NAECB Patient Assessment 5 — Questions and Answers
Question 1: During a physical activity assessment, a patient with type 2 diabetes asks whether they can exercise. Their resting ECG shows ST depression. What is the MOST appropriate CDCES response?
- Clear them for moderate aerobic exercise immediately
- Recommend physician evaluation before initiating an exercise program (Correct answer)
- Suggest low-intensity walking only
- Advise against all exercise until HbA1c is below 7%
Correct answer: Recommend physician evaluation before initiating an exercise program
ST depression on a resting ECG is a cardiac warning sign; the patient must receive physician clearance before starting or modifying an exercise program.
Question 2: A CDCES is assessing a patient of Mexican heritage who eats traditional meals. Which cultural food assessment approach is MOST appropriate?
- Advise the patient to replace traditional foods with Western diet foods
- Explore traditional foods and identify culturally appropriate modifications (Correct answer)
- Provide a standard ADA meal plan handout
- Focus assessment only on portion sizes
Correct answer: Explore traditional foods and identify culturally appropriate modifications
Culturally competent care involves exploring traditional foods and collaborating with the patient to find modifications that preserve cultural practices while improving glucose management.
Question 3: Which complication screening is RECOMMENDED annually for all patients with type 2 diabetes, regardless of current glucose control?
- Coronary calcium scoring
- Urine albumin-to-creatinine ratio (UACR) (Correct answer)
- Ankle-brachial index (ABI)
- Carotid intima-media thickness
Correct answer: Urine albumin-to-creatinine ratio (UACR)
Annual urine albumin-to-creatinine ratio screening for diabetic kidney disease is recommended for all patients with type 2 diabetes by ADA standards of care.
Question 4: A patient is newly diagnosed with latent autoimmune diabetes in adults (LADA). Which assessment finding MOST distinguishes LADA from type 2 diabetes?
- Obesity and insulin resistance
- Positive GAD antibodies (Correct answer)
- Elevated fasting C-peptide
- Rapid response to metformin
Correct answer: Positive GAD antibodies
Positive glutamic acid decarboxylase (GAD) antibodies confirm autoimmune beta-cell destruction, distinguishing LADA from type 2 diabetes.
Question 5: When assessing a patient's ability to perform SMBG (self-monitoring of blood glucose), which factor is MOST likely to result in inaccurate readings?
- Using the side of the fingertip instead of the pad
- Waiting too long after a meal to test
- Not washing hands before testing when hands are visibly contaminated with fruit juice (Correct answer)
- Using a meter that is more than 2 years old
Correct answer: Not washing hands before testing when hands are visibly contaminated with fruit juice
Residual sugar (e.g., from fruit juice) on the finger can significantly falsely elevate glucose readings, making hand washing critical before testing.
Question 6: A CDCES is conducting a social determinants of health (SDOH) assessment. Which finding MOST directly impacts a patient's ability to achieve glycemic goals?
- Living in a rural area with limited public transport and no nearby grocery store (Correct answer)
- Being employed full time
- Having a college education
- Having private health insurance
Correct answer: Living in a rural area with limited public transport and no nearby grocery store
Food deserts combined with lack of transportation create significant barriers to accessing nutritious food, directly undermining glycemic management efforts.
Question 7: During a risk stratification assessment for hypoglycemia, which patient characteristic places them at HIGHEST risk?
- Uses basal insulin only once daily
- Has impaired hypoglycemia awareness (hypoglycemia unawareness) (Correct answer)
- Has an HbA1c of 7.5%
- Follows a consistent meal schedule
Correct answer: Has impaired hypoglycemia awareness (hypoglycemia unawareness)
Hypoglycemia unawareness—loss of adrenergic warning symptoms—dramatically increases risk for severe hypoglycemia because the patient cannot detect and self-treat falling glucose.
NAECB Patient Assessment 5
During a physical activity assessment, a patient with type 2 diabetes asks whether they can exercise.
Their resting ECG shows ST depression.
What is the MOST appropriate CDCES response?