Diabetes Care Exam

The core logic of passing the diabetes nursing exam is never to memorize various blood sugar values ​​and nursing specifications, but to always put "individual patient differences" at the forefront of all decisions. As long as we grasp this core and understand the practical logic of the three core test points of blood sugar management, emergency identification, and patient education, 80% of candidates can pass the exam in one go. There is no need to waste time on a bunch of weird questions.

A while ago, I was helping three nurses who rotated in the department prepare for the exam. There was a girl who knew the critical values ​​of fasting blood sugar and glycosylated hemoglobin by heart, but she still failed in the mock test: the question was given to a 68-year-old elderly person with diabetes who lives alone and has Parkinson's disease. His hands are shaking and he can't hold things steady. The fasting blood sugar is 7.8mmol/L, and he asks if he needs to adjust the blood sugar reduction plan. She directly chose to take metformin, which happened to step on the most common pitfall in today's exams: only remembering the general standards and forgetting about elderly patients who live alone and have movement disorders. The risk of hypoglycemia is ten times worse than mild hyperglycemia. A fasting of 7.8 is a completely acceptable sugar control target for this group of people, and there is no need to add medication at all.

It's interesting to say that the current diabetes nursing examination actually has two completely different examination trends. The first category is the traditional "standard-achieving" question-setting idea, accounting for about 30%. The test is about hard knowledge points: the normal range of fasting blood sugar is 3.9-6.1mmol/L, not exceeding 7.8mmol/L 2 hours after a meal, the glycated hemoglobin control target is less than 7%, and the grading standards for diabetic foot. They are all divided into questions. You will not go wrong if you go through the knowledge points a little. The other type is the "individualized group" whose proportion has been increasing in the past two years. Now the unified examination in many places has raised the proportion of this type of questions to 60%. The core test is whether you can adjust the plan according to the patient's identity, basic diseases, and living habits, which is also the easiest part to score points. The last big question in our city's unified examination last year was given to a 14-year-old type 1 diabetic who loves to play basketball. He was asked how to formulate a care plan. Many people answered "strictly limit strenuous exercise and fix the caloric intake of three meals." Half of the points were deducted. The correct direction is to teach him to exercise. Test your blood sugar regularly beforehand, carry glycemic sugar cubes with you, flexibly adjust the pre-meal insulin dose according to the amount of exercise, and even add more carbohydrates appropriately - after all, the child is in the growth and development period, and restricting calories to prevent exercise will affect development, and blood sugar will not be controlled at all.

When it comes to test points related to complications, many people tend to fall into the trap of "prioritizing slowness over urgency". I have seen many candidates read the question stems saying that people with diabetes have blurred vision and general weakness. Their first reaction is to consider diabetic retinopathy. If this is a test, they will definitely lose points. They must always check for acute complications first: test blood sugar first to see if it is hypoglycemia, and then see if there are signs of ketoacidosis and hyperosmolar hyperglycemia syndrome. These are life-threatening in minutes. Chronic complications should always be considered after the emergency is dealt with. Last month, a patient with diabetes was transferred to the emergency department. His family members said that he was tired of seeing things. The nurse on duty immediately asked for a fundus examination. Fortunately, the teacher took a fingertip blood sugar test first, and it was already 22mmol/L. He also had two plus signs of ketones in his urine. He quickly replenished the fluid to eliminate the ketones. The person may have passed out two hours later. This kind of scene question has been asked in almost every exam in the past two years. Just remember "first respond first, then slow down."

Oh, by the way, there are also health education questions, which are the easiest to answer and lose points. Don't just write clichés like "low-sugar diet, moderate exercise, and regular blood sugar monitoring" when you come up. What the exam asks is whether you can tell specific people something they can understand. For example, when explaining diet to rural patients who grow crops all year round, if you say "daily carbohydrate intake accounts for 50%-65% of total calories" they will not understand at all. You have to say "eat staple food as big as your fist for each meal, eat more green leafy vegetables, and don't drink boiled white porridge." This is the scoring point. There happens to be a controversial test point here: should sugar lovers completely quit refined sugar? Different textbooks have different opinions. Some require strict prohibition of foods such as milk tea and cakes, while others believe that as long as blood sugar control is stable, it is okay to eat a small piece occasionally to satisfy cravings. Don't panic when you encounter this kind of question in the exam. Just answer "On the basis of regular monitoring of blood sugar, flexible adjustments according to the patient's dietary preferences, priority is given to ensuring the quality of life, and avoiding emotional problems caused by excessive food taboos that interfere with blood sugar." No matter which school of marking teachers, this answer can't be wrong.

There is another inconspicuous point that people miss every time: the storage of insulin and the rotation of injection sites. Unopened insulin should be refrigerated at 2-8°C. After opening, just keep it in a cool place at room temperature. Do not put it back in the refrigerator. Injections should be rotated in the abdomen, outer thighs, and upper arms to avoid fat induration affecting absorption. This question does not count for many points, but if you get it wrong, you will really lose.

When I took the exam myself, I memorized the values ​​for three days and three nights with the textbook. It was only after I entered the clinic that I realized that those seemingly flexible case questions were essentially testing whether you treat the patient as a living person, rather than a specimen who needs to lower his blood sugar to a fixed value. To understand this, answer questions along the lines of "Would it be safer?" Will it be better executed? Will it make patients more willing to cooperate?" If you go through these questions, you will basically not make any big mistakes. After all, when testing the essence of nursing, the test is always whether you have the heart, right?