CDE exam test questions

Question 1

Acanthosis nigricans presents as a brown to black pigmentation usually seen in the neck or armpit areas. In relations to DM, this may indicate

a. granuloma annulare
b. diabetic dermopathy
c. type 1 diabetes
d. insulin resistance

Answer 1

d. insulin resistance

Question 2

The large fluid-filled blister that is most often seen on the hands and the feet of individuals with DM is

a. diabetic bulla
b. diabetic dermopathy
c. granuloma annulare
d. diabetic thick skin

Answer 2

a. diabetic bulla

Question 3

Which statement is part of the key concepts for setting glycemic goals in children with type 1 DM

a. goals should be individualized, and lower goals may be reasonable based on benefit-risk assessment
b. plasma glucose goals should be higher than those listed for children with frequent hypoglycemia unawareness
c. postprandial glucose values should be measured when a disparity exists between preprandial blood glucose values and A1c levels
d. all of the above

Answer 3

d. all of the above

Question 4

Which of the following would be least likely to cause hypoglycemia with Metformin monotherapy?

a. deficient calorie intake
b. missing one meal
c. alcohol consumption
d. strenuous exercise

Answer 4

b. missing one meal

Question 5

Which of the following types of insulin may be mistaken for rapid or short-acting insulin because of it’s clear appearance?

a. Lantus
b. Humulin N
c. Novolin N
d. NPH insulin

Answer 5

a. Lantus

Question 6

The classification of type 2 DM is described as

a. an absolute deficiency in insulin secretion
b. insulin resistance
c. gestational DM
d. insulin resistance with a progressive decline in insulin secretion

Answer 6

d. insulin resistance with a progressive decline in insulin secretion

Question 7

One oral agent is now recommended for the treatment of diabetes during pregnancy. This oral agent is

a. glyburide
b. actos
c. Avandia
d. prandin

Answer 7

a. only recently have adequate studies been completed to indicate that glyburide is safe and effective for the treatment of DM during pregnancy.
* metformin now category B

Question 8

Would a women using a rapid-acting insulin analog be required to switch to a different type of insulin after becoming pregnant?

a. no, adequate studies have confirmed the safety of rapid-acting insulin during pregnancy
b. yes, a change to a short-acting insulin would be required because it has been used without associated problems for years.
c. yes, a change to short-acting and intermediate-acting insulin would be required.
d. no, but women would be required to take short-acting insulin with it.

Answer 8

a. the key to FDA use-in pregnancy rating system rates both rapid acting insulin lispro and aspart as category B.

Of the combination insulins, only lispro protamine/insulin lispro (75/25) carries a rating of catefory B.

Levemir is category B
Lantus category C
Apidra category C

Question 9

When fasting blood glucose levels are elevated, which of the following would be the least likely cause?

a. somogyi effect
b. excessive CHO intake during the prior evening
c. inadequate amount of basal insulin
d. dawn phenomenon

Answer 9

b. excessive CHO intake during the prior evening

Question 10

Which of the following does not describe one of the mechanisms by which low-CHO, high-prot diets promote wt loss?

a. ketone production decreases appetite
b. fluid wt loss occurs
c. protein choices are generally lower in calories than are CHO choices
d. food choices are limited

Answer 10

c. protein choices are generally lower in kcals than CHOs

Question 11

Which of the following is considered an outdated nutrition recommendation?

a. wt loss is recommended for all overweight or obese individuals with risk factors for DM
b. foods containing fat and /or fiber in addition to CHO will enter the bloodstream more slowly than will foods containing only CHO
c. one-time diet instructions are usually not effective in the promotion of lifestyle change
d. protein should be consumed to aid in the prevention and/or treatment of hypoglycemia

Answer 11

d. protein

• only fat and fiber delay the absorption of CHO
• when absorbed into the bloodstream, protein does not raise blood glucose, a small portion of ingested protein becomes glucose in the process of gluconeogenesis, which is eventually released into the bloodstream

Question 12

Which of the following statements is not correct related to the use of glucagon in DM management?

a. glucagon is a hormone secreted by the pancreas, which triggers the liver to release glucose stores into the bloodstream.
b. glucagon is normally administered to the individual with DM when they are unconscious in response to hypoglycemia.
c. individuals with depleted glycogen stores may not respond to a glucagon injection
d. glucagon must be administered through an intravenous injection

Answer 12

d. glucagon can be given as an intravenous, intramuscular, or subcutaneous injection.
- Unless an individual has depleted glycogen stores, the injection should bring them back to consciousness within 15 mins.
- individuals with depleted glycogen stores will require intravenous dextrose administration.
- it is always important to place the individual receiving glucagon on their side, because they may vomit in response to the glucagon injection and the rapid elevation in BG

Question 13

A1c is generally expressed as a %, but can also be reported as “average glucose”. For example, an A1c of 7% is equivalent to an average glucose of 154. Reporting A1c as average glucose is the current trend,

a. because it is more meaningful to individuals, who are accustomed to seeing A1c reported as average glucose on their BG monitors daily.
b. because it is less expensive
c. because it contributes to amore meaningful medical record
d. but, experts believe that A1c will again be reported a % after a 1 year trial period of reporting it as average glucose

Answer 13

a. A1c levels are based on an average of BG levels over the previous 3 months

Question 14

Pattern management is a method of DM treatment in which the treatment regimen is adjusted based on trends seen in BG records. The information that would best facilitate the use of patterns management is

a. food and physical activity
b. food, physical activity, pain, and illness
c. timing of insulin and other medications, food intake, physical activity, any stress, and alcohol intake
d. timing of insulin and other medications, food intake, and physical activity

Answer 14

c. Any activities or information that has an impact on blood/sugar levels should be noted to help identify trends

Question 15

When hyperosmolar hyperglycemic syndrome occurs

a. there is no insulin in the bloodstream
b. there is some insulin in the bloodstream that reduces hyperglycemia
c. severe dehydration and decreased renal function occur, which further increase hyperglycemia
d. hyperglycemia is not as severe as that seen in DKA

Answer 15

c. HHS and DKA are both problems associated with a deficit of insulin and a large elevation in the body’s counterregulatory hormones. In DKA the body’s inability to suppress lipolysis is the main issue; in HHS, ketosis is suppressed with some residual insulin but hyperglycemia is not controlled.

Question 16

Which answer is not an indication for ketone testing?

a. BG levels greater than 250-300 mg/dL, particularly in individuals with DM1
b. pregnancy, when the individual is in a fasting state, or if blood glucose exceeds 150 mg/dL
c. illness
d. blood glucose levels of 200 mg/dL or greater

Answer 16

d. ketones are produced in the body by the incomplete metabolism of glucose. In pregnancy, ketones and hyperglycemia endanger the fetus in early pregnancy and later are usually termed “starvation ketosis” and indicate the need for some CHOs at bedtime

Question 17

Vitiligo is the loss of skin pigment usually around joints or orifices of the face, such as the eyes and mouth.  Which one of the following disorders is not associated with vitiligo?
a. Addison's disease
b. lipohypertrophy
c autoimmune type 1 DM
d. hashimoto's thyroiditis

Answer 17

b. vitiligo is more often seen in black individuals and is associated with systemic diseases.
- DM1 is a dominant example because it appears in ~5% of diabetic individuals and in 0.2-1% of individuals with other associated diseases

Question 18

A cutaneous issue related to uncontrolled DM or hypertriglyceridemia that presents as papules with a pearly color appearing on outer surfaces of extremities and buttocks is

a. xanthoma
b. diabetic scleroderma
c. skin infection
d. granuloma annulare

Answer 18

a. xanthomas are papules that are red initially and become a pearly-yellow color. They are formed from cholesterol or triglyceride deposits. If caused by insulin depletion they clear up rapidly with an improvement in BG control; if caused by high TG levels they clear up slowly as serum TG levels decrease.

Question 19

Which of the following may cause cutaneous reactions at the site of insulin injections?

a. latex in the vial stopper
b. site cleanser
c. intradermal rather than subcutaneous injection
d. all of the above

Answer 19

d. all of the above, reactions to insulin injections are rarely associated with insulin allergy

Question 20

A raised area at the site of insulin injection related to repeated use of the site is known as

a. lipohypertrophy
b. lipoatrophy
c. bullae
d. none of the above

Answer 20

a. lipohypertrophy

- reduced insulin absorption if continued to use as an injection site

Question 21

Proliferative diabetic retinopathy is associated with

a. rubeosis iridis
b. diplopia
c. cataracts
d. glaucoma

Answer 21

a. a diagnosis of proliferative diabetic retinopathy indicates significant damage of the vessels of the eyes, which the body attempts to repair through the growth of new vessels. this growth can result in further problems, such as rubeosis iridis, retinal detachment, and vitreous hemorrhage. In rubeosis iridis, new vessels grow from the optic nerve, on the iris, and elsewhere in the retina. In retinal detachment, the two layers of the retina can be pulled apart because of the adhesions and tractions that form. In vitreous hemorrhage, the fragile new vessels that are forming bleed out into the vitreous body. Each of these can cause blindness.

Question 22

Which of the following class of medications used to treat HTN has kidney-protective qualities?

a. calcium channel blockers
b. thiazide diuretics
c. beta blockers
d. ACE inhibitors

Answer 22

d. Using ACE and ARBs is one of the strategies used to delay or prevent the progression of nephropathy in individuals with DM.

Question 23

Which mechanism relates diabetes to other endocrine disorders?

a. the autoimmune process that destroys beta cells may affect other endocrine cells
b. the function of other endocrine cells may improve when beta cells are destroyed
c. hypoinsulinemia may contribute to the development of other endocrinopathies
d. none of the above

Answer 23

a. the process within the body that cause diabetes can also facilitate the development of other endocrine diseases in three ways: via damage to endocrine tissue during the autoimmune process, which destroys beta cells; via disturbances in beta cell as a result of infiltrative processes; and as a result of the presence of insulin resistance and related hyperinsulimia

Question 24

Which of the following statements is true regarding the honeymoon period experienced by many children with diagnosis of type 1 DM?

a. it may last for 6 weeks to 2 years
b. it may occur when the pancreas produces some insulin
c. it can lead some families to believe that the child’s diabetes is cured
d. all of the above

Answer 24

d. the honeymoon period occurs in 62% of children with a diagnosis of DM1. During this period, the pancreas produces some insulin. When the honeymoon period is over, the pancreas stops producing insulin and the need for injectable insulin increases.

Question 25

When troubleshooting an A1c and blood glucose log that do not correlate, the provider should check

a. the date on the meter strips
b. the date on the meter control solution
c. postprandial blood glucose levels
d. all of the above

Answer 25

d. when an A1c level does not correlate with the patient’s blood glucose record, the discrepancy may be due to meter issues, patient technique or willingness to test, or physiological issues. If the meter requires coding, it may not be coded for the strips being used. Meter supplies may be out of date, or the battery may be low. The patient may be recording blood glucose levels incorrectly in their log book or not testing when they fear it may be high. Last, blood glucose levels may be high when the patient is not scheduled to test, such as during the evening

Question 26

Conditions that can cause inaccurate A1c measurements are related to

a. blood pressure
b. unusual hemoglobin molecules
c. white blood cell numbers
d. none of the above

Answer 26

b. conditions can include sickle cell anemia, early stages of pregnancy, recent blood transfusions, anemias, and splenectomy

Question 27

One of the symptoms of diabetic gastroparesis is

a. hunger
b. difficulty swallowing
c. vomiting
d. esophageal reflux

Answer 27

c. in diabetic gastroparesis, stomach emptying is delayed. Diabetic gastroparesis is an autonomic neuropathy associated with chronic hyperglycemia, high A1c levels, and increased glucagon levels. Other symptoms include early satiety, nausea, abdominal pain, and bloating. A combination of changes in medication and diet is the recommended treatment.

Question 28

Which of the following would not suggest that a patient may have had diabetes prior to diagnosis?

a. existing neuropathy at the time of diagnosis
b. diagnosis during cardiac bypass surgery
c. previous documentation of glucose intolerance
d. history of HTN

Answer 28

d. hx of HTN

Question 29

When a patient with DM is asked about his or her education level and cultural or religious beliefs, they are being assessed for

a. barriers to learning
b. readiness to learn
c. learning style
d. physical ability

Answer 29

a. patient assessment of learning and self-care behaviors related to diabetes management indicated that educational, cultural, and religious backgrounds influenced the ability to comprehend information and the willingness to comply with self-care recommendations. An educator’s knowledge of a patient’s educational level can facilitate the provision of appropriate self-care recommendations that do not require the patient to compromise their cultural and religious beliefs

Question 30

Which of the following is a physical capability or limitation that should be considered when assessing learning needs?

a. trouble remembering things
b. problems with vision
c. problems with hearing
d. all of the above

Answer 30

d. all of the above

Question 31

Which of the following is not an effective educational strategy for diabetes self-management training?

a. more emphasis on practice after each education session
b. primary education focus on metabolic goals and risk reduction
c. encouragement of patient participation in education
d. discussions about patients’ feelings related to diabetes management

Answer 31

b. many studies have provided useful information regarding the elements required for a successful diabetes self-management education program. These elements include the provision of self-management information in a format that is easily understood given a patient’s educational level and consideration of a patient’s age, culture, and religion to facilitate incorporation of self-care recommendations into their daily life. Less lecture time and more patient participation is recommended.

Question 32

A DM self-management program that is recognized by the ADA is required to have an annual advisory committee meeting. This advisory committee is made up of

a. key staff members and physicians
b. key staff members, patients, and other stakeholders
c. physicians and diabetes educators
d. diabetes educators and patients

Answer 32

b. an advisory group or committee associated with a DSME program can be useful to ensure that ongoing quality improvements are being made to the program. Programs recognized by the ADA are required to hold yearly advisory committee meetings, during which any proposed policy revisions and /or quality improvements are presented for discussion and approval. Standards set by the ADA dictate standards for advisory committee membership

Question 33

Which of the following is not included in the list of DSME content areas?

a. the diabetes disease process and treatment options
b. monitoring blood glucose and other parameters and interpreting and using the results for self-management decision making
c. making routine physician appointments
d. using medication(s) safely for maximum therapeutic effectiveness.

Answer 33

c. There are 9 diabetes self-management education content areas. Quality and accreditation standards require documentation of the assessment, plan, and education provided. The content areas addressed in the diabetes self-management program need to be documented, including the actual information presented, patient responses to education, barriers to self-management, readiness to learn, and goals selected by the patient. Assessment of individual patient outcomes related to their self-selected behavioral goals is considered the most important individual outcome.

Question 34

Before recommending physical activity, the ADA currently recommends

a. assessment for cardiovascular disease in patients with diabetes and other cardiovascular disease risk factors.
b. stress testing for patients who have had diabetes for more than 10 years or who have had a heart attack.
c. stress testing for patients who have had diabetes for more than 10 years, have heart disease, or are older than 35 years.
d. that providers use clinical judgment and encourage short periods of low intensity activity with a gradual increase in duration over time in high-risk patients

Answer 34

d. the ADA considers any patient with DM and multiple risk factors for CAD to be a high risk patient. For DM1, patients older than 35 yrs who were diagnosed with DM during childhood or adolescence or who have had DM for more than 15 yrs are considered to be at high risk.
ADA guidelines have been relaxed from their previous recommendation for CAD assessment prior to beginning an exercise program for these patients. This recommendation was changed because the area of CAD screening is unclear.

Question 35

Some types of physical activity in patients with DM may be contraindicated if the patient has certain conditions. Choose the most complete list below

a. retinopathy, uncontrolled HTN, renal insufficiency, or severe neuropathy
b. gastroparesis, HTN, neuropathy
c. uncontrolled HTN, severe neuropathy, or renal insufficiency
d. retinopathy, renal insufficiency, or uncontrolled HTN

Answer 35

a. retinopathy, uncontrolled HTN, renal insufficiency, or severe neuropathy

Question 36

When assessing a patient’s psychosocial adaptation, all of the following areas should be assessed except for

a. knowledge of DM
b. A1c level
c. current stress
d. family system/support system

Answer 36

b. A1c

Question 37

The format used for DM education has evolved over the past few years into

a. a more didactic approach
b. empowerment models that honor the patient as the primary decision maker
c. the use of more lecture time
d. all of the above

Answer 37

b. the promotion of self-efficacy is the goal. Self-efficacy is associated with improved self-care in chronic illness, including DM.

Question 38

A 30-year-old single female with DM1 who lives alone is experiencing morning fasting blood glucose levels in the 200s and 300s. The physician treating her DM increased her bedtime Lantus dose in response to these high BG levels. When the patient returned for her follow-up session 3 months later, her logbook entries indicated no improvement in her morning BG levels. Which of the following scenarios would be the most likely cause

a. the patient didn’t increase her Lantus dose because she would rather have high BS levels than risk hypoglycemia while alone at night
b. the patient increased her evening Lantus dose as prescribed, but it had not effect on her morning fasting blood glucose levels
c. the patient increased her evening Lantus dose as prescribed, which facilitated morning fasting blood glucose levels
d. none of the above

Answer 38

a. patient compliance is required for optimal treatment regimens to be successful. It is important to remember that DM educators do not dictate care but rather support patient self-care.

Question 39

A college student with DM1 goes out with a group of friends and consumes several alcoholic beverages during the evening. What would be the main concern regarding the effect of this level of alcohol consumption

a. the alcohol consumed would cause an extreme blood glucose elevation
b. a hypoglycemic effect might occur hours after the alcohol was consumed
c. a reduction in the sodium content of snacks
d. weight loss

Answer 39

b. hypoglycemia

assessing the patient’s use of substances such as alcohol and providing counseling regarding the effects of such substances on blood glucose control are a routine part of treatment planning and DSME. Consumption of sweet mixers or other CHO in sweet wines and beer, for example, may elevate blood glucose levels, but he real danger is the hypoglycemic effect that can occur when the liver is unable to release its usual glycogen stores to support normal BG levels 10-20 hours later

Question 40

For patient with DM not receiving intensive insulin therapy, the first priority for meal planning is

a. a reduction in the fat content of meals
b. the consumption of a consistent amount of CHOs throughout the day
c. a reduction in the sodium content of snacks
d. wt loss

Answer 40

b. a constant CHO intake is paramount to BG management because CHO is the main essential nutrient that serves to elevate blood glucose.

Question 41

Proper disposal of sharps involves

a. breaking off the needles and placing them in the trash
b. capping the lancets and placing them in the trash
c. adhering to the requirements of the Board of Health
d. placing the syringe or lancet directly into a puncture-resistant container with a tight-fitting lid

Answer 41

d.

Question 42

Which of the following is a general guideline regarding the need for insulin injection with snacks?

a. count carb grams and cover all carbs consumed with insulin
b. the patient may require insulin if the food consumed provides greater than 120 calories or greater than 20 g of carb
c. the patient may require insulin if the food consumed provides greater than 160 calories or greater than 30 g of carb
d. if the patient is underweight, no insulin injection is need when a snack is consumed

Answer 42

b. even for the rapid-acting insulins, the duration of action is several hours, although the strength of the effect diminishes with time. With most insulin regimens, the patient would more than likely have enough insulin on hand to cover a small snack.

Question 43

Which of the following would best promote a collaborative treatment relationship between a patient and a health care provider?

a. an educator is meeting with a patient who has DM2. The patient informs her that he has not been testing his blood glucose levels as his physician requested. The nurse than asks the patient what is keeping him from testing and what he can do to resolve the problem
b. after teaching a class on carb counting, the dietitian asks the participants to record their intake and count their carbs for 3 days as practice
c. the dietitian teaches a class on the use of food labels. She asks each participant to read and interpret a food label.
d. all of the above

Answer 43

d. all of the above

Question 44

When providing a patient with MNT, the dietitian will be more effective at facilitating change if

a. the nutrition advice is prioritized based on an assessment of the patient’s usual food intake and the patient’s willingness to make changes
b. the nutrition recommendations are even more severe than necessary to ensure that the patient will at least do the minimal amount to care for their DM
c. the nutrition recommendations ignore the patient’s usual eating environment and strive for a more ideal setting
d. all of the above

Answer 44

a. studies have shown that, initially, it is most effective to ask the patient to choose only one or two major areas for change.

Question 45

MNT is a step-by step process. Which answer below includes the four steps?

a. nutrition diagnosis, monitoring, and intervention
b. nutrition diagnosis, monitoring, and evaluation
c. nutrition assessment, diagnosis, intervention, monitoring, and evaluation
d. nutrition assessment, intervention, and evaluation

Answer 45

c. nutrition intervention is based on an assessment of the patient’s usual behaviors. Once the patient’s usual behaviors are known, problem areas can be identified and a plan of intervention can be presented to facilitate improvement in these areas. The initial phases of diabetes education usually focus on survival skills. Ongoing monitoring of a patient’s progress and an evaluation of future education needs is the last step.

Question 46

In patients with DM2, a modest amount of wt loss can facilitate significant improvement in glycemic control. How much wt loss is usually required for this result?

a. the amount required to decrease the patient’s BMI to below 30
b. the amount required to achieve the IBW
c. 7% to 10% of current body wt
d. none of the above

Answer 46

c. A wt loss of approximately 7-10% ob body wt is needed to improve glycemic control. However, additional wt loss may be optimal if the patient has comorbidities affected by wt.