CH 24 Flashcards
A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will likely find that the patient is:
- hyperglycemic.
- tachypneic.
- breathing deeply.
- dehydrated.
Tachypneic.
Which of the following would the paramedic likely administer to a patient with diabetic ketoacidosis?
- Insulin
- Hydrocortisone
- Magnesium
- Isotonic fluid
Isotonic fluid
A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man’s wife, he has had a fever and flulike symptoms for the past few days. She further tells you that he has “stuck to his diet” as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads “high.” This patient is most likely:
- experiencing hyperosmolar nonketotic coma.
- significantly acidotic and requires bicarbonate.
- hyperglycemic secondary to being dehydrated.
- producing ketones due to fat metabolism.
Experiencing hyperosmolar nonketotic coma
Which of the following is a common symptom of type 2 diabetes?
- Thirst
- Cool, clammy skin
- Dysuria
- Tachycardia
Thirst
Which of the following is consistent with hyperosmolar hyperglycemic syndrome?
- Glucose, 612 mg/dL; pH, 7.39; ketone bodies, absent
- Glucose, 500 mg/dL; pH, 7.20; ketone bodies, absent
- Glucose, 420 mg/dL; pH, 7.25; ketone bodies, present
- Glucose, 340 mg/dL; pH, 7.29; ketone bodies, present
Glucose, 612 mg/dL; pH, 7.39; ketone bodies, absent.
Hyperglycemia is characterized by:
- a blood glucose level above 110 mg/dL.
- shallow respirations and bradycardia.
- a gradual onset and warm, dry skin.
- a rapid onset and cool, clammy skin.
A gradual onset and warm, dry skin
You receive a call to the county jail for a male inmate who is unresponsive. According to the jailer, the patient was arrested for being “drunk.” Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient’s ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should:
- conclude that he will require immediate definitive care and begin transport.
- give him 1 mg of glucagon IM and reassess his blood glucose.
- administer a second dose of dextrose and prepare for immediate transport.
- intubate his trachea to prevent aspiration and transport him immediately.
administer a second dose of dextrose and prepare for immediate transport.
If the body experiences a drop in volume or blood pressure:
- catecholamine release inhibits the conversion of glycogen to glucose in the liver.
- aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
- adrenocorticotropic hormone causes a reduction in the secretion of cortisol.
- aldosterone stimulates the sweat glands, resulting in diaphoretic skin.
aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
A patient with Cushing syndrome would most likely present with:
- hyperglycemia.
- acute hyperactivity.
- decreased urination.
- thickened skin.
Hyperglycemia.
A 50-year-old male with a history of long-term alcohol abuse presents with dull epigastric pain that is worse when he is lying flat. What should you suspect?
- Pancreatitis
- Addisonian crisis
- Addison disease
- Cushing syndrome
Pancreatitis
Secretion of parathyroid hormone is regulated by blood levels of:
- calcium.
- phosphorus.
- sodium.
- potassium.
Calcium
Unlike hypothyroidism, hyperthyroidism:
- causes an increase in oxygen demand.
- often results in acute myxedema coma.
- causes a decrease in the metabolic rate.
- results in a decreased cardiac output.
Causes an increase in oxygen demand.
Patients with hyperosmolar hyperglycemic nonketotic coma:
- present with severe dehydration and neurologic deficits.
- typically require prehospital sodium bicarbonate therapy.
- experience more severe acidosis than patients with diabetic ketoacidosis.
- most commonly have a history of type 1 diabetes mellitus.
Present with severe dehydration and neurologic deficits.
The chief clinical manifestation of addisonian crisis is:
- dehydration.
- lower back pain.
- shock.
- an elevated temperature.
Shock
Diabetic ketoacidosis occurs when:
- blood glucose levels rise above 250 mg/dL.
- insulin production exceeds glucagon production.
- the renal system begins to excrete ketones.
- the cells metabolize fat and produce ketones.
The cells metabolize fat and produce ketones.
Unlike the patient with hypoglycemia, the patient with severe hyperglycemia:
- has a normal breath odor.
- rapidly improves with treatment.
- usually does not vomit.
- is tachypneic and hyperpneic.
Is tachypneic and hyperpneic
A decrease in adrenal hormone production will result in which of the following symptoms?
- Hypertension
- Weakness
- Hypoglycemia
- Darkening of skin on the neck
Weakness
The primary role of cortisol is to:
- decrease the body’s inflammatory response.
- maintain an adequate blood pressure.
- regulate the metabolism of carbohydrates.
- assist with the body’s response to stress.
Assist with the Body’s response to stress
Which of the following is a microvascular complication of diabetes?
- Hyperglycemia
- Hypertension
- Diuresis
- Retinopathy
Retinopathy.
Insulin resistance occurs when:
- the pancreas produces enough insulin, but the body cannot utilize it effectively.
- the body produces excessive insulin, which causes a profound drop in blood glucose.
- autoantibodies break down insulin before it can be utilized by the body.
- the release of epinephrine and norepinephrine renders insulin less effective.
The pancreas produces enough insulin, but the body cannot utilize it effectively.
When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced:
- serum glucose levels will fall and brain damage may occur.
- the cells will metabolize oxygen and function normally.
- the body will stop making glucose as a protective mechanism.
- glucose levels in the blood and urine will be elevated.
Glucose levels in the blood and urine will be elevated
If there is an increased level of antidiuretic hormone in the bloodstream, then:
- the renal tubules are stimulated to reabsorb sodium and water.
- blood pressure decreases secondary to dilation of the vessels.
- the kidneys excrete excessive sodium and water from the body.
- potassium, phosphorus, and magnesium are lost through diuresis.
The renal tubules are stimulated to reabsorb sodium and water
Which of the following statements regarding insulin is correct?
- Insulin is a pancreatic hormone that performs exocrine functions.
- Insulin is the only hormone that decreases blood glucose levels.
- An increase in insulin levels causes an increase in blood glucose.
- Insulin stimulates the conversion of glycogen to glucose.
Insulin is the only hormone that decreases blood glucose levels
The endocrine component of the pancreas:
- releases epinephrine and norepinephrine.
- secretes digestive enzymes into the duodenum.
- comprises the islets of Langerhans.
- comprises the pancreatic duct.
comprises the islets of Langerhans.
The clinical presentation of a hypoglycemic patient would most likely resemble that of a patient with:
- alcohol intoxication.
- a hemorrhagic stroke.
- an opiate overdose.
- classic heatstroke.
Alcohol intoxication
A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will likely find that the patient is:
• breathing deeply.
• hyperglycemic.
• tachypneic.
• dehydrated.
Tachypneic.
Which of the following would cause hypoglycemia in the patient with type 1 diabetes?
• Insulin underdose
• High-protein diet
• Inactivity
• Too much insulin
Too much insulin.
