EMT - Chapter 20 - Acute Diabetic Emergencies

The EMT would recognize dehydration as a concern in a patient with diabetes owing​ to:

A. Excessive urine production and elimination.

B. Decreased desire to drink water.

C. Vomiting leading to fluid loss.

D. Persistent diarrhea from elevated sugar levels.

A. Excessive urine production and elimination.

You are transporting a patient with diabetes who has low blood sugar. En​ route, you receive orders to administer oral glucose. Which piece of emergency equipment is most important to have readily available during this​ procedure?

A. Nasopharyngeal airway.

B. Automated external defibrillator.

C. Suction device.

D. Oropharyngeal airway.

C. Suction Device.

Within the human​ body, what effect does insulin​ have?

A. Frees stored glucose from the liver so as to elevate the blood glucose level.

B. Decreases the level of glucose in the bloodstream.

C. Carries glucose from the digestive tract into the bloodstream.

D. Turns carbohydrates into​ glucose, which can pass into the cells

B. Decreases the level of glucose in the bloodstream.

The EMT should suspect that a patient has diabetes when which medication is found on the​ scene?

A. Nitrostat

B. Lexapro

C. Ecotrin

D. Metformin

D. Metformin

What would be the priority action to take prior to administering oral glucose to a young female​ patient?

A. Determine the​ patient's blood glucose level.

B. Ask whether the patient is allergic to glucose.

C. Determine whether the patient is pregnant.

D. Make sure the patient has insulin available if needed.

A. Determine the​ patient's blood glucose level.

To which of these patients would the EMT elect to administer oral​ glucose?

A. An unresponsive​ 24-year-old male with a blood sugar of 24​ mg/dL and a history of diabetes

B. A confused​ 44-year-old male with a history of diabetes who is able to swallow

C. An alert and oriented​ 32-year-old female with a blood sugar of 52​ mg/dL and no history of diabetes

D. A confused male patient with a blood sugar reading of 96​ mg/dL and a history of diabetes

B. A confused​ 44-year-old male with a history of diabetes who is able to swallow

You suspect that an unresponsive female patient may be diabetic. To help confirm this​ suspicion, where would you send your partner to look for vials of​ insulin?

A. Bedside table.

B. Refrigerator

C. Bathroom

D. Nightstand

B. Refrigerator

Altered mental status resulting from a hypoglycemic episode in a patient with diabetes​ typically:

A. Has a sudden onset

B. Is accompanied by a​ "fruity" breath odor

C. Follows a history of polyuria

D. Benefits from Kussmaul respirations

A. Has a sudden onset

Your partner reports that he has found some small areas of bruising to the abdomen of a patient who takes insulin. He is puzzled by the finding. Which response would be most​ appropriate?

A. ​"The patient must have been involved recently in a car crash or suffered some other sort of​ trauma."

B. ​"There could be several reasons for the​ bruising, but insulin injections are often administered to the​ abdomen."

C. ​"That is a concerning finding. Since patients with diabetes are prone to GI​ bleeds, we should treat her as having​ one."

D. "Why don't we contact the​ patient's primary care physician and see if there are additional medical issues we are not aware​ of?"

B. ​"There could be several reasons for the​ bruising, but insulin injections are often administered to the​ abdomen."

Which of these patients is a candidate for oral​ glucose?

A. An alert but confused patient with diabetes and cool skin

B. A patient who is newly diagnosed with diabetes and who is responsive to painful stimuli

C. An unresponsive patient with diabetes and a rapid heart rate

D. A combative patient with no history of diabetes

A. An alert but confused patient with diabetes and cool skin

You have been called for an adult male patient who is hypoglycemic and responsive to painful stimuli. The family has oral glucose and wants you to administer it.​ However, at this​ time, your medical director has not authorized this​ agent's use and there are no protocols regarding its use. Given the​ patient's condition and the​ family's request, which action should you​ take?

A. Contact ALS backup and remain on scene until they arrive so they can give glucose via the IV line

B. Initiate transport of the patient to the emergency department

C. Instruct the family to administer the oral glucose

D. Carefully administer the oral glucose at the​ family's request

B. Initiate transport of the patient to the emergency department

Your medical director is providing a review of diabetic emergencies and asks you to describe glucose. Which of these statements would be your most appropriate​ response?

A. "It is a toxin that accumulates in the blood of a patient with​ diabetes."

B.​"It is a medication that will lower the blood​ sugar."

C. "It is a hormone produced by the​ pancreas."

D. "It is a sugar that is the​ body's main source of​ energy."

D. "It is a sugar that is the​ body's main source of​ energy."

You have been called for a patient who is confused and slightly combative. Which of these assessment findings would make you suspicious that the patient has​ hyperglycemia?

A. Comment by family that the patient may have taken too much insulin

B. Decreased appetite according to family members

C. Patient's statement that he has not urinated for some time

D. Increased respirations with a sweet smell to the​ patient's breath

D. Increased respirations with a sweet smell to the​ patient's breath

You have been called to a residence for a patient with altered mental status. On​ arrival, a neighbor informs you that he saw the patient washing windows several minutes earlier and then suddenly saw him lying on the ground. He also mentions that the patient has diabetes and has been in and out of the hospital lately because his blood sugar has been dropping suddenly. Your scene​ size-up reveals the patient to be lying next to a ladder propped up to the​ second-story window. Water from a bucket is spilled on the side of the house and yard. The patient is supine and unresponsive. What should be your next most immediate​ action?

A. Insert a nasopharyngeal airway

B. Open the airway with the​ jaw-thrust maneuver

C. Check the glucose level and administer oral glucose if needed

D. Take manual spine motion restriction precautions

D. Take manual spine motion restriction precautions

Prior to the administration of oral​ glucose, a​ patient's blood glucose level was 49​ mg/dL. After administering the oral​ glucose, the patient is alert and oriented. Which repeat blood glucose levels would the EMT expect with this clinical​ presentation?

A. ​"Low"

B. "High"

C. 155​ mg/dL

D. 30​ mg/dL

C. 155​ mg/dL

With which of these patients would the EMT have the strongest suspicion of a diabetic​ emergency?

A. A combative patient with a blood glucose level of 122​ mg/dL

B. An alert and oriented patient with diabetes and generalized weakness

C. A confused patient with a blood glucose of 58​ mg/dL

D. A patient with diabetes who complains of chest pain and shortness of breath

C. A confused patient with a blood glucose of 58​ mg/dL

Family members have called you for a young female patient with a history of diabetes who took insulin earlier in the day. She is confused and combative. Which of these questions is most important for the EMT to immediately ask the​ family?

A. "Do you think that her blood sugar is​ high?"

B. "How long has she had​ diabetes?"

C. "Did she eat after taking the​ insulin?"

D. ​"Did she take any drugs or drink​ alcohol?"

C. "Did she eat after taking the​ insulin?"

A patient exhibits signs and symptoms of​ diabetes, but he informs you that he has not been diagnosed with the disease. You decide to check his blood sugar. If the patient truly has​ diabetes, which of these readings would you​ expect?

A. 465​ mg/dL

B. 0​ mg/dL

C. 70​ mg/dL

D. 110​ mg/dL

A. 465​ mg/dL

Medical direction has ordered you to administer one dose of oral glucose to a patient with diabetes who is exhibiting confusion. Which of these best describes what you should​ do?

A. Carefully administer the entire tube of glucose

B. Place half the contents of the tube of glucose in the​ patient's mouth

C. Have the patient swallow all of the glucose in the tube

D. Repeat and question the order to medical direction

A. Carefully administer the entire tube of glucose

An elderly patient has an altered mental status. On​ scene, the​ patient's son informs you that his father has type 1 diabetes. Based on this​ information, you would understand that the​ patient:

A. Has a history of high blood pressure

B. Has a chronically low blood sugar level

C. Requires daily oral glucose to maintain his blood sugar

D. Needs to take insulin

D. Needs to take insulin

A glucometer reads 50​ mg/dL. The EMT would recognize this reading​ as:

A. Low

B. High

C. Normal

D. Average

A. Low

The EMT would describe diabetes as a disease state in​ which:

A. Not enough sugar is provided to the body

B. The body cannot store and maintain sugar reserves

C. A tumor on the pancreas causes too much insulin to be released

D. There is a problem with the transport of glucose into the cells

D. There is a problem with the transport of glucose into the cells

You have been called for a​ 33-year-old male patient who complains of weakness and dizziness. When getting the​ history, which of these statements made by the patient would raise your suspicion that the patient has undiagnosed​ diabetes?

A. "I feel very weak in the morning after getting​ up."

B. "I get very weak just after eating a​ meal."

C. ​"I feel the need to eat sugar throughout the​ day."

D. "I find myself urinating all of the​ time."

D. "I find myself urinating all of the​ time."

You are sitting next to a​ 24-year-old female patient with diabetes who has altered mental status and a blood sugar reading of 31​ mg/dL. Family members state that she took her normal amount of insulin this morning and ate her breakfast as usual. Which additional statement would the EMT recognize as contributing to her current​ condition?

A. "She likes to stay in shape and ran 4 miles after​ breakfast."

B. "She did not eat anything sweet for breakfast this​ morning."

C. ​"She did not take her nighttime insulin last​ night."

D. "She has been taking Motrin every 6 hours for ankle​ pain."

A. "She likes to stay in shape and ran 4 miles after​ breakfast."

You are called to an outpatient clinic to transfer a​ 39-year-old male patient in diabetic ketoacidosis​ (DKA) to an​ acute-care hospital. When assessing this​ patient, which sign or symptom would you expect to​ find?

A. Slow heart rate and high blood pressure

B. Blood glucose level of 50​ mg/dL

C. Fruity or acetone odor on his breath

D. Slow and shallow respirations

C. Fruity or acetone odor on his breath

The wife of a​ 43-year-old male patient has called 911 because her husband was difficult to wake up and now is lethargic with garbled speech. She reports a history of​ diabetes, stroke, renal​ failure, and high blood pressure. The​ patient's airway is​ patent, respirations are tachypneic but​ adequate, and radial pulse is rapid. Your partner reports the following vital​ signs: pulse,​ 136; respirations, 22​ breaths/min; blood​ pressure, 106/62​ mmHg; SpO2,​ 92%; and blood​ glucose, 642​ mg/dL. What would be the most appropriate action in the care of this​ patient?

A. Administer oral glucose

B. Administer supplemental oxygen

C. Encourage the patient to drink water

D. Assist the patient with taking his insulin

B. Administer supplemental oxygen

To decrease the possibility of a faulty glucometer​ reading, you​ would:

A. Use the first drop of blood obtained

B. Use venous blood only for testing

C. Avoid the use of alcohol as an antiseptic

D. Make sure test strips are not expired

D. Make sure test strips are not expired

A patient informs you that she takes Januvia pills for her diabetes. Which of these statements about this patient and her diabetes is​ true?

A. The pills decrease her craving for sugary foods

B. Her body needs glucose that is provided by the pills

C. The pills contain insulin for use by the body

D. Her pancreas still produces some insulin

D. Her pancreas still produces some insulin

Which of these patients has a normal fasting glucose​ level?

A. A​ 53-year-old female who is alert and oriented with a glucose level of 117​ mg/dL

B. A​ 12-year-old male with a blood glucose level of 38​ mg/dL

C. A​ 37-year-old female who is weak and dizzy with a glucose level of 81​ mg/dL

D. A​ 67-year-old male with no complaints and a glucose level of 127​ mg/dL

C. A​ 37-year-old female who is weak and dizzy with a glucose level of 81​ mg/dL

Which assessment finding is the best means by which to delineate hypoglycemia from​ hyperglycemia?

A. Evaluate the​ patient's blood sugar

B. Determine the rate at onset

C. Examine the signs and symptoms

D. Analyze the vital signs

A. Evaluate the​ patient's blood sugar

Which individual finding would most lead the EMT to suspect that a patient has​ hypoglycemia?

A. A rapid onset of altered mental status

B. A blood glucose reading of 256​ mg/dL

C. A slow pulse rate and low blood pressure

D. Warm and dry skin with a blood glucose of 90​ mg/dL

A. A rapid onset of altered mental status

What is the primary reason to administer oral glucose to a​ patient?

A. Help sugar get into the brain cells

B. Increase the amount of circulating glucose in the bloodstream

C. Improve the​ patient's level of consciousness

D. Stimulate the body to release insulin from the pancreas

B. Increase the amount of circulating glucose in the bloodstream

You are reviewing prehospital care reports and notice that a patient with low blood sugar and no contraindications to oral glucose did not receive the medication. You recognize that this inaction placed the patient at risk for which​ condition?

A. Brain damage

B. Infection

C. Heart failure

D. Liver damage

A. Brain damage

The insulin level in a patient with undiagnosed diabetes is​ elevated, and the cellular receptors for the insulin are not sensitive​ (to the​ insulin). You would anticipate which finding when caring for this​ patient?

A. Peripheral edema from retained fluid

B. Elevated blood sugar levels

C. A low blood sugar reading on the glucometer

D. Slowed respirations and heart rate

B. Elevated blood sugar levels

When providing information about diabetes to a group of Emergency Medical​ Responders, you would tell them that it is a​ disease:

A. That always requires insulin to be injected into the body

B. In which the pancreas fails to produce the proper amount of insulin

C. In which the body cannot turn carbohydrates into sugar

D. In which the​ patient's blood sugar will suddenly drop

B. In which the pancreas fails to produce the proper amount of insulin

You have arrived on the scene of a​ 64-year-old patient with diabetes. He is supine in bed and exhibits snoring respirations. Family members state that they just tested his blood sugar and it is 25​ mg/dL. What should be your immediate​ action?

A. Determine what the patient has eaten

B. Open the airway with a manual technique

C. Have the family recheck the blood sugar

D. Prepare and administer oral glucose

B. Open the airway with a manual technique

A patient with diabetes is noncompliant with taking insulin. On​ scene, your assessment indicates this patient has an open​ airway, rapid and deep​ respirations, and a rapid radial pulse. His skin is warm and flushed. Vital signs are​ pulse, 120;​ respirations, 40​ breaths/min; blood​ pressure, 108/86​ mmHg; and​ SpO2, 98%. The​ patient's blood sugar reads​ "high" on your glucometer. Which of these instructions to other caregivers indicates proper care of this​ patient?

A. "We need to see if his insulin is here so we can help him administer it to​ himself."

B. "Someone needs to start positive pressure ventilation to slow his​ hyperventilation."

C. "Do not worry about his breathing​ rate, it is actually helping him right​ now."

D. "We need to apply supplemental oxygen at 15 liters per minute through a nonrebreather​ mask."

C. "Do not worry about his breathing​ rate, it is actually helping him right​ now."

What is a glucometer used to​ evaluate?

A. Insulin and glucose levels

B. Glucogen levels

C. Insulin levels

D. Glucose levels

D. Glucose levels

You are instructing EMT students on how to obtain a blood sample for use in a glucometer. You are providing accurate information when you​ state:

A. ​"Approximately 15 mL of blood will be needed for an accurate​ result."

B. "Have the patient raise his or her arm in the air before you obtain the blood​ sample."

C. "A small drop of blood obtained from the​ patient's fingertip is​ sufficient."

D. "It is best to check the blood three times and then use the highest​ reading."

C. "A small drop of blood obtained from the​ patient's fingertip is​ sufficient."

You know an EMT is correctly using a glucometer when she performs which procedural​ step?

A. Wastes the first drop of blood obtained from the​ patient's finger

B. Uses a lancet to prick an artery or vein for the blood sample

C. Asks the patient to hold his hand above his head prior to pricking a finger for blood

D. Avoids cleaning the finger with alcohol prior to pricking it with a lancet

A. Wastes the first drop of blood obtained from the​ patient's finger

You are reviewing a prehospital care report for a patient with altered mental status that occurred after he took too much insulin. Based on this​ information, you should assume that at the time of EMS​ contact, the​ patient's blood sugar level was​ probably:

A. Concentrated

B. Normal

C. High

D. Low

D. Low

Which of these most accurately describes​ insulin?

A. Hormone that breaks food into simple sugars

B. Hormone that enables glucose to move into the cells

C. Drug that increases the sugar in the blood

D. Pill that must be taken by patients with diabetes

B. Hormone that enables glucose to move into the cells

A patient with diabetes is exhibiting rapid and deep respirations. As a knowledgeable​ EMT, you would expect this patient to​ have:

A. hypoglycemia.

B. elevated blood glucose.

C. hypoxia.

D. fever and tachycardia.

B. elevated blood glucose.

An alert but confused patient with diabetes is complaining of weakness. Your service carries oral​ glucose, which has been authorized through​ off-line medical direction. In this​ case, you​ should:

A. Transport the patient for further evaluation in the hospital

B. Prepare and administer the oral glucose

C. Contact medical direction for authorization to administer the oral glucose

D. Contact the​ patient's primary care physician

B. Prepare and administer the oral glucose

The most common complaint of patients with diabetes for which EMS is summoned​ is:

A. Difficulty breathing

B. Nausea and vomiting

C. Desire for sugary foods

D. Altered mental status

D. Altered mental status

A​ patient's glucometer measurement reads 39​ mg/dL. The patient is​ alert, but confused. The​ patient's son states that he has a friend who becomes unresponsive when his sugar is less than 50​ mg/dL; therefore, the reading for his father cannot be correct. Which of these statements would be your best​ response?

A. ​"The response to a low blood sugar can vary from patient to​ patient."

B. "You are probably​ right; I feel comfortable in having him sign a​ refusal."

C. "I agree. Just to be​ safe, I am not going to give him any oral​ glucose."

D. "I agree. Anyone with a blood sugar less than 50​ mg/dL should be​ unconscious."

Long-term complications of diabetes commonly​ include:

A. Coma

B. Mental retardation

C. Asthma

D. Kidney disease

D. Kidney disease

A patient with diabetes presents as alert but irritable and confused. His airway is patent with an intact gag reflex and breathing is adequate. You do not have a glucometer available and are not sure if his blood sugar is high or low. In this​ situation, what would be your next best​ action?

A. Insert a nasal airway

B. Have the family members administer his insulin

C. Provide emergency transport

D. Administer oral glucose

D. Administer oral glucose

Which of these statements made by an EMT indicates a correct understanding of glucose in the human​ body?

A. "All cells in the body require glucose for energy and cannot use anything​ else."

B. "Glucose is transformed into​ fats, which the cells of the body use for​ energy."

C. "Once ingested, glucose is broken down into carbohydrates and used for​ energy."

D. ​"The cells of the brain cannot store​ glucose, and are uniquely sensitive to low glucose​ levels."

D. ​"The cells of the brain cannot store​ glucose, and are uniquely sensitive to low glucose​ levels."

After you administer oral glucose to a confused and combative​ patient, she gradually becomes calmer and fully oriented. As a knowledgeable​ EMT, you would recognize that this​ patient:

A. Had a low blood sugar level

B. Will need a second dose of oral glucose

C. Had a high blood sugar level

D. Now has a decreasing blood sugar level

A. Had a low blood sugar level

After you administer oral glucose to a patient with​ diabetes, his level of conscious deteriorates and he becomes unresponsive with snoring respirations. Which action should you take​ immediately?

A. Manually open the airway

B. Administer a full second dose of oral glucose

C. Provide​ high-concentration oxygen via a nonrebreather mask

D. Administer half a second tube of glucose

A. Manually open the airway

A patient who is unresponsive has a blood glucose level of 28​ mg/dL. Her family states that she took her insulin in the morning 3 hours ago. Which of these statements made by the family would make sense in regard to the​ patient's current blood sugar​ level?

A. ​"She ate a lot of cake and ice cream last​ night."

B. "She smoked a cigarette just before becoming​ unresponsive."

C. ​"She did not eat after taking her​ insulin."

D. ​"She is going to the bathroom all of the​ time."

C. ​"She did not eat after taking her​ insulin."

A patient with diabetes who took insulin earlier is found unresponsive with a blood glucose level of 29​ mg/dL. Which piece of information provided by family gives the best explanation for the​ patient's altered mental​ status?

A. "His blood sugar normally goes up after​ eating."

B. "He didn't eat breakfast or lunch today because his belly​ hurt."

C. ​"He took only half of his required dose of insulin this​ morning."

D. "He ate pancakes with syrup after taking his​ insulin."

B. "He didn't eat breakfast or lunch today because his belly​ hurt."

A glucometer is a tool the EMT can use to​ measure:

A. Insulin levels

B. Blood sugar levels

C. Glycogen levels

D. Carbohydrate levels

B. Blood sugar levels

In which form is oral glucose​ packaged?

A. Powder

B. Sugar granules

C. Gel

D. Liquid

C. Gel

An unresponsive patient presents with a blood sugar of 30​ mg/dL. What is the major threat to this​ patient's well-being?

A. Dehydration

B. Glucose toxicity

C. Brain damage

D. Cardiac compromise

C. Brain damage

You determine a​ patient's blood glucose level to be 289​ mg/dL. You would document this result on the prehospital care report​ as:

A. Hyperglycemic

B. Normal

C. Hypoglycemic

D. Depressed

A. Hyperglycemic

You are assisting a paramedic who is administering glucagon to a patient. Based on your understanding of how glucagon works in the human​ body, what is the therapeutic goal of this​ treatment?

A. Raises the amount of circulating blood glucose

B. Rapidly decreases a high amount of circulating glucose

C. Helps red blood cells carry the glucose

D. Increases insulin release from the liver

A. Raises the amount of circulating blood glucose

When administering oral glucose to a patient with​ diabetes, the EMT must take precautions to prevent which adverse​ effect?

A. Low blood glucose level

B. Airway obstruction

C. High blood glucose level

D. Increased blood pressure

B. Airway obstruction

How would an EMT best describe a confused and combative patient with labored respirations and a blood glucose level of 33​ mg/dL?

A. Hyper-insulinemic

B. Hypoglycemic

C. Altered blood glucose

D. Hyperglycemic

B. Hypoglycemic

Five minutes after administering oral glucose to a confused patient with​ diabetes, you do not see any improvement in her mental status. Which action should you​ take?

A. Recheck the expiration date on the oral glucose

B. Administer a second dose of oral glucose

C. Continue to monitor the patient

D. Contact medical direction for further orders

C. Continue to monitor the patient

With normal​ metabolism, what happens after a healthy patient ingests​ food?

A. The liver releases stored glucose

B. Blood levels of insulin rise

C. Glucose levels in the body drop quickly

D. Excess glucose is released in the urine

B. Blood levels of insulin rise

A patient with diabetes is alert but confused. You have decided to administer oral glucose. Which of these descriptions indicates the proper way to administer the​ glucose?

A. Use a tongue depressor to place the glucose on the back of the tongue

B. Place the glucose between the​ patient's cheek and gum

C. Have the patient slowly swallow the glucose

D. Squeeze the glucose under the​ patient's tongue

B. Place the glucose between the​ patient's cheek and gum

You have been called for a​ 32-year-old female patient with altered mental status. On​ scene, you find the patient lethargic and confused. Although information is​ sketchy, it appears that she has a history of diabetes as well as renal failure for which she receives dialysis. You note no deficits in the primary assessment and the vital signs are​ pulse, 124;​ respirations, 28​ breaths/min; blood​ pressure, 106/68​ mmHg; and​ SpO2, 97%. Your partner reports a blood sugar reading of 774​ mg/dL. Based on this​ information, the EMT would understand that definitive care of this patient would involve the administration of which medication at the​ hospital?

A.Insulin

B.Glucose

C. Oxygen

D. Intravenous fluids

A.Insulin

A​ 17-year-old patient is unresponsive. A medical identification bracelet states that he has diabetes. Which action should you perform​ first?

A. Determine the type of diabetes

B. Check for a pulse

C. Assess the airway

D. Administer oral glucose

C. Assess the airway