Deck 20: Acute Diabetic Emergencies

Question 1

You determine a patient's blood glucose level to be 289 mg/dL. You document this result on the prehospital care report as:

A) normal.
B) hyperglycemic.
C) depressed.
D) hypoglycemic.

Answer 1

B

Question 2

How should an EMT best describe a confused and combative patient with labored respirations and a blood glucose level of 33 mg/dL?

A) Hypoglycemic
B) Altered blood glucose
C) Hyperglycemic
D) Hyper-insulinemic

Answer 2

A

Question 3

A glucometer reads 50 mg/dL. The EMT would recognize this as:

A) high.
B) normal.
C) average.
D) low.

Answer 3

D

Question 4

A diabetic patient who took insulin earlier is found unresponsive with a blood glucose level of 29 mg/dL. What piece of information provided by family gives the best explanation for the patient's altered mental status?

A) "He ate pancakes with syrup after taking his insulin."
B) "His blood sugar normally goes up after eating."
C) "He only took half of his required dose of insulin this morning."
D) "He refused to eat breakfast and lunch today."

Question 5

You are called to an outpatient clinic to transfer a 39-year-old male patient in diabetic ketoacidosis (DKA) to an acute-care hospital. When assessing the patient, which one of the following signs or symptoms would you expect to find?

A) Slow and shallow respirations
B) Slow heart rate and high blood pressure
C) Blood glucose level of 50 mg/dL
D) Fruity or acetone odor on his breath

Question 6

A patient's glucometer reads 39 mg/dL. The patient is alert, but confused. The patient's son states that he has a friend who becomes unresponsive when his sugar is less than 50 mg/dL; therefore, the reading on his father cannot be correct. Which one of the following statements would be your best response?

A) "You are probably right; I feel comfortable in having him sign a refusal."
B) "I agree. Anyone with a blood sugar less than 50 should be unconscious."
C) "The response to a low blood sugar can vary from patient to patient."
D) "I agree. Just to be safe, I am not going to give him any oral glucose."

Question 7

You are reviewing a prehospital care report for a patient with altered mental status that occurred after he took too much insulin. Based on this information, you should assume that at the time of EMS contact, the patient's blood sugar level was probably:

A) high.
B) low.
C) normal.
D) concentrated.

Question 8

You suspect that an unresponsive female may be diabetic. To help confirm this suspicion, where would you send your partner to look for vials of insulin?

A) Bathroom
B) Bedside table
C) Refrigerator
D) Nightstand

Question 9

Which one of the following would lead the EMT to suspect that a patient is suffering from hypoglycemia?

A) A rapid onset of altered mental status
B) Slow pulse rate and low blood pressure
C) A blood glucose reading of 256 mg/dL
D) Warm and dry skin with a blood glucose of 90 mg/dL

Question 10

For which patient would the EMT have the strongest suspicion of a diabetic emergency?

A) Confused patient with a blood glucose of 58 mg/dL
B) Alert and oriented diabetic patient with generalized weakness
C) Combative patient with a blood glucose level of 122 mg/dL
D) Diabetic patient complaining of chest pain and shortness of breath

Question 11

Family members have called you for a young female patient with a diabetic history who took insulin earlier in the day. She is confused and combative. Which of the following questions is most important for the EMT to immediately ask the family?

A) "How long has she been a diabetic?"
B) "Do you think that her blood sugar is high?"
C) "Did she eat after taking the insulin?"
D) "Did she take any drugs or drink alcohol?"

Question 12

Which of the following accurately describes insulin?

A) Pill that must be taken by diabetic patients
B) Hormone that breaks food into simple sugar
C) Drug that increases the sugar in the blood
D) Hormone that enables glucose to move into the cells

Question 13

You have arrived on the scene of a 64-year-old diabetic patient. He is supine in bed and exhibits snoring respirations. Family members state that they just tested his blood sugar and it is 25 mg/dL. Which one of the following should be your immediate action?

A) Prepare and administer oral glucose.
B) Have family recheck the blood sugar.
C) Determine what the patient has eaten.
D) Perform the head-tilt, chin-lift.

Question 14

What is a glucometer used to evaluate?

A) Glucose levels
B) Insulin levels
C) Glucogen levels
D) Insulin and glucose levels

Question 15

You have been called to a residence for a patient with altered mental status. On arrival a neighbor informs you that he saw the patient washing windows several minutes earlier and then suddenly saw him lying on the ground. He continues by stating that the patient is diabetic and has been in and out of the hospital lately because his blood sugar has been dropping suddenly. Your scene size-up reveals the patient to be lying next to a ladder propped up to the second-story window. Water from a bucket is spilled on the side of the house and yard. The patient is supine and unresponsive. Which one of the following should be your next most immediate action?

A) Insert a nasopharyngeal airway.
B) Take manual in-line spinal stabilization.
C) Check the glucose level and administer oral glucose if needed.
D) Open the airway with the jaw-thrust maneuver.

Question 16

A 17-year-old patient is unresponsive. A medical identification bracelet states that he is diabetic. Which of the following actions would you perform first?

A) Administer oral glucose.
B) Determine the type of diabetes.
C) Assess the airway.
D) Check for a pulse.

Question 17

The son of a patient with altered mental status informs you that his father is a type I diabetic. Based on this information, you would understand that the patient:

A) needs to take insulin.
B) has a history of high blood pressure.
C) requires daily oral glucose to maintain his blood sugar.
D) has a chronically low blood sugar level.

Question 18

You are instructing EMT students on how to obtain a blood sample for use in a glucometer. You are providing accurate information by stating:

A) "It is best to check the blood three times and then use the highest reading."
B) "Approximately 15 mL of blood will be needed for an accurate result."
C) "A small drop of blood obtained from the patient's fingertip is sufficient."
D) "Have the patient raise his or her arm in the air prior to obtaining blood."

Question 19

The EMT should suspect that a patient is diabetic when which one of the following medications is found on the scene?

A) Nitrostat
B) Metformin
C) Ecotrin
D) Lexapro

Question 20

Your partner reports that he has found some small areas of bruising to the abdomen of a patient who takes insulin. He is puzzled by the finding. Which one of the following responses would be most appropriate?

A) "The patient must have been involved recently in a car crash or suffered some other sort of trauma."
B) "There could be several reasons for the bruising, but insulin injections are often administered to the abdomen."
C) "That is a concerning finding. Since diabetics are prone to GI bleeds, we should treat her as having one."
D) "Why don't we contact her primary care physician and see if there is additional medical issues we are not aware of?"

Question 21

You are reviewing prehospital care reports and notice that a patient with low blood sugar and no contraindications to oral glucose did not receive the medication. You recognize that this inaction placed the patient at risk for what condition?

A) Liver damage
B) Infection
C) Heart failure
D) Brain damage

Question 22

An unresponsive patient presents with a blood sugar of 30 mg/dL. What is the major threat to this patient's well-being?

A) Brain damage
B) Dehydration
C) Cardiac compromise
D) Glucose toxicity

Question 23

When administering oral glucose to a diabetic patient, the EMT must take precautions to prevent what adverse effect?

A) High blood-glucose levels
B) Airway obstruction
C) Low blood-glucose levels
D) Increased blood pressure

Question 24

Prior to the administration of oral glucose, a patient's blood glucose level was 49 mg/dL. After administering the oral glucose, the patient is alert and oriented. Which one of the following repeat blood glucose levels would the EMT expect with this clinical presentation?

A) "Low"
B) 155 mg/dL
C) 30 mg/dL
D) "High"

Question 25

You have been called for a patient who is confused and slightly combative. Which one of the following assessment findings would make you suspicious that the patient is suffering from hyperglycemia?

A) Decreased appetite according to family members
B) Patient statement that he has not urinated for some time
C) Increased respirations with a sweet smell to his breath
D) Comment by family that the patient may have taken too much insulin

Question 26

Your medical director is providing a review of diabetic emergencies and asks you to describe glucose. Which one of the following would be the most appropriate response?

A) "It is a medication that will lower the blood sugar."
B) "It is a hormone produced by the pancreas."
C) "It is a sugar that is the body's main source of energy."
D) "It is a toxin that accumulates in the blood of a diabetic patient."

Question 27

You are assisting a paramedic who is administering glucagon to a patient. Based on your understanding of how glucagon works in the human body, which one of the following is the therapeutic goal of administering it?

A) Increases insulin release from the liver
B) Helps red blood cells carry the glucose
C) Raises the amount of circulating blood glucose
D) Rapidly decreases a high amount of circulating glucose

Question 28

Medical direction has ordered you to administer one dose of oral glucose to a diabetic patient with confusion. Which one of the following actions describes what you should do?

A) Repeat and question the order to medical direction.
B) Place half the contents of the tube of glucose in the patient's mouth.
C) Carefully administer the entire tube of glucose.
D) Have the patient swallow all of the glucose in the tube.

Question 29

In what form is oral glucose packaged?

A) Gel
B) Liquid
C) Powder
D) Sugar granules

Question 30

After you administer oral glucose to a diabetic patient, his level of conscious deteriorates and he becomes unresponsive with snoring respirations. Which one of the following actions should you take immediately?

A) Administer half a second tube of glucose.
B) Provide high-concentration oxygen.
C) Administer a full second dose of oral glucose.
D) Manage the airway.

Question 31

You are transporting a diabetic who has low blood sugar. En route you have received orders to administer oral glucose. What piece of emergency equipment is it most important to have readily available during this procedure?

A) Nasopharyngeal airway
B) Suction device
C) Oropharyngeal airway
D) Automated external defibrillator

Question 32

A diabetic patient presents as alert but irritable and confused. His airway is patent with an intact gag reflex and breathing is adequate. You do not have a glucometer available and are not sure if his blood sugar is high or low. In this situation, which one of the following should be your next best action?

A) Insert a nasal airway.
B) Administer oral glucose.
C) Have the family members administer his insulin.
D) Provide emergency transport.

Question 33

A diabetic patient is alert but confused. You have decided to administer oral glucose. Which one of the following describes how to administer the glucose properly?

A) Squeeze the glucose under the patient's tongue.
B) Place the glucose between the patient's cheek and gum.
C) Use a tongue depressor to place the glucose on the back of the tongue.
D) Have the patient slowly swallow the glucose.

Question 34

Which one of the following patients is a candidate for oral glucose?

A) An unresponsive diabetic patient with a rapid heart rate
B) A combative patient with no history of diabetes
C) An alert but confused diabetic patient with cool skin
D) A newly diagnosed diabetic who is responsive to painful stimuli

Question 35

An alert but confused diabetic patient is complaining of weakness. Your service carries oral glucose, which has been authorized through off-line medical direction. In this case you should:

A) contact the patient's primary care physician.
B) transport for further evaluation in the hospital.
C) contact medical direction for authorization.
D) prepare and administer the oral glucose.

Question 36

What is the best action to take prior to administering oral glucose to a young female patient?

A) Determine the patient's blood glucose level.
B) Make sure the patient has insulin available if needed.
C) Ask if the patient is allergic to glucose.
D) Determine if the patient is pregnant.

Question 37

After you administer oral glucose to a confused and combative patient, she gradually becomes calmer and fully oriented. As a knowledgeable EMT, you would recognize that the patient:

A) had a high blood-sugar level.
B) now has a decreasing blood-sugar level.
C) will need a second dose of oral glucose.
D) had a low blood-sugar level.

Question 38

Which one of the following statements made by an EMT indicates a correct understanding of glucose in the human body?

A) "Once ingested, glucose is broken down into carbohydrates and used for energy."
B) "All cells in the body require glucose for energy and cannot use anything else."
C) "Glucose is transformed into fats, which the cells of the body use for energy."
D) "The cells of the brain cannot use anything else but glucose for energy."

Question 39

You have been called for an adult male who is hypoglycemic and responsive to painful stimuli. The family has oral glucose and wants you to administer it. However, at this time, your medical director has not authorized its use and there are no protocols regarding its use. Given the patient's condition and the family's request, which one of the following actions should you take?

A) Contact medical direction for permission to administer the glucose.
B) Instruct the family to administer the oral glucose.
C) Transport the patient to the emergency department.
D) Carefully administer the oral glucose at the family's request.

Question 40

Five minutes after administering oral glucose to a confused diabetic patient, you do not see any improvement in her mental status. Which one of the following actions should you take?

A) Administer a second dose of oral glucose.
B) Continue to monitor the patient.
C) Recheck the expiration date on the oral glucose.
D) Contact medical direction for further orders.

Question 41

What is the primary reason to administer oral glucose to a patient?

A) Help sugar get into the brain cells
B) Increase the amount of circulating glucose
C) Stimulate the body to release insulin
D) Improve the patient's level of consciousness

Question 42

With normal metabolism, what happens after a healthy patient ingests food?

A) Glucose levels in the body quickly drop.
B) The liver releases stored glucose.
C) Excess glucose is released in the urine.
D) Blood levels of insulin rise.

Question 43

Within the human body, insulin works to:

A) decrease the level of glucose.
B) carry glucose into the cells.
C) free stored glucose from the liver.
D) turn carbohydrates into glucose.

Question 44

The EMT would describe diabetes as a disease state in which:

A) not enough sugar is provided to the body.
B) there is a problem with the metabolism of carbohydrates and other foods.
C) there is a contusion in which too much insulin is produced by the pancreas.
D) the body cannot store and maintain sugar reserves.

Question 45

To which one of the following patients would the EMT administer oral glucose?

A) Alert and oriented 32-year-old female with a blood sugar of 52 and no history of diabetes
B) Confused 44-year-old male with a history of diabetes who is able to swallow
C) An unresponsive 24-year-old male with a blood sugar of 24 and history of diabetes
D) A confused male patient with a blood sugar reading of 96 and history of diabetes

Question 46

Long-term complications of diabetes commonly include:

A) kidney disease.
B) asthma.
C) mental retardation.
D) coma.

Question 47

Which one of the following patients has a normal fasting glucose level?

A) 53-year-old female who is alert and oriented with a glucose level of 117
B) 37-year-old female who is weak and dizzy with a glucose level of 81
C) 67-year-old male with no complaints and a glucose level of 127 mg/dL
D) 12-year-old male with a blood glucose level of 38 mg/dL

Question 48

A patient informs you that she takes Januvia pills for her diabetes. Which one of the following statements about this patient and her diabetes is true?

A) Her pancreas still produces some insulin.
B) The pills contain insulin for use by the body.
C) Glucose is needed by her body and is provided by the pills.
D) The pills decrease her craving for sugary foods.

Question 49

To decrease the possibility of a faulty glucometer reading, you would:

A) use the first drop of blood obtained.
B) use venous blood only for testing.
C) avoid the use of alcohol as an antiseptic.
D) make sure test strips are in date.

Question 50

You have been called for a 32-year-old female with altered mental status. On scene you find the patient lethargic and confused. Although information is sketchy, it appears that she has a history of diabetes as well as renal failure for which she receives dialysis. You note no deficits in the primary assessment and the vital signs are: pulse 124, respirations 28, BP 106/68 mmHg, and SpO₂ 97%. Your partner reports a blood sugar reading of 774 mg/dL. Based on this information, the EMT would understand that definitive care of this patient would involve the administration of which one of the following medications?

A) Insulin
B) Glucose
C) Intravenous fluids
D) Oxygen

Question 51

You have been called for a 33-year-old male complaining of weakness and dizziness. When getting the history, which one of the following statements would make you suspicious that the patient is an undiagnosed diabetic?

A) "I feel the need to eat sugar throughout the day."
B) "I get very weak just after eating a meal."
C) "I feel very weak in the morning after getting up."
D) "I find myself urinating all of the time."

Question 52

When providing information about diabetes to a group of Emergency Medical Responders, you tell them that it is a disease:

A) in which the body cannot make carbohydrates into sugar.
B) where the patient's blood sugar will suddenly drop.
C) that always requires insulin to be injected into the body.
D) in which the pancreas fails to produce the proper amount of insulin.

Question 53

The wife of a 43-year-old male has called 911 because her husband was difficult to wake up and now is lethargic with garbled speech. She reports a history of diabetes, stroke, renal failure, and high blood pressure. His airway is patent, respirations tachypneic but adequate, and radial pulse rapid. Your partner reports the following vital signs: pulse 136, respirations 22, blood pressure 106/62, SpO₂ at 92%, and blood glucose 642. Which one of the following would be most appropriate in the care of this patient?

A) Administer supplemental oxygen.
B) Administer oral glucose.
C) Encourage the patient to drink water.
D) Assist the patient with his insulin.

Question 54

A medical-grade glucometer is used to measure:

A) insulin levels.
B) glycogen levels.
C) blood sugar levels.
D) carbohydrate levels.

Question 55

The most common complaint of a diabetic patient for which EMS is summoned is:

A) desire for sugary foods.
B) difficulty breathing.
C) altered mental status.
D) nausea and vomiting.

Question 56

You know an EMT is correctly using a glucometer when she performs which one of the following?

A) Avoids cleaning the finger with alcohol prior to pricking it with a lancet
B) Wastes the first drop of blood obtained from the patient's finger
C) Asks the patient to hold his hand above his head prior to pricking a finger for blood
D) Uses a lancet to prick an artery or vein for the blood sample

Question 57

An undiagnosed diabetic patient's insulin levels are elevated while the cellular receptors for the insulin are not sensitive (to the insulin). You would anticipate which of the following when caring for this patient?

A) Peripheral edema from retained fluid
B) A low blood sugar reading on the glucometer
C) Slowed respirations and heart rate
D) Elevated blood sugar levels

Question 58

The EMT would recognize dehydration as a concern in the diabetic patient because of:

A) decreased desire to drink water.
B) constant and persistent need to urinate.
C) persistent diarrhea from elevated sugar levels.
D) vomiting leading to fluid loss.

Question 59

A patient who is unresponsive has a blood glucose level of 28. Her family states that she took her insulin in the morning 3 hours ago. Which one of the following statements made by the family would make sense in regards to the patient's current blood sugar level?

A) "She is going to the bathroom all of the time."
B) "She smoked a cigarette just before becoming unresponsive."
C) "She did not eat after taking her insulin."
D) "She ate a lot of cake and ice cream last night."

Question 60

Which one of the following is the best means by which hypoglycemia can be differentiated from hyperglycemia?

A) Determine the rate at onset.
B) Examine the signs and symptoms.
C) Analyze the vital signs.
D) Evaluate the patient's blood sugar.

Question 61

A patient exhibits signs and symptoms of diabetes. However, he informs you that he has not been diagnosed with the disease. You decide to check his blood sugar. If the patient is a diabetic, which of the following readings would you expect?

A) 465 mg/dL
B) 110 mg/dL
C) 0 mg/dL
D) 70 mg/dL

Question 62

You are next to a diabetic 24-year-old female who has altered mental status and a blood sugar reading of 31 mg/dL. Family members state that she took her normal amount of insulin this morning and ate her breakfast as usual. What additional statement would the EMT recognize as causing her current condition?

A) "She has been taking Motrin every 6 hours for ankle pain."
B) "She likes to stay in shape and ran 4 miles after breakfast."
C) "She did not take her nighttime insulin last night."
D) "She did not eat anything sweet for breakfast this morning."

Question 63

You arrive on scene of a known diabetic who is noncompliant with taking insulin. Assessment indicates the patient to have an open airway, rapid and deep respirations, and a rapid radial pulse. His skin is warm and flushed. Vital signs are pulse 120, respirations 40, blood pressure 108/86, and SpO₂ 98%. His blood sugar reads "high" on your glucometer. What instruction to other caregivers indicates proper care of this patient?

A) "We need to apply supplemental oxygen at 15 liters through a nonrebreather."
B) "Someone needs to start positive pressure ventilation to stop his hyperventilation."
C) "Do not worry about his breathing rate, it is actually helping him right now."
D) "We need to see if his insulin is here so we can help him administer it to himself."

Question 64

A diabetic patient is exhibiting rapid and deep respirations. As a knowledgeable EMT, you would expect to find:

A) hypoglycemia.
B) hypoxia.
C) fever and tachycardia.
D) elevated blood glucose.