1.

Patients whose blood glucose levels become too high will begin to use
which of the following substances for energy? A: Fat B: Acid C: Sugar D: Acetone

2. Which of the following statements about the treatment of diabetes is
FALSE? A: Patients with diabetes are treated in different ways. B: Patients with diabetes are all generally treated the same way. C: The first step in caring for a patient with a diabetic emergency is to verify that the airway is open. D: Treating a diabetic emergency often includes the timely administration of oral glucose.

3. Which combination of factors can cause a patient with diabetes to
experience a rapid onset of altered mental status? A: Eating a meal and taking insulin B: Eating a meal and not taking insulin C: Skipping a meal and taking insulin D: Skipping a meal and not taking insulin

4. Of the following questions, the MOST pertinent one to ask a diabetic
patient during your assessment is: A: Have you consumed any alcohol today? B: Do you take pills that lower your blood sugar? C: Are you on any medications for hypertension? D: Do you have a family history of diabetes?

5. In contrast to insulin shock, diabetic coma will usually:
A: present with a rapid onset of symptoms. B: respond within 6 - 12 hours following treatment.

C: present with confusion and seizures. D: require treatment with oral glucose.

6. The form of diabetes that develops as a person ages is called:
A: type I diabetes. B: type II diabetes. C: type III diabetes. D: adult sugar disorder.

7. Which of the following statements is true regarding seizures?
A: Patients should be given oral glucose during the seizure. B: Infections and hypoglycemia are uncommon causes of seizures. C: Idiopathic seizures are those that are the result of arrhythmias. D: Trauma should be considered as the result of a seizure.

8. A known diabetic patient presents with a blood sugar of 240 mg/dL
and severe dehydration. The dehydration is a result of: A: infection that often accompanies hyperglycemia. B: excretion of glucose and water from the kidneys. C: a deficiency of insulin that produces internal water loss. D: failure of the body to produce energy due to a lack of glucose.

9. The major problem associated with insulin-dependant diabetes
mellitus is: A: failure of the body to produce glucose. B: impairment of glucose utilization. C: impairment of insulin utilization. D: permanent failure of the liver.

10. Although no tissue escapes the effect of diabetes, it primarily affects
the patient's:

A: fluid levels. B: metabolism. C: blood count. D: endurance levels.

11. The term "polydipsia" can be defined as frequent:
A: seizure activity. B: bouts of depression. C: large-volume urination. D: drinking to satisfy continuos thirst.

12. When glucose does not reach the cells for metabolism, the cells turn
to another source of energy, primarily fat. Fat metabolism results in: A: the production of strong alkaline particles. B: an increase in the body's production of sugar. C: the formation of ketones and fatty acids. D: an increase in the production of energy.

13. You are summoned to the local jail to care for a patient who is "drunk."
When you arrive, the police officer advises you that the patient was picked up for being intoxicated in public, and shortly after arriving at the jail, the patient's level of consciousness diminished rapidly. Upon assessment, the patient is found to be comatose with cool, clammy skin. His heart rate is weak and thready, and his respirations are rapid and shallow. You should suspect and manage this patient for: A: acute alcohol intoxication. B: diabetic ketoacidosis. C: acutely high blood sugar. D: insulin shock.

14. A woman calls EMS because her 12-year-old son, who had been
experiencing excessive urination, thirst, and hunger for the past 36 hours, is now semiconscious with a rapid, weak, and thready pulse. Which of the following do you suspect? A: Diabetic shock

B: Insulin shock C: Diabetic coma D: Hypoglycemia

15. Which of the following findings are characteristic of diabetic
ketoacidosis? A: Acetone odor on the breath and a rapid onset B: Dehydration and a slow onset of symptoms C: Unconsciousness and a rapid onset of symptoms D: A slow, bounding pulse and slow onset of symptoms

16. The first step in caring for a patient who is experiencing a decreased
level of consciousness from a diabetic emergency is to: A: make sure the airway is open. B: place the patient on his or her side. C: begin suctioning the patient's mouth. D: provide oxygen with a nonbreathing mask.

17. When obtaining a history from a diabetic patient, you should ask which
of the following questions in addition to the SAMPLE history? A: "Are you allergic to insulin?" B: "What kind of insulin do you take?" C: "Have you taken your insulin today?" D: "How long have you been a diabetic?"

18. A young male with a history of insulin-dependent diabetes is found
unconscious. His skin is cool and clammy and his respirations are 30 breaths/min and shallow. The patient's mother advises you that her son had not eaten since last night; however, he took his insulin this morning. Management for this patient includes which of the following? A: Administering more insulin to the patient B: Assisting ventilations with a BVM device C: Administering one tube of oral glucose

D: Placing the patient in a prone position

19. The term "glucose" can be defined as:
A: a simple sugar. B: s metabolic disorder. C: an essential hormone. D: a fight-or-flight hormone.

ANSWERS:
NO ANS REASON
Reason: Patients with blood glucose levels that are too high will use fat for energy. Waste products from fat increase the amount of acid in the blood and tissue, and cells eventually will not work properly and may shut down. (ECTSI 8, pp. 405 - 406) Reason: Patients with diabetes are treated in different ways. Some oral medication, some take insulin, and some control the disease with diet alone. (ECTSI 8, pp. 409 - 410) Reason: The combination that will produce the quickest onset of altered mental status is skipping a meal and taking insulin. The patient will use up all available glucose in the bloodstream and become hypoglycemic. If the glucose level remains low, the patient may lose consciousness, have permanent brain damage, or die. (ECTSI 8, p. 405) Reason: When assessing a diabetic patient, pertinent questions to ask include whether or not the patient takes insulin or medications that lower his or her blood sugar; if so, whether or not the patient has taken the usual dose (or pills) today; if the patient has eaten normally today; and whether or not the patient has had any recent illness, unusual amount of activity, or stress. (ECTSI 8, p. 409) Reason: Insulin shock usually responds immediately following treatment. Patients with diabetic coma generally respond to treatment gradually, within 6 - 12 hours following the appropriate treatment. (ECTSI 8, p. 407) Reason: The form of diabetes that develops as a person ages is called type II diabetes. (ECTSI 8, p. 405) Reason: Because head injury can result in seizures, trauma should always be considered as a potential cause of the seizure. (ECTSI 8, p. 411)

1.

A

2.

B

3.

C

4.

B

5.

B

6.

B

7.

D

8.

B

Reason: In hyperglycemia, especially when the blood sugar exceeds 200 mg/dL, the kidneys excrete excess amounts of glucose. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose. (ECTSI 8, pp. 405 - 406) Reason: Diabetes is a disease in which the pancreas fails to produce enough insulin (or none at all). Insulin is a hormone that promotes the uptake of sugar from the bloodstream and into the cells. The result is impaired utilization of glucose. (ECTSI 8, p. 404) Reason: Diabetes primarily affects the body's metabolism and capacity to use sugar for energy, although no tissue escapes its effect. ( ECTSI 8, pp. 404-405) Reason: Polydipsia is frequent drinking to satisfy continuos thirst. (ECTSI 8, p. 406) Reason: When glucose does not reach the cells, where it is normally converted to energy by metabolism, the cells turn to another source of fuel, primarily fat. Fat metabolism produces ketones and fatty acids, leading to ketoacidosis. (ECTSI 8, p. 406) Reason: Patients with insulin shock are often mistaken for being intoxicated with alcohol due to their bizarre behavior. Signs and symptoms of insulin shock include an altered mental status ranging from confusion to aggressive behavior, normal or rapid respirations, pale and clammy skin, diaphoresis, rapid pulse, and seizures. (ECTSI 8, p. 408) Reason: This child is suffering from diabetic coma, which is characterized by a gradual onset; excessive urination, thirst, and hunger; and a rapid, thready pulse. Other signs and symptoms of diabetic coma include dehydration; deep, rapid breathing with an acetone odor on the breath (Kussmaul's Respirations); and varying degrees of unresponsiveness. (ECTSI 8, pp. 407 - 408) Reason: Diabetic ketoacidosis (diabetic coma) usually presents over a prolonged period of time (hours to days) and is characterized by dehydration, warm and dry skin, a sweet or fruity odor on the breath (acetone), deep and rapid breathing (Kussmaul's respirations), a rapid and weak/thready pulse, and varying degrees of unresponsiveness. (ECTSI 8, pp. 407 - 408) Reason: The first step in caring for a patient experiencing a diabetic emergency is to make sure that the airway is open. (ECTSI 8, p. 409) Reason: When called to the scene of a diabetic emergency, you should ask the patient or his or her family if insulin has been taken, if the usual dose of insulin has been taken, if the patient has eaten normally today, if the patient has experienced any illness, unusual amount of activity, or stress today? (ECTSI 8, p. 409) Reason: Due to the patient's unconsciousness and inadequate breathing, he requires assisted ventilation with a BVM device. Oral glucose should never be administered to a patient who is unable to

9.

B

10.

B

11.

D

12.

C

13.

D

14.

C

15.

B

16.

A

17.

C

18.

B

swallow. (ECTSI 8, pp. 409-411) Reason: Glucose is a basic sugar that is essential for cell metabolism in humans. (ECTSI 8, pp. 405 406)

19.

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