midterm review

In ________, there are fewer insulin receptors, so insulin resistance develops.

Diabetes mellitus type 1

Diabetes mellitus type 2

HHNS

Ketoacidosis

Diabetes mellitus type 2

Diabetes mellitus type 1 is an autoimmune disorder in which the individual's immune system produces antibodies to the pancreatic beta cells, and therefore the pancreas cannot produce insulin.

AMS mnemonic AEIOU-TIPS:

Alcohol

Epilepsy, endocrine, electrolytes

Insulin

Opiates and other drugs

Uremia (kidney failure)

Trauma, temperature

Infection

Poisoning, psychogenic causes

Shock, stroke, seizure, space-occupying lesion, subarachnoid hemorrhage

Most of these items can be associated with or can cause hypoglycemia.

A patient who is hyperglycemic may have Kussmaul respirations and sweet, fruity breath.

TrueFalse

True

Correct. A patient who is hyperglycemic may have Kussmaul respirations and sweet, fruity breath.

A patient with dry and warm skin indicates hypoglycemia.

TrueFalse

False

Correct. A patient with dry and warm skin indicates hyperglycemia.

A patient in symptomatic hypoglycemia is more critical and more likely to suffer from permanent problems than the condition of a patient with hyperglycemia or diabetic ketoacidosis.

TrueFalse

True

Correct. A patient in symptomatic hypoglycemia is far more critical and far more likely to suffer from permanent problems than the condition of a patient with hyperglycemia or diabetic ketoacidosis.

The only contraindications to oral glucose are an inability to swallow and unconsciousness.

TrueFalse

True

Correct. The only contraindications to oral glucose are an inability to swallow and unconsciousness, because aspiration can occur.

Diabetes is a metabolic disorder in which the body's ability to metabolize what is impaired?

Protein

Fats

Glucose

Electrolytes

Diabetes is a metabolic disorder in which the body's ability to metabolize glucose is impaired.

What is the function of insulin in the body?

It prevents glucose from oversaturating cells.

It enables glucose in the blood to enter cells.

It regulates oxygen flow to the cells.

It regulates chemical production in the endocrine glands.

Insulin enables glucose in the blood to enter cells.

What is released when the concentration of glucose drops in the blood?

Insulin

Epinephrine

Glucagon

Dopamine

Glucagon stimulates liver and skeletal muscles to release glycogen, and converts glycogen back to glucose for use as cellular fuel.

Which of the following is the most common metabolic disease of childhood?

Diabetes mellitus type 1

Diabetes mellitus type 2

Ketoacidosis

Hyperosmolar hyperglycemic nonketotic syndrome

Type 1 diabetes is the most common metabolic disease of childhood.

Which of the following organs can rapidly sustain permanent damage when the body's glucose level is too low?

Brain

Heart

Kidney

Liver

Untreated hypoglycemia (low glucose) can result in loss of consciousness and can quickly cause significant brain damage or death.

Which of the following is a normal glucose level in an adult?

20 mg/dL

80 mg/dL

140 mg/dL

200 mg/dL

80 mg/dL

A normal glucose level is 80- 120 mg/dL.

> 70 mg/dL for neonates

You are treating a 36-year-old patient displaying the following signs and symptoms: rapid, shallow respirations; pale, cool, clammy skin; tachycardia; weakness on the left side of the body; and confusion and irritability. What should you suspect?

Symptomatic hyperglycemia

Symptomatic hypoglycemia

Vasoocclusive crisis

DKA

These signs and symptoms indicate symptomatic hypoglycemia

The condition in which blood clots as a result of an abnormality of the system of coagulation is called what?

Hemophilia

Sickle cell disease

Thrombosis

Thrombophilia

Thrombophilia is a tendency toward developing blood clots as a result of an abnormality of coagulation.

Which of the following is classified as an autoimmune disorder?

Type 1 diabetes

Type 2 diabetes

Sickle cell disease

Acidosis

Type 1 diabetes

Type 1 diabetes is an autoimmune disorder in which the individual's immune system produces antibodies to the pancreatic beta cells.

In which condition are you most likely to encounter a vasoocclusive crisis?

Symptomatic hypoglycemia

Sickle cell disease

Hemophilia

Thrombophilia

A vasoocclusive crisis is caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.

A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing:

Select one:

A. an acute stroke.

B. hyperglycemia.

C. hypoglycemia.

D. a heart attack.

D. a heart attack.

Chapter 19, page 735, Patient Assessment of Diabetes

A patient with an altered mental status; high blood glucose levels; and deep, rapid breathing may have a condition known as __________.

Select one:

A. hyperglycemic crisis

B. diabetic ketoacidosis

C. hypoglycemic crisis

D. hyperosmolar hyperglycemic nonketotic coma

B. diabetic ketoacidosis

Which of the following statements regarding sickle cell disease is correct?

Select one:

A. The red blood cells of patients with sickle cell disease are round and contain hemoglobin.

B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.

C. Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a blood vessel.

D. Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly.

B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.

The two main types of cells contained in blood are called _________.

Select one:

A. platelets and plasma

B. hemoglobin A and S

C. transport and clotting

D. erythrocytes and leukocytes

D. erythrocytes and leukocytes

During your assessment of a 19-year-old male, you are told that he is being treated with factor VIII. This indicates that:

Select one:

A. his blood clots too quickly.

B. he has hemophilia A.

C. he has a thrombosis.

D. he has thrombophilia.

B. he has hemophilia A.

The normal blood glucose level is between:

Select one:

A. 80 and 120 mg/dL.

B. 30 and 150 mg/dL.

C. 160 and 200 mg/dL.

D. 60 and 80 mg/dL.

A. 80 and 120 mg/dL.

A patient with hypoglycemia will often present with which of the following signs/symptoms?

Select one:

A. Deep, rapid respirations

B. Pale, cool, and clammy skin

C. Hypertension

D. Warm, red, and dry skin

B. Pale, cool, and clammy skin

Excessive eating caused by cellular "hunger" is called:

Select one:

A. dysphasia.

B. polydipsia.

C. polyphagia.

D. dyspepsia.

C. polyphagia.

Which of the following statements regarding glucose is correct?

Select one:

A. The brain requires glucose as much as it requires oxygen.

B. Blood glucose levels decrease in the absence of insulin.

C. Most cells will function normally without glucose.

D. The brain requires insulin to allow glucose to enter the cells.

A. The brain requires glucose as much as it requires oxygen.

You are treating a 40-year-old male with a documented blood sugar reading of 480 mg/dL. The patient is semiconscious and breathing shallowly, and is receiving assisted ventilation from your partner. You should recognize that definitive treatment for this patient includes:

Select one:

A. glucagon.

B. oxygen.

C. dextrose.

D. insulin.

D. insulin.

A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days' duration. Her blood glucose level reads 320 mg/dL. If this patient's condition is not promptly treated, she will MOST likely develop:

Select one:

A. severe insulin shock.

B. hypoxia and overhydration.

C. acidosis and dehydration.

D. irreversible renal failure.

D. irreversible renal failure.

Symptomatic hypoglycemia will MOST likely develop if a patient:

Select one:

A. misses one or two prescribed insulin injections.

B. markedly overeats and misses an insulin dose.

C. takes too much of his or her prescribed insulin.

D. eats a regular meal followed by mild exertion.

C. takes too much of his or her prescribed insulin.

A 66-year-old woman experienced a sudden onset of difficulty breathing. She has a history of type 2 diabetes and deep vein thrombosis (DVT). On the basis of her medical history, which of the following should the EMT suspect?

Select one:

A. Severe hypoglycemia

B. Diabetic ketoacidosis

C. Pulmonary embolism

D. Congestive heart failure

C. Pulmonary embolism

A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2 diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your assessment reveals that the patient is unresponsive. You should:

Select one:

A. administer 100% oxygen via a nonrebreathing mask.

B. open and maintain her airway and assess breathing.

C. administer oral glucose between her cheek and gum.

D. assess for the presence of a medical identification tag.

B. open and maintain her airway and assess breathing.

The main function of the endocrine system is to _________.

Select one:

A. regulate glucose and calcium

B. maintain homeostasis

C. produce glandular secretions

D. regulate blood flow

B. maintain homeostasis

In contrast to type 1 diabetes, type 2 diabetes:

Select one:

A. occurs when antibodies attack insulin-producing cells.

B. is caused by a complete lack of insulin in the body.

C. is caused by resistance to insulin at the cellular level.

D. is commonly diagnosed in children and young adults.

C. is caused by resistance to insulin at the cellular level.

Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT:

Select one:

A. ensuring the absence of a gag reflex.

B. checking the medication's expiration date.

C. requesting permission from medical control.

D. assessing the patient's mental status.

A. ensuring the absence of a gag reflex.

The EMT should assess for hypoglycemia in small children with a severe illness or injury because:

Select one:

A. illness or injury causes the pancreas to produce less insulin.

B. children overproduce insulin during severe illness or injury.

C. a child's cells do not uptake glucose as rapidly as adults' do.

D. children cannot store excess glucose as effectively as adults.

D. children cannot store excess glucose as effectively as adults.

Which of the following conditions is the diabetic patient at an increased risk of developing?

Select one:

A. Hepatitis B

B. Blindness

C. Depression

D. Alcoholism

B. Blindness

Classic signs and symptoms of hypoglycemia include:

Select one:

A. cool, clammy skin; weakness; tachycardia; and rapid respirations.

B. warm, dry skin; hunger; abdominal pain; and deep, slow respirations.

C. warm, dry skin; irritability; bradycardia; and rapid respirations.

D. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.

A. cool, clammy skin; weakness; tachycardia; and rapid respirations.

acidosis

A pathologic condition that results from the accumulation of acids in the body.

diabetes mellitus

A metabolic disorder in which the ability to metabolize carbohydrates (sugars) is impaired, usually because of a lack of insulin.

dibetic ketoacidosis (DKA)

a form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

endocrine glands

Glands that secrete or release chemicals that are used inside the body.

endocrine system

regulates metabolism and maintains homeostasis

glucose

one of the basic sugars; it is the primary fuel in conjunction with oxygen for cellular metabolism

hematology

the study and prevention of blood-related disorders

hemophilia

A congenital abnormality in which the body is unable to produce clots, which results in uncontrollable bleeding.

horomone

a chemical substance produced by a gland that regulates the activity of organs and tissues

hyperglycemia

An abnormally high blood glucose level

hyperosmolar hyperglycemic nonketotic syncrome (HNNS)

a life-threatening condition resulting from high blood glucose that typically occurs in older adults and which causes altered mental status, dehydration, and organ damage

Hypoglycemia

An abnormally low blood glucose level.

Insulin

A hormone produced by the islets of Langerhans (endocrine gland located throughout the pancreas) that enables glucose in the blood to enter cells; used in synthetic form to treat and control diabetes mellitus.

Kussmaul respirations

Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.

polydipsia

Excessive thirst that persists for long periods, despite reasonable fluid intake; often the result of excessive urination.

polyphagia

Excessive eating; in diabetes, the inability to use glucose properly can cause a sense of hunger.

polyuria

The passage of an unusually large volume of urine in a given period; in diabetes, this can result from the wasting of glucose in the urine.

sickle cell disease

A hereditary disease that causes normal, round red blood cells to become oblong, or sickle shaped.

symptomatic hyperglycemia

A state of unconsciousness resulting from several problems, including ketoacidosis, dehydration because of excessive urination, and hyperglycemia.

symptomatic hypoglycemia

Severe hypoglycemia resulting in changes in mental status.

Thrombophilia

A tendency toward the development of blood clots as a result of an abnormality of the system of coagulation.

type 1 diabetes mellitus

An autoimmune disorder in which the individual's immune system produces antibodies to the pancreatic beta cells, and therefore the pancreas cannot produce insulin, onset in early childhood is common.

type 2 diabetes

A condition in which insulin resistance develops in response to increased blood glucose levels; can be managed by exercise and diet modification, but is often managed by medications.

vasoocclusive crisis

Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.

Which of the following filters, warms, and humidifies air during inhalation?

Upper airway

You are attending to a 28-year-old female patient in severe respiratory distress. The patient has had a high fever all day, and the respiratory distress came on very quickly. Your patient is now sitting in a chair, leaning forward with her hands on her knees. She is making high-pitched sounds with each breath and does not seem to be moving very much air. Based on this information, your patient is likely suffering from:

epiglottitis.

A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing supplemental oxygen, you should:

determine if she has been prescribed a beta-agonist inhaler.

You are attending to a 5-year-old male patient who has had a cold and fever for the last two days. His parents became concerned when he started having coughing spells that would last for over a minute, during which he would turn blue. After the coughing attack, his parents reported that he seemed to be sucking the air back in. Based on this information, your patient is most likely suffering from:

pertussis

The two processes that occur during respiration are:

inspiration and expiration.

During the primary assessment, you determine your patient has a life-threatening emergency. You should now:

transport rapidly.

The hypoxic drive is the body's _________

secondary respiratory drive

A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations:

Deep and rapid.

In a healthy individual, the brain stem stimulates breathing on the basis of:

increased carbon dioxide levels.

You are assessing a patient with respiratory distress and are unsure if the cause is congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Which of the following clinical signs would be the MOST helpful in determining whether the patient has CHF or COPD?

Jugular vein distention

Harsh, high-pitched inspiratory sounds are characteristic of:

Stridors

Your patient is complaining of fatigue. She is breathing at 18 breaths per minute, has equal chest rise and fall, and has clear lung sounds. She is presenting with signs of ___________.

Normal breathing

Albuterol is a generic name for:

Ventolin

Your elderly patient recently had surgery. She now complains of a sudden onset of dyspnea and sharp chest pain. You should suspect ___________.

pulmonary embolus

You are attending to a 6-year-old female patient. Her parents tell you that she has been sick for the last three days with the respiratory infection that has been going around her school. They became concerned when she stopped drinking fluids, and they could not get her to take in any liquids. The patient is showing signs of significant dehydration. Based on this information, your patient is most likely suffering from:

respiratory syncytial virus (RSV) infection.

A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 22 breaths/min with adequate depth. Which of the following treatments is MOST appropriate for this patient?

Oxygen via nonrebreathing mask and a focused secondary assessment

At the onset of an acute asthma attack, patients commonly experience difficulty breathing and:

expiratory wheezing.

Which of the following statements regarding pulse oximetry is correct?

Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood.

Which of the following is a common MDI drug?

Alupent

The respiratory distress that accompanies emphysema is caused by:

chronic stretching of the alveolar walls.

What is the principle function of the lungs?

Respiration

The upper airway consists of all anatomic airway structures above the level of?

Vocal chords

A barrel chest is a sign and symptom of which disease?

Emphysema

A respiratory rate of 25 to 50 breaths in an infant indicates?

A normal rate of respiration

The primary stimulus that triggers a patient to breath is the carbon dioxide level in the arterial blood. Some patients who suffer from chronic carbon dioxide retention will utilize a secondary stimulus, or drive, to breath. What is this secondary stimulus known as?

Hypoxic drive

Which of the following patients is breathing adequately?

29-year old woman with respirations of 20 breaths/min, who is conscious and alert.

Which of the following are examples of "dry" lung sounds?

Wheezes

Atelectasis can be defined as?

Collapsed alveoli

The H1N1 strain of influenza Type A is transmitted by which route?

Both direct contact with nasal secretions and contact with aerosolized droplets from coughing or sneezing.

Which of the following is usually associated with a seal-back cough?

Croup

Dyspnea is a common complaint in patients with which type of disease?

Cardiopulmonary

A patient who has just had a severe asthma episode is now very sleepy. This indicates that the patient?

Might stop breathing

Which of the following sounds are indicative of a partial upper airway obstruction, usually in the oropharynx?

Snoring

Which of these answers is something you should NOT do when assessing breath sounds?

When listening to the patients back, the stethoscope head should be over the scapulas.

Which of the following drugs could you use for asthma, bronchitis, and COPD?

Atrovent

Which of the following is a contraindication for CPAP?

Low blood pressure

The patient with_________ is unlikely to need emergency treatment unless the condition has worsened from generalized cold symptoms?

Hay fever

Which position should a patient with epiglottitis be in?

Sniffing

For which of these conditions is supplemental oxygen mandatory?

Pulmonary embolism

dyspnea

common in patients with cardiopulmonary diseases, always is caused by some obstruction