CDCES Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: When assessing a patient's diabetes distress, which validated screening tool is most appropriate for adults with type 2 diabetes?
- PHQ-9
- Diabetes Distress Scale (DDS) (Correct answer)
- GAD-7
- Beck Anxiety Inventory
Correct answer: Diabetes Distress Scale (DDS)
The Diabetes Distress Scale (DDS) is a validated tool specifically designed to measure emotional burden related to diabetes management.
Question 2: A patient with type 1 diabetes reports frequent nocturnal hypoglycemia. Which assessment finding is most important to evaluate first?
- Current basal insulin dose and timing (Correct answer)
- Dietary carbohydrate intake at dinner
- Exercise habits in the evening
- Sleep quality and duration
Correct answer: Current basal insulin dose and timing
Basal insulin dose and timing is the primary factor to assess because excessive or mistimed basal insulin is the leading cause of nocturnal hypoglycemia.
Question 3: Which physical assessment finding is most consistent with peripheral neuropathy in a patient with longstanding diabetes?
- Diminished dorsalis pedis pulse
- Reduced vibratory sensation at the great toe (Correct answer)
- Pitting edema below the ankles
- Erythema and warmth of the dorsal foot
Correct answer: Reduced vibratory sensation at the great toe
Reduced vibratory sensation at the great toe, tested with a 128-Hz tuning fork, is a hallmark early finding of diabetic peripheral neuropathy.
Question 4: A CDCES is reviewing lab results for a newly diagnosed patient with type 2 diabetes. Which finding would most warrant immediate referral to ophthalmology?
- HbA1c of 9.2%
- Microalbuminuria on urine dipstick
- Visual blurring reported for 3 months (Correct answer)
- Fasting glucose of 245 mg/dL
Correct answer: Visual blurring reported for 3 months
Persistent visual blurring lasting 3 months may indicate advanced diabetic retinopathy requiring urgent ophthalmologic evaluation.
Question 5: During a comprehensive diabetes assessment, a patient discloses they skip insulin doses to lose weight. This behavior is best classified as:
- Diabulimia (Correct answer)
- Insulin resistance
- Dawn phenomenon
- Somogyi effect
Correct answer: Diabulimia
Intentional insulin omission for weight control, most common in females with type 1 diabetes, is termed diabulimia and requires mental health and diabetes team intervention.
Question 6: Which laboratory value best reflects glycemic control over the preceding 8–12 weeks in a patient with normal red cell turnover?
- Fructosamine
- HbA1c (Correct answer)
- 1,5-anhydroglucitol (1,5-AG)
- C-peptide
Correct answer: HbA1c
HbA1c reflects average glycemia over approximately 8–12 weeks, corresponding to the lifespan of red blood cells.
Question 7: When assessing readiness to change dietary habits in a patient with type 2 diabetes, which framework is most appropriate?
- DASH diet guidelines
- Transtheoretical Model (Stages of Change) (Correct answer)
- Carbohydrate counting protocol
- Medical Nutrition Therapy algorithms
Correct answer: Transtheoretical Model (Stages of Change)
The Transtheoretical Model helps assess a patient's readiness to adopt behavior change and guides the CDCES in tailoring counseling to the patient's current stage.
CDCES Patient Assessment and Evaluation 2
When assessing a patient's diabetes distress, which validated screening tool is most appropriate for adults with type 2 diabetes?