Diabetes Care Exam Questions Short Answer Questions

As long as the core principles of these three directions are followed, including the formulation of individualized plans for blood glucose monitoring, the avoidance of adverse reactions of home insulin injections, and the hierarchical nursing intervention for diabetic feet, and supplemented with details based on individual differences, one can basically get a score of more than 90%, and the remaining 10% points are basically based on flexibility in different scenarios.

To be honest, I have participated in the grading of nurse professional qualification examinations and community nursing skills competitions in many regions in the past few years. I have seen many candidates who failed to get points by memorizing the textbooks. They clearly memorized all the knowledge points, but their answers were too rigid and completely divorced from reality. Take the most commonly tested test "Brief description of the nursing care points of blood sugar monitoring for diabetic patients". Many people come up with the template "monitor fasting, 2 hours after three meals, and bedtime blood sugar every day", which directly loses half of the points. Think about it, inpatients who have just undergone major surgery and whose blood sugar has soared to over 18mmol/L do need to be tested so intensively, and even have to test their blood sugar at 3 a.m. to check for Sumujie reaction. But if you are a 72-year-old retired man who lives in an old community and has been stably controlling blood sugar for three years, if you ask him to prick his fingertips five times a day, he will give up in two weeks because of the pain. There are actually two parallel guidance standards in the industry: the inpatient nursing standards of the clinical endocrinology department require patients in the fluctuating phase to be monitored 4-7 times a day, while the home diabetes care guidelines issued by the Chinese Nursing Association state that patients in the stable phase only need to be tested 2-3 days a week, and they can choose 2 different times every day. Both answers are correct. The key is that you have to clearly explain the applicable scenarios. This is what the judge wants to see.

Let’s talk about the insulin injection question that is taken almost every time. Last time a community nurse answered this question, she wrote “rotate injection site” in a very large sentence, but did not mention the details of the rotation in half a sentence, and she did not get full marks in the end. I met an aunt who has been suffering from diabetes for 12 years at a community clinic two months ago. Every time she takes insulin, she sticks to the small area on the left side of her belly button. It feels hard and is full of fat hyperplasia. She also said that she has been taking more insulin recently and her blood sugar has become uncontrollable. Because of the long-term injection of the same part, the insulin absorption rate has dropped by more than 30%. There is another easily confused difference between the old and new guidelines. The old version of the textbook requires that the distance between injection points is at least 2cm. The 2022 version of the "China Diabetes Drug Injection Technical Guidelines" has widened this distance to 1cm. As long as you avoid scars, indurations and the 5cm range around the belly button, you will be fine. There is also the controversial point of whether to pinch the skin. Many candidates memorize "Pinch the skin before injection". However, in fact, adults with a BMI over 25 do not need to pinch the abdomen at all. Only thin people, children, or thighs and upper arms need to pinch. Otherwise, it is easy to penetrate the muscle layer, and insulin is absorbed too quickly and can easily induce hypoglycemia.

There is also a question about diabetic foot care, which is considered a score-raising question every year. Many people only remember to "wash feet with warm water" without even mentioning the temperature, and they will definitely not get points. The traditional nursing requirement is that the water temperature must be lower than 37°C, and it must be measured with a water temperature meter. You cannot test the temperature with your feet. However, in recent years, many nursing scholars have suggested that if the patient's feet feel completely normal and there are no signs of neuropathy, the water temperature can be relaxed to 40°C, which is about the same as our usual bathing temperature. Too harsh requirements will reduce the patient's compliance. I have seen one of the most regrettable cases in the emergency department before. A 68-year-old diabetic patient had neuropathy for more than ten years. His feet were so numb that he could not feel the temperature. His children bought him a foot bath bucket but did not adjust the temperature. He soaked his feet for 20 minutes and felt them blisters. In the end, the infection was so serious that half of his leg was saved. If you can explain this risk thoroughly when answering the question, it will be more effective than if you write ten sentences of "pay attention to the water temperature."

Finally, I would like to mention a little unspoken rule for judging papers. If you encounter a scenario question that you have never seen before, for example, if you are asked to provide nursing guidance to an 18-year-old high school student who has just been diagnosed, do not ask them to eat whole grains and not drink milk tea. You can add "On the premise of calculating the total daily calories, the dietary restrictions can be appropriately relaxed to take into account the patient's social needs and quality of life." This kind of practical answer will always score higher than rote memorization of clichés.