Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer.
So, if you're ready, let's jump right in.
Margaret Fitzgerald: Mrs. Martinez is a 64-year-old woman with a 10-year history of type 2 diabetes, hypertension, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, a statin, an ARB, and a thiazide diuretic. She is at EBP-advised goals, including a recent A1c of 6.9%. Today, she reports she's feeling well. Her history and physical exam are unremarkable.
She mentions that for the past year, and in addition to her prescribed medications, she drinks a special tea blend that her sister makes, taking this every day to help "draw out the sugar” in her blood. She states, "I feel much better when I take it." Your most appropriate response is:
A: I don't believe the tea is helpful in controlling your blood sugar.
B: Please stop taking the tea until I can look at its contents.
C: Homemade teas might interact with your medication.
D: Tell me more about how the tea draws out the sugar.
And the correct answer here is D: Tell me more about how the tea draws out the sugar. First, let's take a look at what kind of a question this is.
This is actually an evaluation question looking at response to care, because what we're doing is following up on a woman who appears to have well-controlled hypertension, dyslipidemia, and type 2 diabetes. You're given the medication she's on, very commonly used meds for the treatment of these three diseases that we almost always find together in a cluster. At one time, particularly on the ANCC exam, this would have been labeled as a professional issues question.
In other words, one that's not focused on a given diagnostic test or a given medication or something along those lines. More part of the larger healthcare system, looking at cultural competency and patient communication. So, what I'm going to do is take a little bit different approach to this question than I have on other podcasts.
I can look at this question and pick out multiple correct, if not incorrect responses. A number of answers that are actually correct but not the best answer. And when you get a question like this, it involves a cultural practice, a folk belief, whatever words are appropriate to use in this scenario. It sometimes is more difficult to answer the question than it is to say, her A1c is 9, therefore add another med.
You know, that's kind of clear cut. But now what we have to do is take a look at her entire person and what she is doing, advocate for her own health. As we said, in other podcasts, let's do a little bit of background information. Patients from all kinds of cultures, backgrounds, etc. use a variety of home-based remedies, whether we know it or not.
And what we have to do is ask these remedies, often based in tradition, ethnic history or family background. Many of these practices appear to have therapeutic benefit and can be encouraged or at minimum are not causing harm. We're told that Mrs. Martinez's hypertension, dyslipidemia, and diabetes are all at EBP-advised recommendations. Her physical exam is unremarkable. Her history is unremarkable.
Consequently, it's easy to assume that this practice is not hurting, and maybe it is, in fact, helping her with the management of her multiple chronic health conditions. At the same time, we'll tell you she is on a number of different meds and drug-nutrient interaction is, of course, a concern. We're going to keep this in mind while we analyze the answers provided.
Acknowledging practices, such as she's telling you she's taking this tea that her sister makes and incorporating these practices in the health record is an important part of providing comprehensive care. For this reason, understanding Mrs. Martinez's motivation and interpretation of her healthcare actions is really important. And so, what we should do is proceed. We're going to take a look at the correct response here.
Mrs. Martinez is a 64-year-old woman with a 10-year history of type 2 diabetes, hypertension, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, a statin, an ARB, and a thiazide diuretic. She's at EBP-advised goals, including a recent A1c of 6.9%. Today, she reports she's feeling well and her history and physical exam are unremarkable.
She mentions that for the past year, in addition to her prescribed medications, she takes a specialty blend that her sister makes, using this every day to help "draw down the sugar" in her blood. She states, "I feel much better when I take it.” Your most appropriate response is A: I don't believe the tea is helpful in controlling your blood sugar.
Clearly, this is not the right answer. This is like one of those flashing red light, incorrect answers because you're just saying to the patient, ‘No, this is not helping.’ And the way it's worded, it's very dismissive of what the patient is sharing with you. And you always want to create an environment in the exam room where the patient feels comfortable sharing health-related information.
The other part, it's technically not correct. You don't even know what's in the tea. There could be something super benign in it, like chamomile-not helpful, not harmful. You just don't know. And using plant-based supplements in type 2 diabetes, I will tell you, there is relatively little study been done on that. There's always a possibility that there's something in the tea that is helping with her diabetes. But you don't know what's in the tea yet.
B: Please stop using the tea until I can look into the contents. Now, I have to tell you, I'm a person who has taught graduate-level pharmacology for more than 30 years. I've taught PT students. I've taught grad students in nursing. I've taught family practice residents, and I've spoken on pharmacology literally all over the world. It's been a great privilege.
Part of me is tempted to say no, no, no, I don't know what's in that tea. You're on multiple meds. There's always a risk of an interacting product in the tea, so that's good. This is a good example of a question that it's not incorrect, but it's also not the best answer. Option C: Homemade teas might interact with your medicines.
Well, this is just another way of saying what was really in B. There could be some kind of interaction with the contents of the tea in her medications. Once again, it's not the best answer. On the boards, you can almost always count on there being at least two answers that you're going to struggle over deciding which one is correct.
And it's more an issue of looking at the question and saying which of these is the best answer. And the best answer is the one that always provides the most robust information in the context of the patient scenario. D: Tell me how the tea draws out the sugar. This is, of course, the right answer. A number of points with this.
It shows respect for the patient; not dismissing it, dismissing a practice that she believes is helpful. It also allows you as the provider to find out more about the patient's beliefs, practices and how this impacts your overall health. Key takeaway: effective communication with patients starts with recognizing that everyone brings their life experiences, beliefs, and health practices to the exam room with every visit.
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