Ch. 20 Post-Test

Which of the following findings is typically present in​ DKA, but NOT​ HHS? A. Kussmaul respirations B. Altered mental status C. Tachycardia D. Warm dry skin

A. Kussmaul respirations Note that there are no Kussmaul respirations or fruity odor on the breath with HHS because there is no significant buildup of ketones in the body and therefore no significant acid load. This is because the pancreas in HHS still produces enough insulin to prevent ketone​ formation, so the development of Kussmaul respirations is diminished. The patient will still have​ tachycardia, dehydration, and an altered mental status with either DKA or HHS.

What value found on the glucometer represents a blood glucose level​ (BGL) that is outside the normal range of a nonfasting​ patient? A. 128​ mg/dL B. 98​ mg/dL C. 148​ mg/dL D. 108​ mg/dL

C. 148​ mg/dL Blood glucose is measured in milligrams per deciliter​ (mg/dL). A normal blood glucose range is 70 to 140​ mg/dL in a nonfasting person. A reading lower than 70​ mg/dL may indicate a​ lower-than-normal level of glucose​ (sugar) in the​ blood, whereas a reading above 140​ mg/dL may indicate a​ higher-than-normal amount of glucose in the blood.

There are a number of medications taken by diabetics. Which of the following is NOT one of those​ medications? A. Orinase B. Diabinese C. Lasix D. Humalog

C. Lasix Lasix is a drug that is used to help manage extra fluid in the body for patients with heart problems.​ Orinase, Humalog, and Diabinese are used by diabetics in the regulation of blood sugar levels.

You are assessing an elderly male patient who is obese and in poor health. If the patient has an elevated blood glucose level and a history of​ diabetes, what should be your first assumption about the type of​ diabetes? A. Type 1 B. Type 4 C. Type 3 D. Type 2

D. Type 2 Type 2 diabetes is also referred to as​ noninsulin-dependent diabetes mellitus​ (NIDDM) because type 2 patients usually do not have to take insulin.​ However, they do have to regulate their​ diet, exercise, and take oral drugs to help the pancreas secrete more insulin or to make the insulin that is secreted more effective in facilitating movement of glucose into the cells. Type 2 diabetic patients are usually​ middle-aged or older. They are typically overweight.

An organ that does not need insulin to help move sugar into the cells is​ the: A. brain. B. pancreas. C. stomach. D. liver.

A. brain. The brain does not need insulin to help move glucose into the cells. Glucose will cross the​ blood-brain barrier​ readily, whether insulin is present or not.​ However, while the other cells and organs can use fats and proteins for​ energy, the brain can use only glucose. As glucose becomes depleted in the​ blood, the brain begins to suffer severely and begins to malfunction as it loses its energy source. If this condition is left​ untreated, the brain cells will eventually die.​ Therefore, a patient with a low blood glucose level is in a serious condition and requires immediate emergency care.

Which finding would be more suggestive of a hypoglycemic episode than of a hyperglycemic​ episode? A. Bradycardia B. BGL of 569​ mg/dL C. Dry mucous membranes D. Rapid onset of AMS

D. Rapid onset of AMS Because the brain relies on adequate glucose​ levels, if the glucose level​ drops, the mental status of the patient also rapidly deteriorates​ (faster than it would with​ hyperglycemia).

The clinical effects of diabetes can be​ include: A. changes in a​ patient's mental status due to changes in blood glucose levels. B. the inability of the body to store glucose. C. an increased sensitivity to insulin that raises blood sugar levels. D. a complete failure of the pancreas causing glucose and hepatic failure.

A. changes in a​ patient's mental status due to changes in blood glucose levels. Diabetes mellitus​ (DM) is a disease that frequently causes changes in the​ patient's mental status resulting from alterations in the blood glucose​ (blood sugar) level. Because there is not enough insulin to transport glucose into the​ cells, the cells cannot function​ properly, and this ultimately causes changes to the​ patient's mental status. Although diabetes results from inadequate production of​ insulin, this does not mean that there is complete failure of the pancreas. Diabetes can also result from a reduced sensitivity to​ insulin, not an increased sensitivity.​ Finally, the body of a person with diabetes can still store​ glucose; it just​ can't get sufficient levels into the cells.

During your assessment of a patient who is​ unresponsive, you obtain a BGL and find a value of 48​ mg/dL. What medical emergency might this help​ indicate? A. Neurological dysfunction syndrome B. Hypoglycemia C. Hypothyroidism D. Hypotension

B. Hypoglycemia Hypoglycemia ​(low blood​ glucose) is typically defined as a BGL of 70​ mg/dL or less with signs or symptoms of hypoglycemia. The primary sign of hypoglycemia is an altered mental status.

What is the priority treatment for a patient who has a blood glucose level of 48​ mg/dL? A. ​Semi-Fowler's positioning B. Prone positioning in case the patient vomits C. Administration of glucose D. AED application

C. Administration of glucose The patient who is suffering from hypoglycemia must be given sugar​ (glucose) to increase the blood glucose level as quickly as possible to prevent the brain cells from dying. Beyond​ this, you would also provide the same treatment as you would give to a patient with an altered mental status.

Which of the following interventions would NOT be provided for a patient with​ DKA? A. Placement of the patient in the recovery position B. Summoning ALS for backup C. Administration of oral glucose D. Administration of oxygen

C. Administration of oral glucose The patient with DKA already has an elevated blood sugar level. The use of oral glucose in this patient would not be​ beneficial, as the underlying cause is a lack of​ insulin, not a lack of available glucose. The other interventions—administering ​oxygen, placing the patient in the recovery​ position, and summoning ALS—would all be appropriate for this patient.

What hormone causes the liver to release​ glycogen? A. Insulin B. Epinephrine C. Glucagon D. Aldosterone

C. Glucagon The function of glucagon is exactly the opposite of​ insulin's function. Insulin is secreted when the blood glucose level is high and works to decrease the blood glucose level.​ Glucagon, by​ contrast, is secreted when the blood glucose level is low and works to increase the blood glucose level by getting the liver to release​ glycogen, which will be converted back to glucose in the blood stream. Epinephrine is secreted by the adrenal gland in response to sympathetic stimulation. Aldosterone is produced by the adrenal cortex and helps to regulate fluid balance.

Which of the following is a function of the hormone​ insulin? A. Causing the liver to release glycogen B. Causing the liver to convert glucose to glucagon C. Increasing the movement of glucose into the cells D. Increasing blood glucose levels

C. Increasing the movement of glucose into the cells Insulin is secreted when the blood glucose level is elevated. Insulin has three main​ functions: it increases the movement of glucose out of the blood and into the​ cells; it causes the liver to take the glucose out of the blood and convert it into​ glycogen, the stored form of​ glucose; and it decreases the blood glucose level by the actions listed​ above, facilitating the movement of the glucose into the cells and the liver. The liver releases glycogen in response to the hormone​ glucagon, which is released by the pancreas when the blood sugar level is low.

A blood sugar of less than​ 50mg/dL would be identified​ as: A. HHS. B. HHC. C. hypoglycemia. D. hyperglycemia.

C. hypoglycemia. Hypoglycemia ​(low blood​ glucose) is typically defined as a BGL of 70​ mg/dL or less with signs or symptoms of hypoglycemia. The primary sign of hypoglycemia is an altered mental status.

When the body has to rely on stored glycogen for​ energy, about how long does this stored energy last in a patient without liver​ disease? A. 12 to 24 hours B. 4 to 12 hours C. 1 to 8 hours D. 24 to 48 hours

D. 24 to 48 hours Glycogen that is stored in the liver can last for up to 24 to 48 hours. After​ that, there is typically no more glycogen left in the liver to be converted into​ glucose, and the blood glucose may drop​ drastically, while the body will begin to use fats and proteins at a high rate for energy.

Which of the following is an example of a simple​ sugar? A. Starches B. Sucrose C. Lactose D. Glucose

D. Glucose There are three major food sources for the​ body's cells:​ carbohydrates, fats, and proteins. Carbohydrates are a primary energy source for the cells. Three major sources of carbohydrates are sucrose​ (table sugar), lactose​ (milk and dairy​ products), and starches​ (potatoes, bread). These sugars are called complex sugars because of their structure. In the​ body, the complex sugars are broken down into simple sugars to be absorbed through the digestive tract and into the bloodstream. The simple sugars are​ glucose, galactose, and fructose.

As the​ patient's blood glucose level begins to​ drop, what other hormone starts to diminish in its​ secretion? A. Amylase B. ACTH C. Glucagon D. Insulin

D. Insulin As the blood glucose level​ decreases, the amount of insulin being secreted from the pancreas also decreases so as to slow or stop the continued drop in the BGL. When this​ occurs, there will be an increase in the glucagon as part of the negative feedback loop to increase the blood glucose level again toward normalcy. Adrenocorticotropic hormone​ (ACTH) is released by the pituitary gland for the adrenal​ cortex, and amylase is an enzyme that catalyzes the hydrolysis of starches into sugars.

You are caring for a patient with HHS who is unresponsive. For this​ patient, what is your goal for oxygen​ therapy? A. Maintain SpO2 between 95 and 100 percent B. Maintain SpO2 at 100 percent C. Maintain SpO2 greater than or equal to 90 percent D. Maintain SpO2 greater than or equal to 94 percent

D. Maintain SpO2 greater than or equal to 94 percent If the breathing is adequate and the SpO2 is greater than or equal to 94 percent and no other signs of respiratory​ distress, hypoxia,​ hypoxemia, or poor perfusion are​ present, there may be no need to administer supplemental oxygen. If the SpO2 is less than 94 percent or signs of respiratory​ distress, hypoxia,​ hypoxemia, or poor perfusion are​ present, administer oxygen via a nasal cannula to maintain an SpO2 reading of greater than or equal to 94 percent. If signs of severe hypoxia are​ present, a nonrebreather mask at 15 lpm could be used.

You are managing a patient who presents with​ unresponsiveness, ongoing​ seizures, heavy secretions in the​ airway, and a BGL of 38​ mg/dL. The patient is a known diabetic who took his insulin but did NOT eat due to ongoing nausea from a stomach virus.​ Finally, the seizure stops and the patient is in the unresponsive postictal phase with a pulse oximeter reading of 91 percent. What medication should the EMT​ administer? A. Nebulized bronchotherapy B. Regular insulin if prescribed to the patient C. Oral glucose D. Oxygen

D. Oxygen If there is a strong clinical correlation between the presenting finding being consistent with hypoglycemia and the presence of seizure​ activity, the EMTs first choice should be to elevate the blood glucose level.​ However, with an altered mental status and the possibility of the patient to aspirate the​ gel, it should be avoided. As​ such, the EMT should at least start oxygen therapy.

You are administering oral glucose to a patient via a tongue depressor when the patient suddenly experiences a grand mal seizure. What should be your next​ action? A. Immediately insert a bite stick into the​ patient's mouth. B. Finish the administration of oral glucose and place the patient on his side. C. Place the patient in a prone​ position, with his head elevated. D. Stop the administration of oral glucose and prepare the suction machine.

D. Stop the administration of oral glucose and prepare the suction machine. If the patient loses responsiveness or has a​ seizure, immediately remove the tongue depressor from the mouth and be prepared to suction. Administering more of the medication may lead to​ aspiration, and a prone position will not allow the EMT to adequately assess the airway.​ Finally, inserting a bite stick will not ensure the patient has an intact airway and may cause stimulation of the gag reflex.

You are assessing a​ 42-year-old female patient who has been feeling​ ill, according to her​ husband, and this morning he was unable to wake her. She is able to control her own​ airway, has deep rapid​ respirations, and has a blood glucose level of 686​ mg/dL. What is her most likely underlying​ pathology? A. Type 3 diabetes B. Hypoglycemia C. Drug overdose D. Type 2 diabetes

D. Type 2 diabetes Type 2 diabetes is also referred to as noninsulin dependent diabetes mellitus​ (NIDDM) and occurs commonly in older patients. Type 2 diabetics typically are not diagnosed until their first episode of hyperglycemia that results in a change in mental status. Type 2 diabetics typically try to have healthier lifestyles to help control their glucose​ levels, and if that is not​ successful, then medications are prescribed. There is no such thing as type 3​ diabetes, and hypoglycemia is a blood glucose level of 70​ mg/dL or less in most cases. A drug overdose would be a logical differential​ impression, but given the blood glucose​ level, this patient would most likely be a type 1 diabetic.

The signs and symptoms of hypoglycemia can differ from those of hyperglycemia. Signs and symptoms of hyperglycemia​ include: A. urinary retention. B. a rapid onset of symptoms. C. cool, moist skin. D. a fruity odor on the breath.

D. a fruity odor on the breath. Hyperglycemic patients may have a fruity odor on the breath due to ketone bodies that are built up as the body converts noncarbohydrates into glucose. Hypoglycemia has a faster onset of AMS than hyperglycemia and presents with​ cool, moist skin. Neither hyperglycemia nor hypoglycemia causes urinary retention.

Which of the following blood glucose levels would be indicative for the administration of oral glucose in the diabetic patient with an altered mental​ status? A. 80 to 100​ mg/dL B. 100 to 120​ mg/dL C. greater than 130​ mg/dL D. less than 70​ mg/dL

D. less than 70​ mg/dL Oral glucose should be administered to a patient who meets all three of the following​ criteria: an altered mental​ status, a history of diabetes that is controlled by medication or a blood glucose level less than 70​ mg/dL, and the ability to swallow the medication. The other blood glucose levels in this question are above 70​ mg/dL.