Emergency Chapter 19 Diabetic Emergencies

43) Which of the following is LEAST important for the patient who has stopped seizing before the EMT's arrival at the scene? A) Checking for mechanism of injury B) Requesting advanced life support C) Suctioning D) Administering oxygen

B) CORRECT. Advanced life support is most likely unnecessary for a patient who is no longer seizing.

59) Which is NOT one of the steps in managing a patient experiencing dizziness and syncope? A) Administer oxygen. B) Apply cold packs to the patient's head. C) Loosen any tight clothing around the neck. D) Lay the patient flat.

B) CORRECT. Applying cold packs to the patient's head is not part of the management of a patient experiencing dizziness and syncope.

28) 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) CORRECT. As long as the patient is conscious and able to manage her own airway, EMTs can administer oral glucose.

13) 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) CORRECT. Cells use the insulin secreted by the pancreas to transfer glucose from the blood across cell membranes into the cells.

17) 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) Takes too much insulin B) Reduces sugar intake by eating too much C) Overexercises or overexerts himself D) Vomits a meal

B) CORRECT. Eating too much will actually raise sugar levels.

23) Compared to hypoglycemia, which of the following is true of hyperglycemia? A) Its onset is more sudden. B) Its onset is more gradual. C) Its onset is preceded by an aura, such as hallucinations or detecting unusual odors. D) It is more easily treated in the prehospital environment than hypoglycemia.

B) CORRECT. Hyperglycemia can takes days or weeks to develop, whereas hypoglycemia occurs quickly.

39) Which of the following is a typical cause of seizures in children 6 months to 3 years of age? A) Administration of glucose to a hyperglycemic patient B) Fever C) Asthma D) Chest pain

B) CORRECT. In young children, febrile seizures are not uncommon.

18) Which of the following is NOT a sign of a hypoglycemic diabetic emergency? A) Combativeness B) Slow heart rate C) Anxiety D) Cold, clammy skin

B) CORRECT. It is likely that someone experiencing a diabetic emergency of hypoglycemia will have an elevated heart rate since the patient will be experiencing the signs of shock.

22) Which of the following may result in hypoglycemia in the diabetic patient? A) Failure to take insulin or oral diabetes medications B) Lack of exercise C) Vomiting after eating a meal D) Overeating

C) CORRECT. A diabetic patient who either does not eat, or vomits after a meal may become hypoglycemic.

54) 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) 60 C) 70 D) 80

C) CORRECT. A patient who demonstrates any one of the three findings of the Cincinnati Prehospital Stroke Scale has a 70% chance of having an acute stroke.

50) Which of the following is a standardized test to evaluate a conscious patient for possible stroke? A) Michigan TIA Assessment B) The Numbness-Aphasia-Paralysis (NAP) Test C) Cincinnati Prehospital Stroke Scale D) The Functional Analysis Stroke Test

C) CORRECT. A very good way to assess conscious patients for stroke is to evaluate them using the Cincinnati Prehospital Stroke Scale.

40) Which of the following is the LEAST important question in obtaining the history of a seizure patient in the prehospital setting? A) How did the patient behave during the seizure? B) Did the patient lose control of his bladder? C) Does the patient have a family history of seizures? D) What was the patient doing before the seizure?

C) CORRECT. Any family history of seizures would not be important for an EMT to ascertain in the prehospital setting.

21) 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) Chronic thirst B) Excessive urination C) Reduced rate of breathing D) Nausea

C) CORRECT. As the blood sugar increases, the patient will develop diabetic ketoacidosis. This can lead to rapid breathing.

38) 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) Trauma B) Hypoglycemia C) Eclampsia D) Any of the above

C) CORRECT. Eclampsia, which is a serious hypertensive disorder associated with pregnancy is the most likely cause of this patient's seizure.

32) A seizure that occurs spontaneously from an unknown cause is called: A) toxinic. B) hypoxic. C) idiopathic. D) hypoglycemic

C) CORRECT. Idiopathic means occurring spontaneously, with an unknown cause. This is often the case with seizures that start in childhood.

45) Treatment of someone with a seizure disorder includes all of the following except: A) placing the patient on the floor or ground. B) loosening restrictive clothing. C) placing a bite block in the patient's mouth so he does not bite his tongue. D) removing objects that might harm the patient.

C) CORRECT. Never place anything in the mouth of a seizing patient. Many objects can be broken, thereby obstructing the patient's airway.

51) 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) Control of facial muscles, ability to speak, and ability to hold both arms in an extended position for 10 seconds D) Ability to walk, ability to hold both arms in an extended position for 10 seconds, and ability to name common objects

C) CORRECT. The Cincinnati Prehospital Stroke Scale focuses the assessment on three areas; facial muscles, ability to speak, and the ability to hold both arms extended for 10 seconds.

58) Many factors that cause dizziness and syncope are generally related to the: A) kidneys. B) lungs. C) brain. D) nervous system.

C) CORRECT. The factors that cause dizziness and syncope are generally related to the brain. Problems such as hypoxia, hypoglycemia, and hypovolemia all interfere with normal brain function.

41) 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) aura phase. B) clonic phase. C) postictal phase. D) tonic phase.

C) CORRECT. The postictal phase of a seizure is after the convulsions have stopped; the patient may be groggy, confused, or even unresponsive. Headaches are common at this stage.

8) Your patient is a 25-year-old female 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 which of the following as the likely cause of the patient's presentation? A) Failure to take her insulin B) A nondiabetic-related problem, such as a head injury or mental illness C) Failure to intake sufficient sugar D) Excessive intake of foods high in sugar, such as soda or candy

C) CORRECT. This patient is most likely suffering from hypoglycemia after taking her insulin and failing to eat properly.

53) 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) Keep the patient in a supine position. C) Immediately transport the patient to a hospital with specialized treatment for stroke patients. D) Administer oral glucose and then assess the patient's blood sugar.

C) CORRECT. To provide a patient with the best chance for recovery from a stroke, rapid transport to a stroke center would be indicated.

36) The signs and symptoms of a transient ischemic attack (TIA) may last up to: A) 1 hour. B) 30 minutes. C) 24 hours. D) 6 hours.

C) CORRECT. Unlike a stroke, a patient with a TIA has complete resolution of his symptoms without treatment within 24 hours.

5) A hormone called insulin is secreted by the: A) islets of Langerhans in the liver. B) gallbladder found in the pancreas. C) islets of Langerhans in the pancreas. D) None of the above.

C) CORRECT. Within the pancreas, specialized clusters of cells called the islets of Langerhans secrete insulin.

19) Looking at the following list, which of the items does NOT correctly compare the signs and symptoms of hypoglycemia and hyperglycemia? A) Hyperglycemia usually has a slower onset than hypoglycemia. B) Hyperglycemic patients often have warm, red, dry skin, whereas hypoglycemic patients have cold, pale, moist, or clammy skin. C) The hyperglycemic patient often has acetone breath, whereas the hypoglycemic patient does not. D) The hypoglycemic patient is usually complaining of a headache, whereas the hyperglycemic patient is not.

D) CORRECT. A headache would not be a likely sign for either condition.

46) Which of the following is the cause of most strokes? A) A spasm in an artery supplying part of the brain B) A ruptured cerebral artery due to an aneurysm C) A ruptured cerebral artery due to hypertension D) Blockage of an artery supplying part of the brain

D) CORRECT. A stroke caused by a blockage, called an ischemic stroke, can occur when a clot or embolism occludes an artery. This mechanism is responsible for most strokes.

3) 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): A) tonic phase. B) postictal phase. C) clonic phase. D) aura.

D) CORRECT. An aura is a sensation the patient has when a seizure is about to happen; often it is a smell, a sound, or even just a general feeling.

33) Which of the following refers to difficulty in speaking or understanding speech as a result of a stroke? A) Hemiparesis B) Ischemia C) Ataxia D) Aphasia

D) CORRECT. Aphasia is a general term that refers to difficulty in communication, and should not be confused with aphagia, which refers to a difficulty swallowing.

44) 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) Suction B) Cervical collar C) Glucometer D) Bite block

Explanation: A) CORRECT. A patient who has just had a generalized seizure will sometimes drool and will usually be very drowsy for a little while, so the EMT may need to suction the airway.

52) Which of the following is NOT a sign or symptom of stroke? A) Chest pain B) Vomiting C) Sudden impairment of vision D) Seizure

Explanation: A) CORRECT. Chest pain is not generally a symptom described by stroke patients.

27) 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?

Explanation: A) CORRECT. Determining the patient's last oral intake will provide the most useful information for an EMT treating a diabetic patient.

1) The medical term for fainting is: A) syncope. B) altered RAS status. C) dehydration. D) vertigo

Explanation: A) CORRECT. Dizziness and syncope (another term for fainting) are common reasons EMS is called.

14) If the blood sugar level is very high, which of the following may result? A) Excessive urination, excessive thirst, and excessive hunger B) Polyuria and hyperactivity C) Excessive insulin, excessive glucose, and excessive urination D) Hyperactivity, excessive thirst, and polyuria

Explanation: A) CORRECT. Elevated glucose levels can cause excessive hunger, thirst, and urination.

42) 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) Insert a bite block, cloth, wallet, or similar item between the patient's teeth to prevent her from biting her tongue. B) Move furniture and other objects away from the patient to prevent injury. C) Restrain the patient's extremities to prevent injury from flailing of the arms and legs. D) Place a tongue depressor or spoon in the back of the mouth to prevent the patient from swallowing her tongue.

B) CORRECT. The best way to care for a seizing patient is move furniture and objects out of the way so the patient doesn't get injured during convulsions.

12) Which of the following is the role of glucose in the body? A) It assists the pancreas in the manufacture of insulin. B) It provides energy for brain cells and other cells in the body. C) It allows the body to use insulin. D) It is an essential building block for body tissues, such as muscle and bone.

B) CORRECT. The cells of the body run on glucose.

4) The death of brain tissue due to deprivation of oxygen because of a blocked or ruptured artery in the brain is known as which of the following? A) Transient ischemic attack B) Stroke C) Aphasia D) Seizure

B) CORRECT. The death of brain tissue due to hypoxia cause by a ruptured or blocked artery in the brain is known as a stroke.

7) 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) CORRECT. The medical term for insufficient sugar in the bloodstream is hypoglycemia.

15) 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) A "fruity" odor of the breath C) Cool, moist skin, agitated behavior, and increased heart rate D) Sudden onset of altered mental status

B) CORRECT. Untreated hyperglycemia can lead to patients presenting with a "fruity" breath odor.

25) 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) CORRECT. For an unresponsive patient who is breathing adequately, the EMT should place the patient in the recovery position, provide oxygen and continue to monitor his airway.

55) With advances in clot-busting (thrombolytic) drugs, the patient has a window of ________ hours to receive treatment. A) 6 B) 4 C) 5 D) 3

D) CORRECT. In order to be effective, thrombolytic drugs must be administered no more than 3 hours following the onset of stroke symptoms.

29) Which of the following would be an acceptable substitute for the administration of commercially prepared oral glucose solution? A) Having the patient eat a banana B) Diet soda C) Having the patient eat something high in protein, such as a deli sandwich D) Cake icing

D) CORRECT. In the absence of oral glucose, cake icing would be an acceptable substitute due to the high sugar content.

6) 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) generalized seizure. C) postictal seizure. D) partial seizure.

D) CORRECT. Partial seizures often affect only one area of the body and the patient may or may not lose consciousness.

30) 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 on the belt. C) They have a catheter that enters into the abdomen. D) They are usually worn around the ankle.

D) CORRECT. Since the pumps deliver insulin through a catheter into the patient's abdomen, it would not be advisable to wear an insulin pump around the ankle.

10) 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) Oxygen B) Glucose C) Water D) Sodium

D) CORRECT. Sodium is not one of the specific requirements of RAS functioning.

34) Which statement below is NOT true about seizures? A) A partial seizure affects one part, or one side, of the brain. B) A generalized seizure affects the entire brain. C) The most common seizure that EMTs are likely to be called on is a tonic-clonic seizure. D) Many seizures are followed by an aura.

D) CORRECT. Some seizures are preceded by an aura, a sensation the patient has when a seizure is about to happen.

2) Which of the following BEST describes status epilepticus? A) A seizure involving convulsions on only one side of the body B) A seizure that occurs without a known cause C) A period of drowsiness following tonic-clonic seizures D) Two or more seizures with tonic-clonic activity without an intervening period of consciousness

D) CORRECT. Status epilepticus is best described as two or more tonic-clonic seizures with no return to consciousness between convulsive periods.

20) When someone is experiencing hypoglycemia, the body attempts to compensate by using the fight-or-flight mechanism of the autonomic nervous system. Which one of the statements below is NOT one of the fight-or-flight responses? A) Blood vessels constrict. B) The heart pumps faster. C) Breathing accelerates. D) The skin is hot and dry.

D) CORRECT. The autonomic fight-or-flight response to low blood sugar will make the patient's skin pale, cool, and diaphoretic.

9) For the reticular activating system (RAS) to work correctly, what three substances are needed? A) Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and sodium to keep the brain hydrated B) Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and water to keep the brain hydrated C) Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and sodium to keep the brain hydrated D) Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and water to keep the brain hydrated

D) CORRECT. The brain tissue of the RAS has simple requirements to function properly and, thereby, keep a person alert and oriented. Oxygen is needed to perfuse brain tissue, glucose is needed to nourish brain tissue, and water is needed to keep brain tissue hydrated.

49) 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 suffered a stroke. B) The patient is suffering from aphasia. C) The patient has had a subarachnoid hemorrhage. D) The patient suffered a transient ischemic attack.

D) CORRECT. Transient ischemic attacks, caused by temporary blockages to arteries in the brain, can present with stroke-like symptoms that resolve themselves with no damage or lingering effects.

35) What is epilepsy? A) A condition in which a person has multiple seizures usually controlled by medication. B) A condition in which a person has an aura followed by seizure usually controlled by medication. C) A condition caused by congenital brain abnormalities that causes seizures only twice a year. D) A condition in which a person has general seizures that start in childhood.

Explanation: A) CORRECT. Epilepsy is perhaps the best-known of the conditions that result in seizures; it is not a disease itself, but rather an umbrella term used when a person has multiple seizures from an unknown cause. Most patients with epilepsy are able to control their seizures with consistent medication.

31) Which of the following conditions may be mimicked by hypoglycemia? A) Intoxication B) Respiratory distress C) Heart attack D) All of the above

Explanation: A) CORRECT. Hypoglycemic patients can present with confusion, slurred speech, and be physically uncoordinated; it is not uncommon for others to think these patients may be intoxicated.

24) 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

Explanation: A) CORRECT. Normal blood glucose levels for adults generally range between 60 and 140 mg/dL.

47) 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

Explanation: A) CORRECT. One of the most common signs of a stroke is one-sided weakness, called hemiparesis.

57) 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) determine the exact time of onset of symptoms. B) transport the patient to a Level I Trauma Center. C) do a thorough physical exam of the patient. D) transport to the closest hospital since the patient must go to the operating room as soon as possible.

Explanation: A) CORRECT. Patients must meet very specific criteria that include definite onset of stroke symptoms less than 3 hours prior to the administration of the thrombolytic drug. Therefore, it is extremely important to determine the exact time of onset of symptoms.

48) 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) receptive aphasia. B) disorientation to time. C) unresponsive to verbal stimuli. D) expressive aphasia.

Explanation: A) CORRECT. Receptive aphasia refers to the condition where a patient can speak clearly, but cannot understand what others are saying, so he will clearly say things that do not make much sense or are inappropriate for the situation.

11) During your primary assessment you find your patient has an altered mental status. This could indicate which of the following? A) Failing respiratory system B) Problems with the RAS due to hypertension C) The need for suctioning of the airway D) The need to complete a secondary assessment

Explanation: A) CORRECT. Respiratory failure can cause a patient to present with altered mental status.

56) Which of the items below is NOT part of the Cincinnati Prehospital Stroke Scale? A) Test for equal grip strength. B) Ask the patient to smile. C) Have the patient repeat a simple sentence. D) Test the patient for arm droop or lack of movement.

Explanation: A) CORRECT. Testing grip strength is not part of the Cincinnati Prehospital Stroke Scale.

37) Which of the following is the most common cause of seizures in adults? A) Failure to take prescribed medication B) Withdrawal from alcohol C) Fever D) Head trauma

Explanation: A) CORRECT. The most common cause of seizures in adults is failure to take prescribed anti-seizure medication.

16) As an EMT, you will be called on frequently to treat diabetic emergencies. Diabetic emergencies are usually caused by: A) poor management of the patient's diabetes. B) falls. C) hypoxia. D) pancreatitis.

Explanation: A) CORRECT. There are many causes for diabetic emergencies but the most frequent one experienced by an EMT is poor management of the diabetes by the patient.

26) 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) Apply oxygen and begin transport without taking further action. B) Use your glucometer to check his blood sugar level. C) Use the patient's glucometer to check his blood sugar level. D) Administer oral glucose, as it will not cause additional harm in hyperglycemia, but may prevent brain damage if the patient is hypoglycemic.

Explanation: A) CORRECT. This patient would benefit most from oxygen therapy and transport to the hospital.