Endocrine and Hematologic Emergencies Ch. 18
A 39-year-old male with a history of type 1 diabetes is found unresponsive by his wife. When obtaining initial information from the wife, which of the following questions would be LEAST pertinent? A. "Has your husband been ill or unusually stressed recently?" B. "Did your husband take his prescribed insulin and eat today?" C. "Was your husband hospitalized for this problem in the past?" D. "Has your husband's medication regimen been changed recently?"
C. "Was your husband hospitalized for this problem in the past?"
Which of the following conditions would result in the MOST rapid loss of consciousness? A. Ketoacidosis B. Diabetic coma C. Acute hypoglycemia D. Blood glucose of 200 mg/dL
C. Acute hypoglycemia
In addition to supplemental oxygen, prehospital treatment for a patient with hyperglycemic ketoacidosis should focus on: A. administering sugar. B. glucagon administration. C. IV fluid rehydration. D. insulin administration.
C. IV fluid rehydration
Which of the following statements regarding hyperglycemic crisis (diabetic coma) is correct? A. It usually progresses over hours or days. B. Insulin overdose is the most common cause. C. It is typically associated with overhydration. D. Fat metabolism results in severe lactic acidosis.
A. It usually progresses over hours or days
Which of the following complications is MOST commonly associated with hypoglycemic crisis (insulin shock)? A. Seizures B. Alkalosis C. Dehydration D. Cardiac arrest
A. Seizures
Which of the following statements regarding diabetes is correct? A. Type 1 diabetes occurs most commonly in children. B. Type 1 diabetes is typically managed by changes in diet habits. C. Patients with type 2 diabetes must take daily injections of insulin. D. Type 2 diabetes is more likely to cause organ damage.
A. Type 1 diabetes occurs most commonly in children
Insulin is produced when: A. absorbed carbohydrates stimulate the beta cells of the pancreas. B. the alpha cells of the pancreas sense a decrease in blood glucose. C. the metabolization of glucose in the brain significantly decreases. D. complex carbohydrates stimulate the alpha cells of the pancreas.
A. absorbed carbohydrates stimulate the beta cells of the pancreas
A common clinical finding in patients with hypo- or hyperglycemic crisis is: A. an altered mental status. B. profound dehydration. C. diaphoresis and pale skin. D. rapid and shallow breathing.
A. an altered mental status
Elderly patients with diabetes commonly develop neuropathy, which predisposes them to: A. atypical acute coronary syndrome. B. a massive hemorrhagic stroke. C. an increased risk of septic shock. D. poor healing following an injury.
A. atypical acute coronary syndrome
Prior to administering IV dextrose to an unresponsive 43-year-old male with a blood glucose reading of 35 mg/dL, you should: A. ensure that the IV line is patent and running effectively. B. assess the patient for signs of severe diabetic neuropathy. C. dilute 25 mL of D50 in 25 mL of normal saline solution. D. reassess his blood glucose to ensure an accurate reading.
A. ensure that the IV line is patent and running effectively
Glucagon will NOT be effective if: A. glycogen stores in the liver are depleted. B. blood glucose levels are less than 40 mg/dL. C. the patient weighs less than 20 kilograms. D. given in conjunction with 50% dextrose.
A. glycogen stores in the liver are depleted
The cells convert glucose into energy through the Krebs cycle and: A. glycolysis. B. gluconeogenesis. C. glycogenolysis. D. glucogenesis.
A. glycolysis
A 30-year-old female presents with severe acute pain to the left upper quadrant of her abdomen. During your assessment, she tells you that she has sickle cell disease. You should suspect that: A. her spleen is enlarged because of red blood cell engorgement. B. the pain in her abdomen is referred pain from an enlarged liver. C. she has gastrointestinal bleeding due to large blood vessel rupture. D. she is experiencing an aplastic crisis and needs a blood transfusion.
A. her spleen is enlarged because of red blood cell engorgement
The anterior pituitary gland secretes thyroid-stimulating hormone (TSH) in response to the: A. hypothalamus' secretion of thyrotropin-releasing hormone (TRH). B. thyroid gland, which is constantly regulating the metabolic rate. C. core body temperature, which is regulated by the hypothalamus. D. secretion of growth hormone by somatotroph cells within the pituitary gland.
A. hypothalamus' secretion of thyrotropin-releasing hormone (TRH)
A young male with sickle cell disease presents with chest pain, fever, and a cough. His vital signs are stable, although he is experiencing mild respiratory distress. You should suspect: A. pneumonia. B. a pneumothorax. C. an aplastic crisis. D. acute aspiration.
A. pneumonia
Excessive eating caused by cellular "hunger" is called: A. polyphagia. B. polydipsia. C. dysphasia. D. dyspepsia.
A. polyphagia
A 50-year-old male with a blood sugar level of 38 mg/dL would be expected to present with all of the following, EXCEPT: A. severe dehydration. B. pale and moist skin. C. an altered mental status.
A. severe dehydration
The normal range for blood glucose levels in nonfasting adults and children ranges from: A. 70 to 100 mg/dL. B. 80 to 120 mg/dL. C. 90 to 130 mg/dL. D. 100 to 130 mg/dL.
B. 80 to 120 mg/dL
You are caring for a 27-year-old male with suspected ketoacidosis. He is unresponsive and his blood glucose level, as measured by glucometer, reads "high." His blood pressure is 80/50 mm Hg, pulse is 130 beats/min and weak, and respirations are 40 breaths/min and shallow. Which of the following represents the MOST appropriate treatment approach? A. Oxygen via nonrebreathing mask, 10 mL/kg crystalloid boluses to maintain perfusion, and prompt transport B. Assisted ventilation, 20 mL/kg crystalloid boluses to maintain perfusion, transport, and consider an advanced airway C. Oxygen via nonrebreathing mask, an IV of normal saline set to keep the vein open, 50 mL of D50, and rapid transport. D. Assisted ventilation, 0.5 to 1 mg of glucagon IM, 20 mL/kg crystalloid boluses to maintain perfusion, and transport.
B. Assisted ventilation, 20 mL/kg crystalloid boluses to maintain perfusion, transport, and consider an advanced airway
Which of the following organs does NOT utilize insulin for the cellular uptake of glucose? A. Liver B. Brain C. Heart
B. Brain
Which of the following statements regarding hyperosmolar hyperglycemic nonketotic coma (HHNC) is correct? A. HHNC most often occurs in patients with type 1 diabetes. B. HHNC is not associated with a fruity odor on the patient's breath. C. Most cases of HHNC are caused by severe overhydration. D. Pneumonia and urinary tract infections are often caused by HHNC.
B. HHNC is not associated with a fruity odor on the patient's breath
In which of the following situations would a diabetic patient MOST likely develop hypoglycemic crisis (insulin shock)? A. An inadvertent underdose of insulin B. Heavy exertion following a small meal C. Nausea after taking a regular insulin dose D. A large meal following a normal insulin dose
B. Heavy exertion following a small meal
Which of the following statements regarding sickle cell disease is correct? A. Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly. B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen. C. The red blood cells of patients with sickle cell disease are round and contain hemoglobin A. D. Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a blood vessel.
B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen
A 22-year-old female with type 1 diabetes is unresponsive and has a blood glucose level of 29 mg/dL. She is receiving high-flow oxygen and several attempts to establish IV access have failed. You should: A. begin transport and continue to attempt IV access en route. B. administer 0.5 to 1 mg of glucagon via the intramuscular route. C. call for a paramedic unit so they can establish intraosseous access. D. place small amounts of oral glucose between her cheek and gum.
B. administer 0.5 to 1 mg of glucagon via the intramuscular route
When assessing a patient with von Willebrand disease, you should be especially alert for: A. peripheral edema. B. any evidence of bleeding. C. signs of splenic enlargement. D. evidence of a pulmonary embolism.
B. any evidence of bleeding
You respond to a movie theater for a 70-year-old male who is confused. His wife tells you he has type 2 diabetes but refuses to take his pills. Your assessment reveals that he is diaphoretic, tachycardic, and tachypneic. Initial treatment for this patient should include: A. administering one to two tubes of oral glucose. B. applying a nonrebreathing mask at 15 L/min. C. assisting the patient with his diabetic medication. D. performing a rapid exam and obtaining vital signs.
B. applying a nonrebreathing mask at 15 L/min
Tachycardia in a patient experiencing a sickle cell crisis represents a compensatory response that: A. is caused by an acute increase in the red blood cell count. B. attempts to force sickled cells through smaller vasculature. C. is in response to an accelerated increase in hemoglobin levels. D. maintains perfusion because the patient is spontaneously bleeding.
B. attempts to force sickled cells through smaller vasculature
Patients with hypothyroidism often gain weight because of: A. chronic water retention. B. decreased metabolism. C. excessive adipose tissue. D. an overactive appetite.
B. decreased metabolism
You are requested by law enforcement to assess a "drunken patient". When you arrive at the jail, you find the patient to be unresponsive with deep, rapid respirations. His skin is warm and dry and he is incontinent of urine. There is no evidence of trauma and the patient's medical history is not known. You should suspect: A. that he had a seizure. B. diabetic ketoacidosis. C. chronic hypoglycemia. D. acute alcohol intoxication.
B. diabetic ketoacidosis
Kussmaul respirations indicate that the respiratory system is: A. trying to lower the blood's pH. B. excreting ketones from the blood. C. compensating for severe hypoxia. D. removing lactic acid from the body.
B. excreting ketones from the blood
Insulin maintains homeostasis by: A. converting glycogen to glucose. B. facilitating cellular glucose uptake. C. causing the cells to produce glucose. D. increasing blood glucose circulation.
B. facilitating cellular glucose uptake
Excess glucose is stored in the liver and skeletal muscles in the form of: A. glucagon. B. glycogen. C. lactose. D. fructose.
B. glycogen
An acute accelerated drop in the hemoglobin level, which is caused by red blood cells breaking down at a faster rate than normal, occurs during a(n) __________ crisis. A. aplastic B. hemolytic C. vasoocclusive D. splenic sequestration
B. hemolytic
The primary physiologic abnormality that causes diabetes is: A. depletion of blood glucose. B. ineffective action of insulin. C. excessive glycogen production. D. cellular production of ketones.
B. ineffective action of insulin
You are dispatched to a residence for a 60-year-old diabetic male who is unresponsive. As you are assessing the patient, your partner attempts to obtain a blood glucose reading; however, the glucometer reads "error" after two attempts. You should manage this patient's airway appropriately and then: A. transport rapidly to the closest appropriate facility. B. start an IV and administer 50 mL of 50% dextrose. C. treat him for hyperglycemia with severe ketoacidosis. D. administer oral glucose in between his cheek and gum.
B. start an IV and administer 50 mL of 50% dextrose
Diabetic ketoacidosis (DKA) occurs when: A. the kidneys excrete large amounts of glucose from the body. B. the body's cells metabolize fat as an immediate energy source. C. excessive amounts of cellular glucose cause ketone production. D. lactic acid is produced within the cell in the absence of glucose.
B. the body's cells metabolize fat as an immediate energy source
Hypoglycemic crisis tends to develop more often and more severely in children because: A. they have larger glucose stores than adults do. B. they do not always eat correctly and on schedule. C. their cells do not uptake glucose as fast as adults' do. D. their low activity levels cause rapid glucose depletion.
B. they do not always eat correctly and on schedule
A potential complication associated with the administration of D50 is: A. respiratory depression and significant bradycardia. B. tissue necrosis if it extravasates into the soft tissues. C. exacerbated hyperkalemia in a patient taking diuretics. D. increased blood glucose levels and acute water retention.
B. tissue necrosis if it extravasates into the soft tissues
A 72-year-old male with type 2 diabetes complains of "not feeling well." He is diaphoretic and his blood sugar reading is 110 mg/dL. You should be MOST suspicious for: A. an acute ischemic stroke. B. slowly developing insulin shock. C. an acute myocardial infarction. D. impending diabetic ketoacidosis.
C. an acute myocardial infarction
Fifty percent dextrose (D50) is indicated in all of the following situations, EXCEPT: A. a semiconscious patient with a blood glucose of 50 mg/dL. B. an unresponsive patient with no obtainable medical history. C. an asymptomatic patient with a blood glucose of 60 mg/dL.
C. an asymptomatic patient with a blood glucose of 60 mg/dL
A 29-year-old confused female has a blood glucose reading of 50 mg/dL. After administering one tube of oral glucose, you note marked improvement in her mental status. As you are taking her vital signs, her level of consciousness suddenly decreases. You should: A. reassess her blood glucose level. B. administer another tube of oral glucose. C. assess her airway and treat accordingly. D. start an IV and administer 50 mL of D50.
C. assess her airway and treat accordingly
Hemoglobin is: A. the fluid portion of the blood that transports cells throughout the body. B. essential for the formation of clots, such as when vessel damage occurs. C. found within the red blood cells and is responsible for carrying oxygen. D. a key component of the blood and is produced in response to an infection.
C. found within the red blood cells and is responsible for carrying oxygen
The primary fuels for cellular metabolism are: A. glucagon and insulin. B. oxygen and glucagon. C. glucose and oxygen. D. oxygen and insulin.
C. glucose and oxygen
The metabolic conversion of glucose into energy is called: A. glucogenesis. B. glycogenolysis. C. glycolysis. D. gluconeogenesis.
C. glycolysis
In contrast to endocrine glands, exocrine glands: A. secrete hormones that transfer information between cells to regulate body functions. B. lack ducts, so they release hormones directly into the surrounding tissue and blood. C. have ducts that carry their secretions to the surface of the skin or inside a body cavity. D. regulate functions such as mood, growth and development, and sexual function.
C. have ducts that carry their secretions to the surface of the skin or inside a body cavity
During your assessment of a 19-year-old male, you are told that he is being treated with factor VIII. This indicates that: A. he has a thrombosis. B. he has hemophilia b. C. he has hemophilia a. D. his blood clots too quickly.
C. he has hemophilia a
You are treating a 40-year-old male with a documented blood sugar reading of 300 mg/dL. The patient is semiconscious and breathing shallowly, and is receiving assisted ventilation from your partner. You should recognize that definitive treatment for this patient includes: A. oxygen. B. glucagon. C. insulin. D. dextrose.
C. insulin
When a patient's blood glucose level increases significantly, the: A. pancreas secretes additional insulin. B. renal system retains secreted glycogen. C. kidneys excrete excess glucose via water. D. liver releases more glycogen into the blood.
C. kidneys excrete excess glucose via water
Following the administration of one tube of oral glucose, your 20-year-old female diabetic patient's condition markedly improves. You should: A. avoid giving further glucose in order to avoid hyperglycemia. B. allow her to drive herself to the hospital if she remains stable. C. transport her to the hospital and reassess her blood sugar en route. D. administer 25 mL of D50 via IV push and transport promptly.
C. transport her to the hospital and reassess her blood sugar en route
In which of the following patients would it be MOST appropriate to administer oral glucose? A. Conscious patient with a blood glucose level of 70 mg/dL B. Unresponsive patient with adequate ventilatory effort C. Stroke patient with a depressed swallowing mechanism D. Confused diabetic patient who is breathing adequately
D. Confused diabetic patient who is breathing adequately
Which of the following statements regarding Kussmaul respirations is correct? A. Kussmaul respirations are characterized by rapid, shallow breathing. B. It is the body's compensatory mechanism for rapidly lowering the pH. C. You should assist ventilations in all patients with Kussmaul respirations. D. The SpO2 may be normal due to an increase in respiratory rate and depth.
D. The SpO2 may be normal due to an increase in respiratory rate and depth
A 56-year-old male is found unresponsive by a neighbor. Your assessment reveals that he is diaphoretic, pale, and is breathing rapidly and shallowly. His blood glucose reading is 49 mg/dL. The MOST appropriate management for this patient includes: A. oxygen via nonrebreathing mask and administration of oral glucose. B. oxygen via nasal cannula, a 20 mL/kg normal saline bolus, and glucagon IM. C. assisted ventilation, a 1,000 mL fluid bolus, and insertion of a King airway. D. assisted ventilation, 50 mL of D50 IV, and oropharyngeal suctioning as needed.
D. assisted ventilation, 50 mL of D50 IV, and oropharyngeal suctioning as needed
Common findings in patients with blood disorders include all of the following, EXCEPT: A. chronic bruising. B. pallor or jaundice. C. bleeding or infected gums. D. flushed skin and bradycardia.
D. flushed skin and bradycardia
Glycogenolysis is a metabolic process in which: A. insulin facilitates the cellular uptake of glucose. B. glucagon destroys glycogen in the bloodstream. C. insulin causes increased production of glycogen. D. glucagon converts stored glycogen into glucose.
D. glucagon converts stored glycogen into glucose
Medically, the term "diabetes" refers to: A. failure of the liver to produce adequate glycogen. B. increase in cell permeability and resistance to insulin. C. failure of the pancreas to produce adequate glucagon. D. impairment of the body to metabolize carbohydrates.
D. impairment of the body to metabolize carbohydrates
Type 1 diabetes: A. typically occurs in patients between 50 and 70 years of age. B. is defined as a blood sugar level that is less than 120 mg/dL. C. is typically treated with medications such as metformin (Glucophage). D. is a metabolic condition in which no insulin is produced by the body.
D. is a metabolic condition in which no insulin is produced by the body
When managing a semiconscious patient with adequate breathing, you should administer oxygen and: A. insert an oropharyngeal airway, and assist ventilations as needed. B. position the patient in a full Fowler position to prevent aspiration. C. give D50 if the blood glucose reading is less than 90 mg/dL. D. position the patient on his or her side and have suction ready.
D. position the patient on his or her side and have suction ready
A 45-year-old female with type 1 diabetes presents with an altered mental status. Her skin is pale and moist, and her respirations are rapid and shallow. You should: A. obtain an immediate blood glucose reading. B. ask her husband if she took her insulin today. C. start an IV and administer 25g of 50% dextrose. D. provide ventilatory assistance with 100% oxygen.
D. provide ventilatory assistance with 100% oxygen
Patients with thrombophilia are at an increased risk for: A. various cancers. B. hemorrhagic stroke. C. acute arterial rupture. D. pulmonary embolism.
D. pulmonary embolism
Prior to administering glucagon, you must: A. establish IV access. B. attempt to give oral glucose. C. administer 50% dextrose. D. reconstitute it with diluent.
D. reconstitute it with diluent
A 29-year-old male with a history of type 1 diabetes presents with excessive urination and marked thirst. These signs indicate that the: A. kidneys are excreting excess insulin. B. blood glucose has exceeded 120 mg/dL. C. cells of the body are producing fructose. D. renal system is excreting excess glucose.
D. renal system is excreting excess glucose
You respond to a residence for a patient who is "not acting right." As you approach the door, the patient, a 35-year-old male, begins shouting profanities at you and your partner while holding a baseball bat. The man is confused and diaphoretic, and is wearing a medical identification bracelet. You should: A. calm him down so you can assess him. B. be assertive and talk the patient down. C. contact medical control for instructions. D. retreat at once and call law enforcement.
D. retreat at once and call law enforcement
A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma and the patient's blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should: A. administer oxygen via a nonrebreathing mask, apply oral glucose in between his cheek and gum, and transport. B. suspect that he has internal bleeding and is in shock, administer high-flow oxygen, and transport at once. C. administer high-flow oxygen, perform a detailed secondary assessment at the scene, and transport promptly. D. suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.
D. suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital
Signs and symptoms of hyperthyroidism include: A. an irregular pulse, weight gain, and flushed skin. B. tachycardia, cool skin, and sluggish reflexes. C. bradycardia, weight loss, and muscle weakness. D. tachycardia, weight loss, and hyperactive reflexes.
D. tachycardia, weight loss, and hyperactive reflexes
