NCAS Chronic Disease Management 2 — Questions and Answers
Question 1: What HbA1c level indicates diabetes diagnosis in the US according to the American Diabetes Association?
- 6.5% or higher on two separate tests (Correct answer)
- 5.7% or higher on one test
- 7.0% or higher on two separate tests
- 8.0% or higher
Correct answer: 6.5% or higher on two separate tests
An HbA1c of 6.5% or higher on two separate occasions (or combined with other confirmatory tests) meets the ADA diagnostic criteria for diabetes mellitus.
Question 2: In community chronic disease management, which of the following is an example of SECONDARY prevention?
- Colorectal cancer screening with colonoscopy in asymptomatic adults over 45 (Correct answer)
- Childhood immunization against hepatitis B
- Cardiac rehabilitation after myocardial infarction
- Smoking cessation to prevent lung cancer
Correct answer: Colorectal cancer screening with colonoscopy in asymptomatic adults over 45
Secondary prevention detects disease early in asymptomatic individuals; colonoscopy screening identifies colorectal cancer before symptoms appear.
Question 3: A community nurse is educating a patient with heart failure on the 'Rule of 2 Pounds.' This rule advises patients to:
- Contact their provider if they gain more than 2 pounds overnight or 5 pounds in a week (Correct answer)
- Limit fluid intake to 2 pounds per day
- Exercise for at least 2 pounds of calorie burn daily
- Restrict sodium to 2 pounds per week
Correct answer: Contact their provider if they gain more than 2 pounds overnight or 5 pounds in a week
The Rule of 2 Pounds teaches heart failure patients to monitor daily weight and report a gain of more than 2 lbs overnight or 5 lbs in a week, indicating fluid retention.
Question 4: Which community intervention has the strongest evidence for reducing cardiovascular disease mortality at the population level?
- Sodium reduction policies and tobacco control legislation (Correct answer)
- Individual dietary counseling sessions only
- Hospital-based cardiac surgery expansion
- Annual cholesterol screening without follow-up
Correct answer: Sodium reduction policies and tobacco control legislation
Population-level policies such as sodium reduction in food processing and tobacco control laws have the largest impact on cardiovascular mortality across the entire population.
Question 5: A community nurse teaches a patient with asthma to use a peak flow meter. The 'yellow zone' (50–79% of personal best) indicates:
- Caution: worsening asthma requiring use of rescue inhaler and possible medical contact (Correct answer)
- Good control requiring no action
- Emergency requiring immediate 911 call
- Need to stop all medications immediately
Correct answer: Caution: worsening asthma requiring use of rescue inhaler and possible medical contact
The yellow zone in peak flow monitoring signals caution and worsening asthma control, requiring rescue bronchodilator use and evaluation of whether further care is needed.
Question 6: Which of the following best describes a community health nurse's role in tertiary prevention for a patient with Type 2 diabetes?
- Preventing complications such as nephropathy through medication adherence and annual foot and eye exams (Correct answer)
- Teaching newly diagnosed patients about blood sugar monitoring
- Screening undiagnosed community members for prediabetes
- Administering vaccines to prevent infections
Correct answer: Preventing complications such as nephropathy through medication adherence and annual foot and eye exams
Tertiary prevention in established disease focuses on preventing complications and disability; in diabetes, this includes regular foot/eye exams and medication adherence.
NCAS Chronic Disease Management 2
What HbA1c level indicates diabetes diagnosis in the US according to the American Diabetes Association?