EMT Chapter 20 Endocrine and Hematologic Emergencies

Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT:
A. assessing the patient's mental status.
B. checking the medication's expiration date.
C. ensuring the absence of a gag reflex.
D. requesting permission from medical control.

C. ensuring the absence of a gag reflex

In contrast to type 1 diabetes, type 2 diabetes:
A. is commonly diagnosed in children and young adults.
B. occurs when antibodies attack insulin-producing cells.
C. is caused by a complete lack of insulin in the body.
D. is caused by resistance to insulin at the cellular level.

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

A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she:
A. has overdosed on her insulin.
B. has a low blood glucose level.
C. is significantly hyperglycemic.
D. has a urinary tract infection

C. is significantly hyperglycemic

The normal blood glucose level is between:
A. 80 and 120 mg/dL.
B. 130 and 150 mg/dL.
C. 160 and 200 mg/dL.
D. 60 and 80 mg/dL.

A. 80 and 120 mg/dL

You respond to a movie theater for a 70-year-old male who is confused. His wife tells you he has type 2 diabetes but refuses to take his pills. Your assessment reveals that the patient is diaphoretic, tachycardic, and tachypneic. Initial management for this patient should include:
A. administering one to two tubes of oral glucose.
B. performing a rapid exam and obtaining vital signs.
C. assisting the patient with his diabetic medication.
D. applying a nonrebreathing mask at 15 L/min.

D. applying a nonrebreathing masks at 15 L/min

Common signs and symptoms of severe hyperglycemia include all of the following, EXCEPT:
A. cool, clammy skin.
B. warm, dry skin.
C. rapid, thready pulse.
D. acetone breath odor.

A. cool, clammy skin

In general, oral glucose should be given to any patient who:
A. has a blood glucose level that is less than 100 mg/dL.
B. has documented hypoglycemia and an absent gag reflex.
C. has an altered mental status and a history of diabetes.
D. is unresponsive, even in the absence of a history of diabetes.

C. has an altered mental status and a history of diabetes

A 50-year-old man with diabetes has an altered mental status and is unable to tell you when he last ate or took his insulin. Your glucometer keeps malfunctioning and you are unable to determine his blood glucose level. Which of the following clinical signs would MOST likely lead you to the correct diagnosis?
A. Rapid and weak pulse
B. Restlessness and irritability
C. Deep and rapid breathing
D. Hypotension and tachycardia

C. deep and rapid breathing

Symptomatic hypoglycemia will MOST likely develop if a patient:
A. misses one or two prescribed insulin injections.
B. takes too much of his or her prescribed insulin.
C. markedly overeats and misses an insulin dose.
D. eats a regular meal followed by mild exertion.

B. takes too much of his or her prescribed insulin

You respond to a residence for a patient who is "not acting right." As you approach the door, the patient, a 35-year-old male, begins shouting profanities at you and your partner while holding a baseball bat. The man is confused and diaphoretic, and is wearing a medical identification bracelet. You should:
A. contact medical control for instructions.
B. calm him down so you can assess him.
C. be assertive and talk the patient down.
D. retreat at once and call law enforcement.

D. retreat at once and call law enforcement

When assessing an unresponsive diabetic patient, the primary visible difference between hyperglycemia and hypoglycemia is the:
A. rate and depth of breathing.
B. presence of a medical identification tag.
C. patient's mental status.
D. rate of the patient's pulse.

A. rate and depth of breathing

A 31-year-old male with a history of diabetes had a seizure that stopped prior to EMS arrival. He is unresponsive and has rapid, shallow breathing. His pulse is rapid and weak, and his skin is cyanotic. The EMT should:
A. assist the patient's ventilations with a bag-valve mask.
B. place a thin layer of oral glucose between his cheek and gums.
C. administer oxygen by nasal cannula and assess his blood glucose level.
D. position the patient on his side and give oxygen via nonrebreathing mask.

A. assist the patient's ventilations with a bag-valve mask

Classic signs and symptoms of hypoglycemia include:
A. cool, clammy skin; weakness; tachycardia; and rapid respirations.
B. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.
C. warm, dry skin; hunger; abdominal pain; and deep, slow respirations.
D. warm, dry skin; irritability; bradycardia; and rapid respirations.

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

Diabetes is MOST accurately defined as a(n):
A. lack of insulin production in the pancreas.
B. abnormally high blood glucose level.
C. mass excretion of glucose by the kidneys.
D. disorder of glucose metabolism.

D. disorder of glucose metabolism

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?
A. Diabetic ketoacidosis
B. Severe hypoglycemia
C. Pulmonary embolism
D. Congestive heart failure

C. Pulmonary embolism

Glipizide, a non-insulin-type medication, is another name for:
A. Glucophage.
B. Diabinese.
C. Micronase.
D. Glucotrol.

D. Glucotrol

In contrast to hypoglycemia, hyperglycemia:
A. commonly results in excess water retention.
B. is rapidly reversible if oral glucose is given.
C. is a rapidly developing metabolic disturbance.
D. can only be corrected in the hospital setting.

D. can only be corrected in the hospital setting

Patients with uncontrolled diabetes experience polyuria because:
A. low blood glucose levels result in cellular dehydration.
B. they drink excess amounts of water due to dehydration.
C. excess glucose in the blood is excreted by the kidneys.
D. high blood sugar levels cause permanent kidney damage

C. excess glucose in the blood is excreted by the kidneys

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:
A. hyperglycemia.
B. a heart attack.
C. an acute stroke.
D. hypoglycemia

B. a heart attack

Hemoglobin is:
A. essential for the formation of clots, such as when vessel damage occurs.
B. a key component of the blood and is produced in response to an infection.
C. the fluid portion of the blood that transports cells throughout the body.
D. found within the red blood cells and is responsible for carrying oxygen.

D. found within the red blood cells and is responsible for carrying oxygen

Insulin functions in the body by:
A. increasing circulating blood glucose.
B. enabling glucose to enter the cells.
C. producing new glucose as needed.
D. metabolizing glucose to make energy.

B. enabling glucose to enter the cells

A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma, and the patient's blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should:
A. suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.
B. suspect that he has internal bleeding and is in shock, administer high-flow oxygen, and transport at once.
C. administer high-flow oxygen, perform a detailed secondary assessment at the scene, and transport promptly.
D. administer oxygen via a nonrebreathing mask, apply oral glucose in between his cheek and gum, and transport.

A. suspect that he has intracranial bleeding, assist his ventilations, and transport radpialy to an appropriate hospital

A 29-year-old female presents with confusion and disorientation. Her respirations are rapid and shallow, and her pulse is 120 beats/min and thready. She is markedly diaphoretic and has an oxygen saturation of 89%. You should:
A. treat her for hyperglycemia.
B. administer oral glucose.
C. provide ventilatory support.
D. transport immediately.

C. provide ventilatory support

Assessment of a patient with hypoglycemia will MOST likely reveal:
A. sunken eyes.
B. combativeness.
C. hyperactivity.
D. warm, dry skin.

B. combativeness

Diabetic ketoacidosis occurs when:
A. the pancreas produces excess insulin.
B. the cells rapidly metabolize glucose.
C. blood glucose levels rapidly fall.
D. insulin is not available in the body.

D. insulin is not available in the body

When obtaining a SAMPLE history from a patient with diabetes who has an altered mental status, it would be MOST important to determine:
A. if he or she has had any recent illnesses or excessive stress.
B. if there is a family history of diabetes or related conditions.
C. the name of the physician who prescribed his or her insulin.
D. approximately how much water the patient drank that day.

A. if he or she has had any recent illnesses or excessive stress

To which of the following diabetic patients should you administer oral glucose?
A. A confused 55-year-old male with tachycardia and pallor
B. An unconscious 33-year-old male with cool, clammy skin
C. A semiconscious 40-year-old female without a gag reflex
D. A conscious 37-year-old female with nausea and vomiting

A. A confused 55-year old male with tachycardia and pallor

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:
A. oxygen.
B. glucagon.
C. insulin.
D. dextrose.

C. insulin

Which of the following statements regarding glucose is correct?
A. Most cells will function normally without glucose.
B. The brain requires glucose as much as it requires oxygen.
C. Blood glucose levels decrease in the absence of insulin.
D. The brain requires insulin to allow glucose to enter the cells.

B. the brain requires glucose as much as it requires oxygen

Patients with type 2 diabetes usually control their disease with all of the following, EXCEPT:
A. tolbutamide (Orinase).
B. diet and exercise.
C. glyburide (Micronase).
D. supplemental insulin.

D. supplemental insulin

Type 1 diabetes:
A. is defined as a blood sugar level that is less than 120 mg/dL.
B. is a condition in which no insulin is produced by the body.
C. typically occurs in patients between 50 and 70 years of age.
D. is typically treated with medications such as metformin.

B. is a condition in which no insulin is produced by the body

Patients with thrombophilia are at an increased risk for:
A. acute arterial rupture.
B. pulmonary embolism.
C. hemorrhagic stroke.
D. various cancers.

A. acute arterial rupture

Which of the following statements regarding sickle cell disease is correct?
A. The red blood cells of patients with sickle cell disease are round and contain hemoglobin.
B. Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly.
C. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.
D. Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a blood vessel.

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

Which of the following conditions is the diabetic patient at an increased risk of developing?
A. Depression
B. Blindness
C. Hepatitis B
D. Alcoholism

B. blindness

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:
A. administer oral glucose between her cheek and gum.
B. administer 100% oxygen via a nonrebreathing mask.
C. assess for the presence of a medical identification tag.
D. open and maintain her airway and assess breathing.

D. open and maintain her airway and assess breathing

Kussmaul respirations are an indication that the body is:
A. compensating for decreased blood glucose levels.
B. attempting to eliminate acids from the blood.
C. severely hypoxic and eliminating excess CO2.
D. trying to generate energy by breathing deeply.

B. attempting to eliminate acids from the blood

During your assessment of a 70-year-old woman, she tells you that she takes blood-thinning medication and has to wear compression stockings around her legs. This information should make you suspect that she has:
A. hemophilia
B. deep vein thrombosis.
C. severe hyperglycemia.
D. sickle-cell disease

B. deep vein thrombosis

Ketone production is the result of:
A. rapid entry of glucose across the cell membrane.
B. blood glucose levels higher than 120 mg/dL.
C. acidosis when blood glucose levels are low.
D. fat metabolization when glucose is unavailable

D. fat metabolization when glucose in unavailable

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:
A. acidosis and dehydration.
B. hypoxia and overhydration.
C. severe insulin shock.
D. irreversible renal failure

A. acidosis and dehydration

A 19-year-old male complains of "not feeling right." His insulin and a syringe are on a nearby table. The patient says he thinks he took his insulin and cannot remember whether he ate. He is also unable to tell you the time or what day it is. The glucometer reads "error" after several attempts to assess his blood glucose level. You should:
A. contact medical control and administer oral glucose.
B. transport only with close, continuous monitoring en route.
C. request a paramedic ambulance to administer IV glucose.
D. assist him with his insulin injection and reassess him.

A. contact medical control and administer oral glucose