Ch. 23 Flashcards
Which of the following statements regarding diabetic ketoacidosis is TRUE?
A) DKA is a complication of type 2 diabetes without ketoacidosis.
B) DKA is an extreme, life-threatening form of hyperthyroidism.
C) Hallmark signs of DKA include polyphagia, polyuria, and polydipsia.
D) DKA is a disease of glucose regulation and excess insulin production.
C) Hallmark signs of DKA include polyphagia, polyuria, and polydipsia.
Page Ref: 600
Objective: 23.7 Compare and contrast diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
Which of the following is an action of insulin?
A) It increases the transfer of sugar from the stomach and small intestine to the bloodstream.
B) It increases the movement of sugar from the bloodstream to the cell.
C) It increases the circulating level of glucose in the blood.
D) It blocks the uptake of sugar by the body’s cells.
B) It increases the movement of sugar from the bloodstream to the cell.
Page Ref: 595
Objective: 23.1 Define key terms introduced in this chapter; 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
In diabetic ketoacidosis, which of the following may result?
A) Excessive urination, excessive thirst, and excessive hunger
B) Polyuria, polydipsia, polyphagia, and hyperactivity
C) Excessive insulin, excessive glucose, and excessive urination
D) Hyperactivity, excessive thirst, and polyuria
A) Excessive urination, excessive thirst, and excessive hunger
Page Ref: 600
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
The condition in which there is an insufficient amount of sugar in the blood is called:
A) diabetic coma.
B) hypoglycemia.
C) hyperglycemia.
D) diabetic ketoacidosis.
B) hypoglycemia.
Page Ref: 599
Objective: 23.1 Define key terms introduced in this chapter.
The homeostatic function of the endocrine system is regulated by:
A) hormonal release.
B) baroreceptors.
C) nervous system stimulation.
D) voluntary control.
A) hormonal release.
Page Ref: 592
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Which of the following may result in hypoglycemia in the diabetic patient?
A) Failure to take insulin
B) Vigorous exercise
C) High fever
D) Overeating
B) Vigorous exercise
Page Ref: 601
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Diabetes mellitus is an endocrine disorder characterized by:
A) inadequate glucose production.
B) inadequate regulation of blood glucose.
C) excessive glucose production.
D) excessive catecholamine production.
B) inadequate regulation of blood glucose.
Page Ref: 592
Objective: 23.1 Define key terms introduced in this chapter.
The pancreas secretes two major hormones, including:
A) prolactin.
B) calcitonin.
C) aldosterone.
D) glucagon.
D) glucagon.
Page Ref: 593
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Your patient is a 25-year-old woman with a history of diabetes. She is confused, agitated, and verbally abusive to you, and she is very sweaty. Although she refuses to give a history of the present illness, you should suspect low blood glucose levels as the likely cause of her presentation. If this patient accepts treatment and transport, how often should you reassess her?
A) Every five minutes
B) Every 10 minutes
C) Every 15 minutes
D) Once
C) Every 15 minutes
Page Ref: 598
Objective: 23.12 Describe the reassessment of a patient with a diabetic emergency.
Which of the following blood glucose levels is considered normal for an adult?
A) 40 mg/dL
B) 80 mg/dL
C) 120 mg/dL
D) 150 mg/dL
B) 80 mg/dL
Page Ref: 599
Objective: 23.3 Given a patient’s blood glucose level, determine whether it is within normal limits.
What are the two endocrine hormones released by the pancreas?
A) Epinephrine and norepinephrine
B) Glucose and glycogen
C) Dopamine and neurontin
D) Insulin and glucagon
D) Insulin and glucagon
Page Ref: 593
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Which of the following is characteristic of a patient with hyperglycemia?
A) Use of excessive amounts of insulin or lack of adequate food intake
B) Slow onset, Kussmaul’s respirations, and acetone odor on breath
C) Cool, moist skin, agitated behavior, and increased heart rate
D) Sudden onset of altered mental status and combativeness
B) Slow onset, Kussmaul’s respirations, and acetone odor on breath
Page Ref: 599
Objective: 23.6 Compare and contrast the speed of onset and signs and symptoms of hypoglycemia and hyperglycemia.
When cells are unable to utilize glucose for fuel, they will slowly begin to use ________ as an energy source.
A) fats
B) insulin
C) pancreatic enzymes
D) carbohydrates
A) fats
Page Ref: 594
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
The management of medical and trauma emergencies in diabetic patients is complicated by impaired:
A) cortisol production.
B) insulin depletion.
C) glucose homeostasis.
D) ketoacidosis.
C) glucose homeostasis.
Page Ref: 599
Objective: 23.9 List common complications of diabetes.
The patient with type 2 diabetes is MOST likely to control the condition with:
A) oral antihyperglycemic agents.
B) methimazole.
C) steroids.
D) insulin.
A) oral antihyperglycemic agents.
Page Ref: 598
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
A patient is hypoglycemic and unconscious. You administer all of a 50 mL prefilled syringe of 50 percent dextrose, or:
A) 5 mg.
B) 50 mg.
C) 0.25 grams.
D) 25 grams.
D) 25 grams.
Page Ref: 601-602
Objective: 23.10 Given a scenario with a patient suffering a diabetic emergency, provide emergency medical care for the patient; 23.11 Identify indications and contraindications to the administration of oral glucose, intravenous dextrose, and intramuscular glucagon.
An unconscious patient is hypoglycemic and has no suitable intravenous site. What do you administer to this patient and by which route?
A) dextrose 25 percent IM
B) insulin SQ
C) glucagon IM
D) insulin IV
C) glucagon IM
Page Ref: 602
Objective: 23.10 Given a scenario with a patient suffering a diabetic emergency, provide emergency medical care for the patient; 23.11 Identify indications and contraindications to the administration of oral glucose, intravenous dextrose, and intramuscular glucagon.
The patient in a hyperosmolar hyperglycemic state is at risk for dehydration due to:
A) osmotic diuresis.
B) vasodilation.
C) sepsis.
D) hemorrhage.
A) osmotic diuresis.
Page Ref: 601
Objective: 23.7 Compare and contrast diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
The dose of glucagon when given IM is:
A) 50 mg IV.
B) 5 mg IV.
C) 1 mg IM.
D) 10 mg IM.
C) 1 mg IM.
Page Ref: 602
Objective: 23.10 Given a scenario with a patient suffering a diabetic emergency, provide emergency medical care for the patient; 23.11 Identify indications and contraindications to the administration of oral glucose, intravenous dextrose, and intramuscular glucagon.
Which of the following statements regarding a hyperosmolar hyperglycemic state (HHS) relative to diabetic ketoacidosis (DKA) is TRUE?
A) Blood glucose in a patient with HHS is lower than in the patient with DKA.
B) There is a lack of ketone formation in a patient with HHS.
C) Alkalosis results from inadequate tissue perfusion in a patient with HHS.
D) Glucose is unavailable for metabolism in HHS.
B) There is a lack of ketone formation in a patient with HHS.
Page Ref: 600-601
Objective: 23.7 Compare and contrast diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
Your patient is a 28-year-old man who is found unconscious, breathing deeply and rapidly with a weak, rapid pulse. The patient’s skin is warm with dry mucous membranes and you note a fruity odor to the breath. Treatment for this patient would EXCLUDE:
A) isotonic IV fluid administration.
B) high-flow oxygen by mask.
C) possible dextrose administration.
D) oral glucose.
D) oral glucose.
Page Ref: 602
Objective: 23.11 Identify indications and contraindications to the administration of oral glucose, intravenous dextrose, and intramuscular glucagon.
What is the recommendation of the American Diabetes Association for diabetic patients’ HbA1c levels?
A) Greater than or equal to 8.0 percent
B) 6.5 percent or less
C) 1.5 percent
D) 9 percent
B) 6.5 percent or less
Page Ref: 599
Objective: 23.3 Given a patient’s blood glucose level, determine whether it is within normal limits.
Which of the following statements regarding glucose use by the cells is TRUE?
A) The brain can convert to using fats for energy.
B) The brain requires insulin to absorb glucose.
C) Glycogen is stored in the pancreas for cellular use.
D) Brain cells require glucose to function.
D) Brain cells require glucose to function.
Page Ref: 595
Objective: 23.4 Recognize the brain’s particular sensitivity to decreased blood glucose levels.
The basis of the excessive urination characteristic of untreated diabetes is called:
A) facilitated elimination.
B) osmotic diuresis.
C) gluconeogenesis.
D) facilitated diffusion.
B) osmotic diuresis.
Page Ref: 601
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Your patient is a 38-year-old man with diabetes who took his insulin, but he is ill and can’t keep anything down. He is so dehydrated that you are unable to start an IV line. Which of the following statements regarding glucagon is TRUE?
A) 50 mg of glucagon IM will allow the release of glucose from the liver.
B) Adequate glycogen stores must be available in the liver for it to be effective.
C) Glucose molecules are synthesized from stores of fat in the spleen.
D) Glucagon is metabolized slowly to provide a steady source of energy.
B) Adequate glycogen stores must be available in the liver for it to be effective.
Page Ref: 602
Objective: 23.5 Predict the consequences of insufficient glycogen stores.
For the AEMT, which of the following is the MOST important question to ask of a diabetic patient or his family members?
A) When was the last time you ate?
B) Do you have a fruity taste in your mouth?
C) Does diabetes run in your family?
D) What kind of insulin do you take?
A) When was the last time you ate?
Page Ref: 597
Objective: 23.8 Describe how to conduct direct history taking and assessment to obtain information relevant to the patient with a diabetic emergency.
For a critical patient with type 2 diabetes in a hyperosmolar hyperglycemic state, you would document each of the following in the patient care report EXCEPT:
A) the patient’s initial SpO2 was 94 percent.
B) the patient was unresponsive.
C) a rapid physical examination was performed.
D) the patient’s family history is unknown.
D) the patient’s family history is unknown.
Page Ref: 597
Objective: 23.13 Document the assessment and management of a patient with a diabetic emergency.
You respond for a patient who tells you he has hypothyroidism. Which of the following signs or symptoms would you expect?
A) A patient who is much thinner than normal
B) Eyes that seem to protrude
C) Fatigue and a lack of energy
D) Evidence of increased thyroid activity
C) Fatigue and a lack of energy
Page Ref: 603
Objective: 23.14 Give a brief overview of the pathophysiology and the signs and symptoms of hyperthyroidism and hypothyroidism.
Which of the following is TRUE regarding Cushing’s disease?
A) It is the result of increasing intracranial pressure.
B) It is the result of a tumor on the pituitary gland.
C) It often results from damage to the adrenal cortex.
D) It presents with hypotension that does not respond to fluid therapy.
B) It is the result of a tumor on the pituitary gland.
Page Ref: 604
Objective: 23.15 Give a brief overview of the pathophysiology and the signs and symptoms of disorders of the adrenal glands, including Cushing’s syndrome and Addison’s disease.
What is the only organ in the body that does NOT require insulin in order for glucose to enter its cells?
A) Liver
B) Pancreas
C) Heart
D) Brain
D) Brain
Page Ref: 595
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
If insulin production and secretion are insufficient for metabolic needs:
A) glucose will enter the cells more efficiently.
B) glucose will rapidly decrease in the bloodstream.
C) metabolism will not be affected.
D) glucose will accumulate in the bloodstream.
D) glucose will accumulate in the bloodstream.
Page Ref: 599-600
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Which of the following are common complications of diabetes?
A) Blindness, peripheral neuropathy, and kidney failure
B) Autoimmune disease, adrenal disease, and sepsis
C) Myxedema, cardiac disease, stroke
D) Gangrene, hemorrhagic stroke, high cholesterol
A) Blindness, peripheral neuropathy, and kidney failure
Page Ref: 598
Objective: 23.9 List common complications of diabetes.
Which of the following blood glucose readings would you see in a patient in a hyperosmolar hyperglycemic state?
A) 60 mg/dL.
B) 80 mg/dL.
C) 300 mg/dL
D) 900 mg/dL
D) 900 mg/dL
Page Ref: 600
Objective: 23.7 Compare and contrast diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
Type 1 diabetes mellitus is characterized by:
A) excessive insulin production.
B) insufficient insulin production.
C) insufficient glucose production.
D) excessive glucose production.
B) insufficient insulin production.
Page Ref: 598
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
In which of the following conditions would you find a patient with myxedema?
A) Hyperthyroidism
B) Graves’ disease
C) Hypothyroidism
D) Addison’s disease
C) Hypothyroidism
Page Ref: 603
Objective: 23.14 Give a brief overview of the pathophysiology and the signs and symptoms of hyperthyroidism and hypothyroidism.
Type 2 diabetes occurs when there is both a decrease in the amount of insulin produced and a decrease in:
A) glucose in the bloodstream.
B) cellular response to insulin.
C) insulin use by the brain cells.
D) insulin entering the cells for metabolism.
B) cellular response to insulin.
Page Ref: 598
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Under stress, cortisol from the adrenal glands stimulates an increase in ________, and thus an increase in BGL, to provide energy.
A) glucose
B) insulin
C) glucagon
D) fatty acids
C) glucagon
Page Ref: 595
Objective: 23.2 Describe the pathophysiology of type 1 and type 2 diabetes mellitus.
Exophthalmos, in which swelling of the tissues behind the eyes causes the eyes to protrude, is characteristic of which of the following disorders?
A) Graves’ disease
B) Cushing’s syndrome
C) Addison’s disease
D) Diabetic ketoacidosis
A) Graves’ disease
Page Ref: 603
Objective: 23.14 Give a brief overview of the pathophysiology and the signs and symptoms of hyperthyroidism and hypothyroidism.
The signs and symptoms related to hypoglycemia have a(n) ________ onset.
A) slow
B) unpredictable
C) delayed
D) rapid
D) rapid
Page Ref: 601
Objective: 23.6 Compare and contrast the speed of onset and signs and symptoms of hypoglycemia and hyperglycemia.
When using the mnemonic AEIOU TIPS to assess a patient to determine causes of altered mental status, what issue does the “I” in TIPS remind you to investigate?
A) Infection
B) Infiltration
C) Insulin
D) Ischemia
C) Insulin
Page Ref: 597, Table 23-3
Objective: 23.13 Document the assessment and management of a patient with a diabetic emergency.
When assessing a patient with type 2 diabetes, which of the following is an oral antihyperglycemic medication you might document that the patient takes?
A) Levothyroxine
B) Methimazole
C) Propylthiouracil
D) Chlorpropramide
D) Chlorpropramide
Page Ref: 597, Table 23-4
Objective: 23.13 Document the assessment and management of a patient with a diabetic emergency.
When assessing a patient, what symptom might be present to help determine that the patient has Cushing’s syndrome versus Addison’s disease?
A) Hyperpigmentation of skin and gums
B) Fatigue
C) Inability to respond to stressors
D) “Moon face” appearance
D) “Moon face” appearance
Page Ref: 604, Table 23-9
Objective: 23.13 Document the assessment and management of a patient with a diabetic emergency.
