medication can precipitate hyperglycemic crisis, and limiting fluids worsens dehydration risk.

Question 45Diabetes self-management education and support

A patient with type 1 diabetes has vomiting, abdominal pain, and a glucose of 280 mg/dL. Which additional self-care step should the educator emphasize?

  1. Drink only caffeinated beverages to stay awake.
  2. Delay all contact with the care team until the next scheduled visit.
  3. Check blood or urine ketones and seek medical advice if ketones are moderate or large. Correct answer.
  4. Take extra long-acting insulin without checking ketones.

Explanation

Symptoms plus hyperglycemia warrant ketone testing because moderate or large ketones signal possible ketoacidosis requiring urgent care. Ketone results guide the urgency of contacting the care team and can prompt emergency evaluation.

Question 46Diabetes self-management education and support

Which time frame defines the recommended frequency of comprehensive diabetes self-management education and support reviews for adults with diabetes?

  1. Only once, at the time of initial diagnosis.
  2. At four critical times: at diagnosis, annually or when not meeting targets, when complications arise, and during care transitions. Correct answer.
  3. Only when the patient requests a refresher.
  4. Every five years regardless of clinical status.

Explanation

National guidance identifies four critical times for diabetes self-management education and support: at diagnosis, annually or when targets are not met, when complicating factors develop, and during transitions in care. This structure ensures education is revisited as needs change.

Question 47Diabetes self-management education and support

Which outcome is the most appropriate primary goal of diabetes self-management education and support?

  1. Standardizing all patients to one meal plan
  2. Guaranteeing an A1C below 7 percent for every participant
  3. Helping the person make informed self-management decisions and build problem-solving skills Correct answer.
  4. Replacing the need for pharmacologic therapy

Explanation

Diabetes self-management education and support aims to equip people with knowledge and skills for informed decision-making and problem-solving. Glycemic targets are individualized, and education complements rather than replaces medication or individualized nutrition planning.

Question 48Diabetes self-management education and support

A patient with type 2 diabetes and a body mass index of 34 asks about physical activity. Which recommendation best reflects standard guidance?

  1. Avoid resistance training because it raises glucose acutely.
  2. Exercise only on days when fasting glucose is below 100 mg/dL.
  3. Aim for at least 150 minutes per week of moderate-intensity aerobic activity spread over at least three days, plus resistance training twice weekly. Correct answer.
  4. Perform only high-intensity interval training once weekly.

Explanation

Standard guidance recommends at least 150 minutes weekly of moderate aerobic activity across at least three days plus resistance training on two or more days. Spacing activity and avoiding gaps longer than two days improves insulin sensitivity; resistance training is beneficial despite transient glucose rises.

Question 49Diabetes self-management education and support

A patient who takes insulin and exercises regularly asks how to reduce hypoglycemia risk during a planned 60-minute moderate workout. Which strategy is most appropriate?

  1. Take extra rapid-acting insulin immediately before exercise.
  2. Skip the pre-exercise glucose check to avoid anxiety.
  3. Exercise immediately after a large insulin bolus without monitoring.
  4. Check glucose before exercise, consider a carbohydrate snack if glucose is low, and check again afterward. Correct answer.

Explanation

Pre-exercise glucose checks allow carbohydrate intake if glucose is low, and post-exercise checks detect delayed hypoglycemia from increased insulin sensitivity. Adding rapid-acting insulin before activity increases rather than reduces hypoglycemia risk.

Question 50Diabetes self-management education and support

Which statement about foot care is the most accurate teaching point for a patient with diabetes and reduced sensation?

  1. Cut calluses at home with a sharp blade.
  2. Soak feet in hot water daily to improve circulation.
  3. Wear tight shoes to prevent blisters from friction.
  4. Inspect feet daily, including between the toes, and avoid walking barefoot. Correct answer.

Explanation

Daily inspection including between the toes and avoiding barefoot walking help prevent unrecognized injury in people with sensory loss. Hot water soaks risk burns, self-cutting calluses risks infection, and tight shoes promote pressure injury.