NAECB Patient Assessment 2 ā Questions and Answers
Question 1: When performing a nutritional assessment on a patient with chronic kidney disease, which laboratory value is MOST critical to evaluate?
- Serum albumin (Correct answer)
- Serum creatinine
- Blood urea nitrogen (BUN)
- Glomerular filtration rate (GFR)
Correct answer: Serum albumin
Serum albumin is a key marker of nutritional status and protein stores, making it the most critical lab for nutritional assessment in CKD patients.
Question 2: A certified diabetes care and education specialist (CDCES) is assessing a new patient. Which finding would MOST suggest insulin resistance?
- Low fasting glucose with elevated HbA1c
- Acanthosis nigricans on the neck and axillae (Correct answer)
- Thin body habitus with rapid weight loss
- Low C-peptide levels
Correct answer: Acanthosis nigricans on the neck and axillae
Acanthosis nigricansādark, velvety skin patches in body foldsāis a classic physical sign associated with insulin resistance.
Question 3: During a dietary assessment, a patient states they use the 'plate method' but still has uncontrolled postprandial glucose. What should the CDCES assess FIRST?
- Medication adherence
- Portion sizes within each plate section (Correct answer)
- Carbohydrate counting accuracy
- Physical activity level
Correct answer: Portion sizes within each plate section
Even when using the plate method correctly, oversized portions can lead to postprandial hyperglycemia, so portion size should be assessed first.
Question 4: Which assessment tool is MOST appropriate for identifying depression in a patient newly diagnosed with type 2 diabetes?
- Diabetes Distress Scale (DDS)
- PHQ-9 (Patient Health Questionnaire-9) (Correct answer)
- GAD-7 (Generalized Anxiety Disorder-7)
- SF-36 Health Survey
Correct answer: PHQ-9 (Patient Health Questionnaire-9)
The PHQ-9 is the validated screening tool for depression and is recommended for use in people with diabetes by major diabetes organizations.
Question 5: A patient with type 1 diabetes reports frequent nocturnal hypoglycemia. Which assessment finding would BEST explain this pattern?
- Elevated bedtime glucose consistently above 180 mg/dL
- Consuming high-protein snacks before bed
- Engaging in vigorous evening exercise (Correct answer)
- Using rapid-acting insulin with dinner
Correct answer: Engaging in vigorous evening exercise
Vigorous evening exercise increases insulin sensitivity and can deplete glycogen stores, leading to delayed hypoglycemia during the night.
Question 6: When assessing a patient's readiness to change their diet, which stage of the Transtheoretical Model describes a patient who says 'I've been eating healthier for the past two months'?
- Contemplation
- Preparation
- Action (Correct answer)
- Maintenance
Correct answer: Action
The Action stage is defined by the patient actively making behavior changes within the past six months.
Question 7: A CDCES is reviewing a CGM report and notices a high coefficient of variation (CV) above 36%. This indicates:
- Consistently high average glucose
- High glucose variability requiring further assessment (Correct answer)
- Poor CGM sensor accuracy
- Stable glucose control with occasional spikes
Correct answer: High glucose variability requiring further assessment
A CV above 36% indicates high glucose variability, which is associated with increased hypoglycemia risk and worse outcomes regardless of average glucose.
NAECB Patient Assessment 2
When performing a nutritional assessment on a patient with chronic kidney disease, which laboratory value is MOST critical to evaluate?