Chapter 19 Study Plan
Which of the following blood glucose levels is considered normal for an adult? A. 80 mg/dL B. 40 mg/dL C. 180 mg/dL D. 150 mg/dL
A. 80 mg/dL
Which of the following is characteristic of a patient with hyperglycemia? A. A "fruity" odor of the breath B. Sudden onset of altered mental status C. Use of excessive amounts of insulin or lack of adequate food intake D. Cool, moist skin, agitated behavior, and increased heart rate
A. A "fruity" odor of the breath
Which of the following is the medical name of a stroke that is defined as the death or injury of brain tissue that has been deprived of oxygen? A. Cerebral vascular accident B. Carotid vessel aneurysm C. Cerebral vascular aneurysm D. Carotid vascular accident
A. Cerebral vascular accident A cerebral vascular accident (CVA) is the medical term for a stroke.
Which of the following is NOT a sign or symptom of stroke? A. Chest pain B. Vomiting C. Seizure D. Sudden impairment of vision
A. Chest pain
Which of the following is a standardized test to evaluate a conscious patient for possible stroke? A. Cincinnati Prehospital Stroke Scale B. Michigan TIA Assessment C. The Numbness-Aphasia-Paralysis (NAP) Test D. The Functional Analysis Stroke Test
A. Cincinnati Prehospital Stroke Scale
Which of the following is the LEAST important question in obtaining the history of a seizure patient in the prehospital setting? A. Does the patient have a family history of seizures? B. How did the patient behave during the seizure? C. What was the patient doing before the seizure? D. Did the patient lose control of his bladder?
A. Does the patient have a family history of seizures?
Your patient is a 19-year-old female who is 7 months pregnant. She just experienced a seizure. Although she has no previous history of seizures or any other medical condition, she was just diagnosed with pregnancy-induced hypertension. Which of the following is the most likely cause of the seizure? A. Eclampsia B. Hypoglycemia C. Trauma D. Any of the above
A. Eclampsia
Which of the following is a typical cause of seizures in children 6 months to 3 years of age? A. Fever B. Asthma C. Administration of glucose to a hyperglycemic patient D. Chest pain
A. Fever
Which of the following is a type of stroke in which a blood vessel in the brain has ruptured? A. Hemorrhagic B. Occlusive C. Ischemic D. Aneurysm
A. Hemorrhagic A hemorrhagic stroke is one in which a blood vessel ruptures and results in a space-occupying hematoma. Not only does this reduce distal blood flow, but the pressure buildup can cause ICP damage. Although an aneurysm frequently leads to bleeding, it can exist as simply a ballooning of the vessel. Ischemic and occlusive strokes occur because the vessel has been blocked.
Which of the following categories should be assigned to a patient who presents with an acute change in his or her mental status? A. High priority B. Delayed candidate C. Moderate priority D. Low priority
A. High priority Every patient with a disturbance to the airway, breathing, or circulation or an acute change in mental status should be considered as a high priority for transport.
Which of the following terms BEST describes a type of stroke caused by a blood vessel in the brain that has been blocked, causing distal cells to begin to die? A. Ischemic B. Hemorrhagic C. Vasodilatory D. Aneurysm
A. Ischemic An ischemic stroke occurs when the cerebral artery is blocked by a clot or other foreign matter. The resulting diminishment or cessation of distal blood flow results in cellular ischemia and death if perfusion is not returned rapidly. A hemorrhagic stroke occurs as a result of bleeding. An aneurysm occurs due to blood seeping into the middle layers of a blood vessel.
Which of the following is characterized by sudden, temporary loss of consciousness caused by insufficient blood flow to the brain, with return of consciousness almost immediately on becoming supine? A. Syncope B. Transient ischemic attack (TIA) C. Concussion D. Reversible ischemic neurological disorder (RIND)
A. Syncope Syncope is a neurological condition characterized by the sudden, temporary loss of consciousness caused by insufficient blood flow to the brain, with recovery of consciousness almost immediately on becoming supine. Nearly half of all Americans will experience at least one episode of syncope during their lifetime. TIAs can cause neurological deficit but rarely cause unconsciousness. Concussion can cause unconsciousness but is not caused by interruption of blood flow to the brain.
Which of the items below is NOT part of the Cincinnati Prehospital Stroke Scale? A. Test for equal grip strength. B. Have the patient repeat a simple sentence. C. Test the patient for arm droop or lack of movement. D. Ask the patient to smile.
A. Test for equal grip strength.
Which of the following stroke screening methods relies on speech as one of the screening criteria? A. The Cincinnati Prehospital Stroke Scale B. Speech is not a criterion for any common stroke screening system C. The Los Angeles Prehospital Stroke Screen (LAPSS) D. Both the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen
A. The Cincinnati Prehospital Stroke Scale The Cincinnati Prehospital Stroke Scale utilizes speech as one of its criteria. During the test, the patient is asked to say a simple, familiar saying, and the ability to clearly do so is evaluated.
Which of the following may result in hypoglycemia in the diabetic patient? A. Vomiting after eating a meal B. Lack of exercise C. Failure to take insulin or oral diabetes medications D. Overeating
A. Vomiting after eating a meal
Which of the following is one of the most common characteristics of a stroke? A. Weakness on one side of the body B. Projectile vomiting C. Sudden onset of bizarre behavior D. Sudden, severe headache
A. Weakness on one side of the body
For the EMT, 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 had something to eat? B. Do you have a fruity taste in your mouth? C. Do you have a family history of diabetes? D. What kind of insulin do you take?
A. When was the last time you had something to eat?
Many factors that cause dizziness and syncope are generally related to the: A. brain. B. nervous system. C. lungs. D. kidneys.
A. brain.
The reticular activating system (RAS) is responsible for: A. consciousness. B. urinary output. C. blood glucose levels. D. hormone levels.
A. consciousness. The RAS is a series of neurological circuits in the brain that are responsible for consciousness. Although blood glucose levels, hormone levels, and urinary output all can affect consciousness, the RAS is the system that is responsible for it.
The basic primary fuel for the cell is: A. glucose. B. glucagon. C. oxygen. D. carbon dioxide.
A. glucose. Cellular metabolism, also known as cellular respiration, is the process in which, normally, molecules of glucose are broken down to produce energy for the body. There are two types of cellular metabolism: aerobic and anaerobic. Although oxygen is a necessary component in aerobic metabolism, it is not the primary fuel. Carbon dioxide is a byproduct of metabolism. Glucagon is a hormone.
A seizure that occurs spontaneously from an unknown cause is called: A. idiopathic. B. hypoxic. C. hypoglycemic. D. toxinic.
A. idiopathic.
The islets of Langerhans are located in the: A. pancreas. B. rear of the thyroid. C. kidneys. D. anterior neck.
A. pancreas. Component of the endocrine system, the islets of Langerhans are located in the pancreas and make insulin for the body. The kidneys are the location of the thyroid gland. The anterior neck houses the thyroid gland.
Treatment of someone with a seizure disorder includes all of the following except: A. placing a bite block in the patient's mouth so he does not bite his tongue. B. loosening restrictive clothing. C. placing the patient on the floor or ground. D. removing objects that might harm the patient.
A. placing a bite block in the patient's mouth so he does not bite his tongue.
A 16-year-old female has altered mental status. Her blood glucose is 40 mg/dl. This finding tells you that: A. the patient is hypoglycemic. B. the patient is hyperglycemic. C. the patient's blood glucose is normal. D. the glucometer has malfunctioned.
A. the patient is hypoglycemic. A blood glucose level below 60 mg/dl indicates hypoglycemia. Modern glucometers are typically very reliable, and the patient's altered mental status would help to confirm your finding.
TIA is a commonly accepted abbreviation for: A. transient ischemic attack. B. telephoned in advance. C. tube in airway. D. transported in ambulance.
A. transient ischemic attack. TIA is the medical abbreviation for "transient ischemic attack."
When a patient tells you that it feels as though the room is going round and round, the specific term for this symptom is: A. vertigo. B. petit mal seizure. C. dizziness. D. ataxia.
A. vertigo. The sensation that the room is spinning is called vertigo. Stroke patients sometimes complain of this sensation. Although the term "dizziness" can typically be used to describe vertigo, vertigo is the more specific term. Ataxia, or uncoordinated muscle movement, can result from vertigo. A petit mal seizure usually results in a brief loss of awareness.
Which of the following readings on the glucometer would be of concern to the EMT? A. 108 mg/dl B. 150 mg/dl C. 98 mg/dl D. 118 mg/dl
B. 150 mg/dl A blood glucose level over about 140 mg/dl indicates hyperglycemia and therefore would be concerning. That said, high blood glucose levels are rarely life threatening until they reach much higher levels.
The signs and symptoms of a transient ischemic attack (TIA) may last up to: A. 30 minutes. B. 24 hours. C. 6 hours. D. 1 hour.
B. 24 hours.
A patient who is experiencing a transient ischemic attack (TIA) may develop MOST of the same symptoms as a patient who is suffering a stroke. The key difference is that the signs and symptoms of a TIA usually disappear within: A. two to four weeks. B. 24 hours. C. two to three days. D. one week.
B. 24 hours. Patients who experience a TIA develop most of the same signs and symptoms as those who are experiencing a stroke. The key difference between a stroke and a TIA is that the signs and symptoms of a TIA disappear without any obvious permanent neurological deficits. The signs and symptoms of the TIA will typically resolve within one to two hours after the onset; however, they may last up to 24 hours.
A patient who demonstrates any one of the three symptoms from the Cincinnati Prehospital Stroke Scale has a(n) ________% chance of having an acute stroke. A. 50 B. 70 C. 80 D. 60
B. 70
What is epilepsy? A. A condition caused by congenital brain abnormalities that causes seizures only twice a year. B. A condition in which a person has multiple seizures usually controlled by medication. C. A condition in which a person has general seizures that start in childhood. D. A condition in which a person has an aura followed by seizure usually controlled by medication.
B. A condition in which a person has multiple seizures usually controlled by medication.
Which of the following is within the EMT's scope of practice for the treatment of the diabetic patient? A. Assisting the patient with the administration of his insulin B. Administration of oral glucose C. Rectal administration of glucose D. Both A and B
B. Administration of oral glucose
Which of the following is the cause of most strokes? A. A ruptured cerebral artery due to hypertension B. Blockage of an artery supplying part of the brain C. A ruptured cerebral artery due to an aneurysm D. A spasm in an artery supplying part of the brain
B. Blockage of an artery supplying part of the brain
Which of the following is MOST likely to cause an altered mental status? A. Hypertension B. Hypoxia C. Dizziness D. Headache
B. Hypoxia Although any of these factors can influence mental status, hypoxia should always be considered first as the possible cause of altered mental status.
Your patient is a 59-year-old female with a sudden onset of slurred speech and weakness on her right side. Which of the following measures is appropriate? A. Test the patient's sensation with a series of pinpricks, beginning at the feet and working upward. B. Immediately transport the patient to a hospital with specialized treatment for stroke patients. C. Administer oral glucose and then assess the patient's blood sugar. D. Keep the patient in a supine position.
B. Immediately transport the patient to a hospital with specialized treatment for stroke patients.
Which statement below is NOT true about seizures? A. A generalized seizure affects the entire brain. B. Many seizures are followed by an aura. C. A partial seizure affects one part, or one side, of the brain. D. The most common seizure that EMTs are likely to be called on is a tonic-clonic seizure.
B. Many seizures are followed by an aura.
A patient who loses the ability to speak or feel sensations is experiencing what type of deficit? A. Hemorrhagic B. Neurological C. Urinary D. Muscular
B. Neurological A neurological deficit is one that causes a change in the patient's mental status or other neurological finding and is caused by some type of disturbance or injury to the neurological system itself.
Which of the following findings from the SAMPLE and OPQRST history of a seizure patient is of GREATEST concern to the EMT? A. The patient has a history of diabetes. B. The patient stopped taking his antiseizure medicine. C. The patient is being treated for hypertension. D. The patient does not have a history of epilepsy.
B. The patient stopped taking his antiseizure medicine. Although all the information is relevant, a patient who is on medicine for seizures has an active condition that is being treated to keep the seizures from recurring. If the patient stops taking that medicine, the seizures will start to break through again and may lead to a status epilepticus situation.
You have arrived on the scene of a call for a possible stroke. On your arrival, the patient denies signs and symptoms, is alert and oriented, and moves all extremities well. Her husband states that before you arrived the patient could not move her right arm and the left side of her face seemed to be "slack." Which of the following has most likely occurred? A. The patient is suffering from aphasia. B. The patient suffered a transient ischemic attack. C. The patient has had a subarachnoid hemorrhage. D. The patient suffered a stroke.
B. The patient suffered a transient ischemic attack.
To which of the following hypoglycemic seizure patients should the EMT administer oral glucose? A. The seizure patient who is still in the tonic phase B. The postictal patient who can manage his or her own airway C. The actively seizing patient D. The postictal patient who has sonorous breathing
B. The postictal patient who can manage his or her own airway The EMT cannot administer oral glucose to a patient who cannot manage his or her own airway. Oral glucose can be given when the patient is in the postictal phase and is able to manage his or her own airway.
Many diabetics today have an insulin pump. Which of the following statements about insulin pumps is NOT true? A. They are about the size of an MP3 player or a pager. B. They are usually worn around the ankle. C. They have a catheter that enters into the abdomen. D. They are usually worn on the belt.
B. They are usually worn around the ankle.
The condition in which there is an insufficient amount of sugar in the blood is called: A. hyperglycemia. B. hypoglycemia. C. diabetic ketoacidosis. D. diabetic coma.
B. hypoglycemia.
A hormone called insulin is secreted by the: A. gallbladder found in the pancreas. B. islets of Langerhans in the pancreas. C. islets of Langerhans in the liver. D. None of the above.
B. islets of Langerhans in the pancreas
If you suspect that your unresponsive patient suffered a syncopal episode but he did not regain consciousness within a few moments, then: A. you should administer an ammonia ampoule. B. it is likely something more serious than a syncopal episode. C. you should perform a sternal rub. D. you should administer oral glucose.
B. it is likely something more serious than a syncopal episode. The definition of syncope includes rapid recovery of consciousness (usually less than a minute) once the patient is in a supine position and blood flow to the brain improves. If a patient does not spontaneously regain consciousness within a few moments, the EMT should consider that something more serious caused the unconsciousness. You should not administer anything orally to an unconscious patient. Take great care with noxious or painful stimuli, as they can cause harm in the patient.
You respond to a 32-year-old female who is having a seizure. You arrive on the scene to find the patient drowsy, confused, and complaining of a headache. This patient is demonstrating the: A. tonic phase. B. postictal phase. C. aura phase. D. clonic phase.
B. postictal phase.
A 26-year-old female complains of six hours of vomiting and diarrhea. She is dizzy and lightheaded but feels better while lying down. If you were to take her blood pressure and pulse after sitting her up, you would expect the: A. pulse to drop and blood pressure to increase. B. pulse to increase and blood pressure to drop. C. pulse to increase and blood pressure to increase. D. pulse to drop and blood pressure to drop.
B. pulse to increase and blood pressure to drop. Postural changes in a hypovolemic patient will result in an increase in pulse rate and a drop in blood pressure.
A prolonged generalized seizure or two or more seizures without the patient regaining consciousness in between are known as: A. postictal stasis. B. status epilepticus. C. clonic infinitus. D. petit corpus.
B. status epilepticus. Status epilepticus is a life-threatening prolonged seizure or consecutive seizures without the patient regaining consciousness in between.
The medical term for fainting is: A. dehydration. B. syncope. C. altered RAS status. D. vertigo.
B. syncope.
Which of the following are the MOST important treatment elements to consider in transporting a patient with possible stroke, seizures, coma, or headache? A. Maintaining a state of hyperoxia to reduce swelling B. Airway, oxygen, and glucose levels C. Medication levels D. The administration of antiemetics
B. Airway, oxygen, and glucose levels Your treatment must remain focused on assessing and maintaining the patient's airway, oxygen, and glucose levels. Rapid identification and early notification to your receiving facility are also key in achieving successful recovery from strokes and other neurological impairments.
What is the cause of most strokes?
Blockage of an artery supplying part of the brain
Which of the following refers to difficulty in speaking or understanding speech as a result of a stroke? A. Ataxia B. Ischemia C. Aphasia D. Hemiparesis
C. Aphasia
Which is NOT one of the steps in managing a patient experiencing dizziness and syncope? A. Lay the patient flat. B. Loosen any tight clothing around the neck. C. Apply cold packs to the patient's head. D. Administer oxygen.
C. Apply cold packs to the patient's head.
Which of the following is a probable cause of dizziness? A. External otitis B. Aphasia C. Blood loss D. Ataxia
C. Blood loss Blood loss is a probable cause of dizziness. Aphasia is an inability to speak. Ataxia refers to a loss of muscle coordination, as in difficulty walking. Although otitis media (inner ear infection) typically causes dizziness, external otitis is not a cause of dizziness.
Which of the following would be an acceptable substitute for the administration of commercially prepared oral glucose solution? A. Having the patient eat something high in protein, such as a deli sandwich B. Diet soda C. Cake icing D. Having the patient eat a banana
C. Cake icing
Which of the following is the most common cause of seizures in adults? A. Withdrawal from alcohol B. Head trauma C. Failure to take prescribed medication D. Fever
C. Failure to take prescribed medication
A 50-year-old female patient has been found unconscious and unresponsive. She is breathing rapidly and is diaphoretic. Her vital signs are P 130, R 30, BP 140/80. Which of the following conditions would most likely explain these findings? A. High blood pressure B. TIA C. Hypoglycemia D. Beta-blocker overdose
C. Hypoglycemia Given the patient's signs and symptoms, the most likely probable cause is diabetes. Diaphoresis and tachycardia are common findings associated with low blood sugar. A TIA can cause altered mental status but rarely results in frank unconsciousness. A beta-blocker overdose would result in a slow heart rate and would be far less common than hypoglycemia.
A 19-year-old male is found combative after a prolonged asthma attack. Which of the following reasons would best explain the altered mental status in this patient? A. Overdose of asthma medications B. Acute psychosis C. Hypoxia D. Fear and anxiety
C. Hypoxia In a patient with a prolonged asthma attack, any altered mental status should be assumed to be the result of hypoxia. Although fear, anxiety and even overdose could explain this finding, each of these explanations is significantly less likely than hypoxia. Psychosis would not be a likely explanation.
Which of the following conditions may be mimicked by hypoglycemia? A. Heart attack B. Respiratory distress C. Intoxication D. All of the above
C. Intoxication
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 circulating level of glucose in the blood. C. It increases the movement of sugar from the bloodstream to the cell. D. It blocks the uptake of sugar by the body's cells.
C. It increases the movement of sugar from the bloodstream to the cell.
Your patient is a 19-year-old male who was reportedly unconscious for a brief time. You learn that he regained consciousness in about 30 seconds. You find no evidence of drowsiness or neurological deficits. Which of the following is MOST likely the cause? A. Stroke B. Hyperglycemia C. Syncope D. Status epilepticus
C. Syncope On the basis of the findings, syncope is the most likely cause, as other conditions would likely have a much longer recovery time. Although a seizure would also explain these findings, status epilepticus would involve a prolonged seizure (longer than 10 minutes), which does not appear to be the case in this scenario. Hyperglycemia frequently causes altered mental status but not for brief periods. Stroke does not usually lead to unconsciousness.
Which of the following BEST describes status epilepticus? A. A seizure that occurs without a known cause B. A period of drowsiness following tonic-clonic seizures C. Two or more seizures with tonic-clonic activity without an intervening period of consciousness D. A seizure involving convulsions on only one side of the body
C. Two or more seizures with tonic-clonic activity without an intervening period of consciousness
A 69-year-old female complains of acute-onset slurred speech. She also notes difficulty moving her right arm. She has no history of diabetes and was feeling fine before the onset. You should suspect that: A. the patient had a transient ischemic attack the day before. B. electrical activity in the brain has caused the cells to conduct nerve impulses. C. at least a portion of the patient's brain is not receiving an adequate blood supply. D. the amount of glucose in the brain is more than sufficient to support cellular function.
C. at least a portion of the patient's brain is not receiving an adequate blood supply. There could be several reasons for the patient's slurred speech, but the most likely explanation is that her brain is not receiving an adequate blood supply. The symptoms that she demonstrates indicate ischemia from a stroke. Although hypoglycemia is possible, a lack of diabetes makes this less likely.
Which of the following substances specifically nourishes the brain to enable consciousness? A. carbon dioxide B. water C. glucose D. oxygen
C. glucose Although water and oxygen are necessary for the brain to maintain consciousness, glucose specifically provides nourishment. Carbon dioxide is the byproduct of the metabolism that transforms glucose into energy.
Your patient is a 70-year-old man whose wife called EMS because her husband began exhibiting unusual behavior. Upon your arrival you introduce yourself to the patient, who responds, "Not until nine o'clock." This phenomenon is BEST described as: A. expressive aphasia. B. unresponsive to verbal stimuli. C. receptive aphasia. D. disorientation to time.
C. receptive aphasia
Your DKA patient has rapid breathing and a fruity odor on his breath. This is likely due to: A. acute hypoglycemia. B. the rapid onset of symptoms. C. the presence of ketones. D. too much insulin.
C. the presence of ketones. Ketones are a byproduct product of the acidosis associated with DKA and often cause rapid breathing and a fruity odor. DKA is caused by a lack of insulin and extremely high blood glucose levels.
Emergency medical care of the unresponsive patient who has a nontraumatic brain injury may include: A. placing the unresponsive patient in the Trendelenburg position. B. applying low-concentration oxygen by face mask. C. ventilating the patient who has inadequate breathing. D. placing the unresponsive patient in the prone position.
C. ventilating the patient who has inadequate breathing. Hypoxia is one of the most common causes of death associated with brain injury. If any patient displays ventilatory inadequacy, the EMT will need to immediately institute positive-pressure ventilations with oxygen. Remember that if the patient is breathing inadequately, supplemental oxygen is not enough. Positive-pressure ventilations must be initiated. Brain-injured patients should not be positioned prone or in Trendelenburg position.
With advances in clot-busting (thrombolytic) drugs, the patient has a window of ________ hours to receive treatment. A. 4 B. 6 C. 5 D. 3
D. 3
When assessing a patient for a possible stroke, which of the following three functions should be tested by the EMT? A. Memory, ability to speak, and ability to track movement with the eyes B. Ability to walk, control of facial muscles, and balance C. Ability to walk, ability to hold both arms in an extended position for 10 seconds, and ability to name common objects D. Control of facial muscles, ability to speak, and ability to hold both arms in an extended position for 10 seconds
D. Control of facial muscles, ability to speak, and ability to hold both arms in an extended position for 10 seconds
Which of the following is LEAST important for the patient who has stopped seizing before the EMT's arrival at the scene? A. Suctioning B. Checking for mechanism of injury C. Administering oxygen D. Determining when the patient was last transported to the hospital for seizures
D. Determining when the patient was last transported to the hospital for seizures
If the blood sugar level is very high, which of the following may result? A. Polyuria and hyperactivity B. Excessive insulin, excessive glucose, and excessive urination C. Hyperactivity, excessive thirst, and polyuria D. Excessive urination, excessive thirst, and excessive hunger
D. Excessive urination, excessive thirst, and excessive hunger
Following a period of confusion and disorientation, your patient has weakness and loss of movement in his right arm and right leg. Which of the following is the MOST likely explanation? A. He is probably postictal from a seizure. B. He has likely suffered a stroke in both hemispheres. C. He is probably hypoglycemic. D. He has likely suffered a stroke in his left hemisphere.
D. He has likely suffered a stroke in his left hemisphere. Although there could be several causes, the most accurate explanation is that the patient has likely suffered a stroke in his left hemisphere. Although seizures and hypoglycemia can cause similar neurological symptoms, the most likely explanation is stroke.
A severe headache is more common with what kind of stroke? A. Occlusive B. Transient C. Ischemic D. Hemorrhagic
D. Hemorrhagic Severe headache is more common with hemorrhagic strokes and may be due to a ruptured blood vessel.
Which of the following is the role of glucose in the body? A. It is an essential building block for body tissues, such as muscle and bone. B. It assists the pancreas in the manufacture of insulin. C. It allows the body to use insulin. D. It provides energy for brain cells and other cells in the body.
D. It provides energy for brain cells and other cells in the body.
Compared to hypoglycemia, which of the following is true of hyperglycemia? A. Its onset is more sudden. B. Its onset is preceded by an aura, such as hallucinations or detecting unusual odors. C. It is more easily treated in the prehospital environment than hypoglycemia. D. Its onset is more gradual.
D. Its onset is more gradual.
Your patient is a 21-year-old female with a history of epilepsy. She is having a convulsion upon your arrival. Which of the following should you do? A. Place a tongue depressor or spoon in the back of the mouth to prevent the patient from swallowing her tongue. B. Insert a bite block, cloth, wallet, or similar item between the patient's teeth to prevent her from biting her tongue. C. Restrain the patient's extremities to prevent injury from flailing of the arms and legs.
D. Move furniture and other objects away from the patient to prevent injury.
Your patient is a 44-year-old male with a history of diabetes. He is lying on the living room floor, unresponsive to all stimuli. He has a respiratory rate of 12 breaths per minute, heart rate of 112 beats per minute, and is pale and sweaty. Which of the following should you do to treat this patient? A. Encourage the patient's family to administer his insulin. B. Apply oral glucose solution to a tongue depressor and insert it between the patient's cheek and gums. C. Place the patient in the recovery position to protect the airway and place oral glucose solution under the patient's tongue. D. Place the patient in the recovery position, administer oxygen, and monitor his airway status.
D. Place the patient in the recovery position, administer oxygen, and monitor his airway status.
Your patient is an unresponsive 30-year-old male wearing a Medic-Alert bracelet indicating that he is a diabetic. The patient's coworkers came by his house to check on him when he did not show up for work and did not call in sick. Your assessment does not clearly indicate to you whether the patient may be hypoglycemic or hyperglycemic. Which of the following should you do next? A. Administer oral glucose, as it will not cause additional harm in hyperglycemia, but may prevent brain damage if the patient is hypoglycemic. B. Use the patient's glucometer to check his blood sugar level. C. Use your glucometer to check his blood sugar before taking any further action. D. Protect the patient's airway, administer oxygen, and consider assessing the patient's blood glucose per local protocol.
D. Protect the patient's airway, administer oxygen, and consider assessing the patient's blood glucose per local protocol.
Most of the diabetic emergencies that you will be called to deal with will be related to hypoglycemia. However, occasionally you will experience an instance of hyperglycemia. In the list below, which item is NOT likely to be a sign or symptom of hyperglycemia? A. Nausea B. Excessive urination C. Chronic thirst D. Reduced rate of breathing
D. Reduced rate of breathing
The most common medical emergency for the diabetic is hypoglycemia, or low blood sugar. Which one of the factors below is NOT a cause of hypoglycemia? A. Vomits a meal B. Takes too much insulin C. Overexercises or overexerts himself D. Reduces sugar intake by eating too much
D. Reduces sugar intake by eating too much
After a period of syncope lasting 30 seconds, your patient is now reporting a "fluttering" in his chest and generalized weakness. Which of the following is necessary? A. Having the patient sign a refusal and not transporting B. Administration of oral glucose C. Rapid transport to the hospital with lights and siren D. Requesting ALS to support the patient's care
D. Requesting ALS to support the patient's care Because the cause of the patient's symptoms may be cardiac, paramedics would be indicated to perform an ECG. Urgent transport is not indicated, given the current findings. Because there are no signs of hypoglycemia, oral glucose is not indicated. However, the patient should be transported and should not sign off.
Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the reticular activating system (RAS). The RAS has simple requirements to function properly. Which one of the following items is NOT one of those requirements? A. Water B. Glucose C. Oxygen D. Sodium
D. Sodium
Which of the following is the most critical piece of equipment to have immediately available for the seizure patient who has just stopped convulsing? A. Glucometer B. Bite block C. Cervical collar D. Suction
D. Suction
A 62-year-old male complains of weakness on one side of his body and slurred speech. After you arrive and evaluate the patient, you notice that the symptoms are beginning to subside. What is the likely cause of the patient's condition? A. Subdural hematoma B. Status epilepticus C. Acute coronary syndrome D. Transient ischemic attack
D. Transient ischemic attack When a patient has symptoms of a stroke and they begin to subside within the first day, this is referred to as a transient ischemic attack (TIA). Subdural hematomas can sometimes show periods of improvement but typically worsen quickly. Status epilepticus would be a prolonged seizure.
Which of the following would be an appropriate description of the reticular activating system? A. React and move center B. Feed or breed center C. Vegetative and thought center D. Wake and sleep center
D. Wake and sleep center The RAS is often referred to as the wake and sleep center or the on/off center because it determines whether the patient remains awake and aware of his or her surroundings or not. The RAS is continuously transmitting impulses about the patient's surroundings to the brain for constant stimulation and response.
Hyperglycemia is often due to: A. forgetting to eat. B. an insulin overdose. C. too much insulin. D. a lack of insulin.
D. a lack of insulin. Hyperglycemia is usually due to a lack of insulin. Without insulin, sugar cannot be transported out of the bloodstream to most cells.
A 45-year-old male presents agitated and confused. Your assessment identifies an oxygen saturation of 90%. You should next: A. administer oral glucose. B. conduct a Cincinnati Prehospital stroke examination. C. Restrain the patient for safety. D. administer oxygen.
D. administer oxygen. Oxygen therapy should be guided by the level of oxygen saturation in the blood (SpO2 reading) and presenting signs and symptoms, not by a predetermined oxygen concentration, liter flow, or device. If the SpO2 is 94% or lower or the patient shows signs of respiratory distress, hypoxia, hypoxemia, or poor perfusion, administer oxygen via nasal cannula at 2 to 4 lpm to maintain an SpO2 reading of 94% or more.
DKA patients are prone to: A. hypertension. B. bradycardia. C. hypoglycemia. D. dehydration.
D. dehydration. DKA patients often have an increased urinary output, leading to dehydration.
Many stroke patients are candidates for thrombolytic drugs. One of the most important things that an EMT can do to optimize the care of a stroke patient who is a candidate for the drugs is: A. transport the patient to a Level I Trauma Center. B. do a thorough physical exam of the patient. C. transport to the closest hospital since the patient must go to the operating room as soon as possible. D. determine the exact time of onset of symptoms.
D. determine the exact time of onset of symptoms.
There are two types of seizures; if your patient is having a seizure that affects only one body part and does not cause her to lose consciousness, it is called a: A. tonic-clonic seizure. B. postictal seizure. C. generalized seizure. D. partial seizure.
D. partial seizure.
A patient is considered to be in status epilepticus if: A. a patient with a history of medication-controlled seizures experiences a generalized seizure. B. the patient has two or more seizures consecutively with a period of responsiveness between them. C. the patient remains unresponsive after the seizure. D. the patient suffers two seizures without regaining consciousness in between.
D. the patient suffers two seizures without regaining consciousness in between. A patient is considered to be in status epilepticus if he or she is seizing for over five minutes or having seizures that occur consecutively without a period of responsiveness between them.
Which of the following BEST describes the term "hemiparesis"? A. Bilateral paralysis B. Bilateral weakness C. One-sided paralysis D. One-sided weakness
D. One-sided weakness Hemiparesis is a term that used to describe one-sided weakness. Hemiparalysis would describe one-sided paralysis.
Which of the following statements is TRUE about paralysis caused by stroke? A. It is difficult to distinguish stroke from spinal injury, as both can cause paralysis to both legs. B. It is common for both sides of the body to be paralyzed from stroke. C. It is a good sign when patients experience only weakness in the extremities, as they will not deteriorate further. D. Typically, paralysis from strokes affects only one side of the body.
D. Typically, paralysis from strokes affects only one side of the body. Motor function and fine sensory interpretation are controlled by the side of the brain opposite from the side of the body it innervates. Thus, if a patient has had a stroke in the right hemisphere of the brain, there will likely be findings on the left side of the body.
During your primary assessment you find your patient has an altered mental status. What could this indicate?
Failing respiratory system
For the reticular activating system (RAS) to work correctly, what three substances are needed?
Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and water to keep the brain hydrated
What is NOT a sign of a hypoglycemic diabetic emergency?
Slow heart rate
What does NOT correctly compare the signs and symptoms of hypoglycemia and hyperglycemia?
The hypoglycemic patient is usually complaining of a headache, whereas the hyperglycemic patient is not.
You have arrived on the scene of a call for a possible stroke. On your arrival, the patient denies signs and symptoms, is alert and oriented, and moves all extremities well. Her husband states that before you arrived the patient could not move her right arm and the left side of her face seemed to be "slack." Which of the following has most likely occurred?
The patient suffered a transient ischemic attack.
When someone is experiencing hypoglycemia, the body attempts to compensate by using the fight-or-flight mechanism of the autonomic nervous system. What is NOT one of the fight-or-flight responses?
The skin is hot and dry.
Your patient is waking up from a seizure; it was the patient's first seizure ever. When you ask what happened, the patient tells you she had the smell of fresh mown grass just before she seized. This sensation is known as a(n):
aura
As an EMT, you will be called on frequently to treat diabetic emergencies. Diabetic emergencies are usually caused by:
poor management of the patient's diabetes.
