Chapter 19 – Endocrine and Hematologic Emergencies

Insulin shock will MOST likely develop if a patient: A. takes too much of his or her prescribed insulin. B. markedly overeats and misses an insulin dose. C. eats a regular meal followed by mild exertion. D. misses one or two prescribed insulin injections.

2. Assessment of a patient with hypoglycemia will MOST likely reveal: A. sunken eyes. B. hyperactivity. C. warm, dry skin. D. combativeness.

3. Glutose is a trade name for: A. glucotrol. B. oral glucose. C. micronase. D. glucophage.

4. Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT: A. assessing the patient's mental status. B. ensuring the absence of a gag reflex. C. checking the medication's expiration date. D. requesting permission from medical control.

5. Which of the following statements regarding glucose is correct? A. Most cells will function normally without glucose. B. Blood glucose levels decrease in the absence of insulin. C. The brain requires glucose as much as it requires oxygen. D. The brain requires insulin to allow glucose to enter the cells.

6. Diabetes is MOST accurately defined as a(n): A. disorder of carbohydrate metabolism. B. abnormally high blood glucose level. C. mass excretion of glucose by the kidneys. D. lack of insulin production in the pancreas.

7. 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.

8. Excessive eating caused by cellular "hunger" is called: A. polyphagia. B. polydipsia. C. dysphasia. D. dyspepsia.

A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she: A. is significantly hyperglycemic. B. has a low blood glucose level. C. has a urinary tract infection. D. has overdosed on her insulin.

10. Diabetic coma is a life-threatening condition that results from: A. hypoglycemia, excess insulin, and dehydration. B. hyperglycemia, ketoacidosis, and dehydration. C. hypoglycemia, dehydration, and ketoacidosis. D. hyperglycemia, excess insulin, and ketoacidosis.

11. When assessing an unconscious diabetic patient, the primary visible difference between hyperglycemia and hypoglycemia is the: A. patient's mental status. B. rate of the patient's pulse. C. presence of a medical identification tag. D. rate and depth of breathing.

12. Glipizide, a non-insulin-type medication, is another name for: A. Glucophage. B. Glucotrol. C. Micronase. D. Diabinese.

13. 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 the patient is diaphoretic, tachycardic, and tachypneic. Initial management 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.

14. To which of the following diabetic patients should you administer oral glucose? A. an unconscious 33-year-old male with cool, clammy skin B. a conscious 37-year-old female with nausea and vomiting C. a semiconscious 40-year-old female without a gag reflex D. a confused 55-year-old male with tachycardia and pallor

15. Patients with uncontrolled diabetes experience polyuria because: A. they drink excess amounts of water due to dehydration. B. excess glucose in the blood is excreted by the kidneys. C. low blood glucose levels result in cellular dehydration. D. high blood sugar levels cause permanent kidney damage.

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.

17. A 19-year-old male complains of "not feeling right." His insulin and a syringe are on a nearby table. The patient says he thinks he took his insulin and cannot remember whether he ate. He is also unable to tell you the time or what day it is. The glucometer reads "error" after several attempts to assess his blood glucose level. In addition to administering oxygen, you should: A. contact medical control and administer oral glucose. B. assist him with his insulin injection and reassess him. C. request a paramedic ambulance to administer IV glucose. D. transport only with close, continuous monitoring en route.

18. A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days' duration. You apply 100% oxygen and assess her blood glucose level, which reads 320 mg/dL. If this patient's condition is not promptly treated, she will MOST likely develop: A. severe insulin shock. B. acidosis and dehydration. C. complete renal failure. D. hypoxia and overhydration.

19. Insulin functions in the body by: A. producing new glucose as needed. B. enabling glucose to enter the cells. C. increasing circulating blood glucose. D. metabolizing glucose to make energy.

20. When obtaining a SAMPLE history from a patient with diabetes, it would be MOST important to determine: A. if he or she has had any recent illnesses or excessive stress. B. approximately how much water the patient drank that day. C. if there is a family history of diabetes or related conditions. D. the name of the physician who prescribed his or her insulin.

21. The normal blood glucose level, as measured by a glucometer, is between: A. 60 and 80 mg/dL. B. 80 and 120 mg/dL. C. 130 and 150 mg/dL. D. 160 and 200 mg/dL.

22. A 29-year-old female presents with confusion and disorientation. Her respirations are rapid and shallow and her pulse is 120 beats/min and thready. She is markedly diaphoretic and has an oxygen saturation of 89%. You should: A. transport immediately. B. administer oral glucose. C. provide ventilatory support. D. treat her for hyperglycemia.

23. 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.

24. 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.

25. Which of the following statements regarding diabetic coma is correct? A. Diabetic coma can be prevented by taking smaller insulin doses. B. Diabetic coma typically develops over a period of hours or days. C. Patients with low blood glucose levels are prone to diabetic coma. D. Diabetic coma rapidly progresses once hyperglycemia develops.

26. In contrast to insulin shock, diabetic coma: A. is rapidly reversible if oral glucose is given. B. commonly results in excess water retention. C. can only be corrected in the hospital setting. D. is a rapidly developing metabolic disturbance.

27. Ketone production is the result of: A. acidosis when blood glucose levels are low. B. blood glucose levels higher than 120 mg/dL. C. fat metabolization when glucose is unavailable. D. rapid entry of glucose across the cell membrane.

28. 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.

29. 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.

30. Diabetic ketoacidosis occurs when: A. blood glucose levels rapidly fall. B. the cells rapidly metabolize glucose. C. the pancreas produces excess insulin. D. insulin is not available in the body.