CH 24

Question 1

Which of the following is a microvascular complication of diabetes?
Diuresis
Hypertension
Retinopathy
Hyperglycemia

Answer 1

Retinopathy

Question 2

A decrease in adrenal hormone production will result in which of the following symptoms?

Weakness
Darkening of skin on the neck
Hypoglycemia
Hypertension

Answer 2

Weakness

Question 3

Which of the following would the paramedic likely administer to a patient with diabetic ketoacidosis?

Insulin
Magnesium
Hydrocortisone
Isotonic fluid

Answer 3

Isotonic fluid

Question 4

Insulin resistance occurs when:

the release of epinephrine and norepinephrine renders insulin less effective.
the body produces excessive insulin, which causes a profound drop in blood glucose.
autoantibodies break down insulin before it can be utilized by the body.
the pancreas produces enough insulin, but the body cannot utilize it effectively.

Answer 4

the pancreas produces enough insulin, but the body cannot utilize it effectively.

Question 5

You receive a call to the county jail for a male inmate who is unresponsive. According to the jailer, the patient was arrested for being “drunk.” Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient’s ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should:

conclude that he will require immediate definitive care and begin transport.
administer a second dose of dextrose and prepare for immediate transport.
give him 1 mg of glucagon IM and reassess his blood glucose.
intubate his trachea to prevent aspiration and transport him immediately.

Answer 5

administer a second dose of dextrose and prepare for immediate transport.

Question 6

When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced:

serum glucose levels will fall and brain damage may occur.
glucose levels in the blood and urine will be elevated.
the cells will metabolize oxygen and function normally.
the body will stop making glucose as a protective mechanism.

Answer 6

glucose levels in the blood and urine will be elevated.

Question 7

The primary role of cortisol is to:

decrease the body’s inflammatory response.
assist with the body’s response to stress.
maintain an adequate blood pressure.
regulate the metabolism of carbohydrates.

Answer 7

assist with the body’s response to stress

Question 8

Which of the following is a common symptom of type 2 diabetes?

Dysuria
Tachycardia
Thirst
Cool, clammy skin

Answer 8

Thirst

Question 9

Which of the following would cause hypoglycemia in the patient with type 1 diabetes?

Insulin underdose
Too much insulin
High-protein diet
Inactivity

Answer 9

Too much insulin

Question 10

Which of the following statements regarding insulin is correct?

An increase in insulin levels causes an increase in blood glucose.
Insulin stimulates the conversion of glycogen to glucose.
Insulin is a pancreatic hormone that performs exocrine functions.
Insulin is the only hormone that decreases blood glucose levels.

Answer 10

Insulin is the only hormone that decreases blood glucose levels.

Question 11

A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man’s wife, he has had a fever and flulike symptoms for the past few days. She further tells you that he has “stuck to his diet” as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads “high.” This patient is most likely:

experiencing hyperosmolar nonketotic coma.
hyperglycemic secondary to being dehydrated.
significantly acidotic and requires bicarbonate.
producing ketones due to fat metabolism.

Answer 11

experiencing hyperosmolar nonketotic coma.

Question 12

Unlike the patient with hypoglycemia, the patient with severe hyperglycemia:

usually does not vomit.
is tachypneic and hyperpneic.
has a normal breath odor.
rapidly improves with treatment.

Answer 12

is tachypneic and hyperpneic.

Question 13

Diabetic ketoacidosis occurs when:

blood glucose levels rise above 250 mg/dL.
insulin production exceeds glucagon production.
the renal system begins to excrete ketones.
the cells metabolize fat and produce ketones.

Answer 13

the cells metabolize fat and produce ketones.

Question 14

A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will likely find that the patient is:
tachypneic.
hyperglycemic.
breathing deeply.
dehydrated.

Answer 14

Tachypneic

Question 15

Secretion of parathyroid hormone is regulated by blood levels of:

potassium.
calcium.
sodium.
phosphorus.

Answer 15

Calcium

Question 16

The endocrine component of the pancreas:

secretes digestive enzymes into the duodenum.
releases epinephrine and norepinephrine.
comprises the pancreatic duct.
comprises the islets of Langerhans.

Answer 16

comprises the islets of Langerhans.

Question 17

Hyperglycemia is characterized by:

a rapid onset and cool, clammy skin.
shallow respirations and bradycardia.
a gradual onset and warm, dry skin.
a blood glucose level above 110 mg/dL.

Answer 17

a gradual onset and warm, dry skin.

Question 18

The chief clinical manifestation of addisonian crisis is:

dehydration.
shock.
an elevated temperature.
lower back pain.

Answer 18

Shock

Question 19

If there is an increased level of antidiuretic hormone in the bloodstream, then:

potassium, phosphorus, and magnesium are lost through diuresis.
the kidneys excrete excessive sodium and water from the body.
the renal tubules are stimulated to reabsorb sodium and water.
blood pressure decreases secondary to dilation of the vessels.

Answer 19

the renal tubules are stimulated to reabsorb sodium and water.

Question 20

Which of the following is consistent with hyperosmolar hyperglycemic syndrome?

Glucose, 340 mg/dL; pH, 7.29; ketone bodies, present
Glucose, 500 mg/dL; pH, 7.20; ketone bodies, absent
Glucose, 612 mg/dL; pH, 7.39; ketone bodies, absent
Glucose, 420 mg/dL; pH, 7.25; ketone bodies, present

Answer 20

Glucose, 612 mg/dL; pH, 7.39; ketone bodies, absent

Question 21

Unlike hypothyroidism, hyperthyroidism:

causes a decrease in the metabolic rate.
causes an increase in oxygen demand.
results in a decreased cardiac output.
often results in acute myxedema coma.

Answer 21

causes an increase in oxygen demand.

Question 22

A 50-year-old male with a history of long-term alcohol abuse presents with dull epigastric pain that is worse when he is lying flat. What should you suspect?

Addison disease
Pancreatitis
Addisonian crisis
Cushing syndrome

Answer 22

Pancreatitis

Question 23

Patients with hyperosmolar hyperglycemic nonketotic coma:

typically require prehospital sodium bicarbonate therapy.
present with severe dehydration and neurologic deficits.
experience more severe acidosis than patients with diabetic ketoacidosis.
most commonly have a history of type 1 diabetes mellitus.

Answer 23

present with severe dehydration and neurologic deficits.

Question 24

If the body experiences a drop in volume or blood pressure:

catecholamine release inhibits the conversion of glycogen to glucose in the liver.
aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
adrenocorticotropic hormone causes a reduction in the secretion of cortisol.
aldosterone stimulates the sweat glands, resulting in diaphoretic skin.

Answer 24

aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.

Question 25

The clinical presentation of a hypoglycemic patient would most likely resemble that of a patient with: alcohol intoxication. an opiate overdose. a hemorrhagic stroke. classic heatstroke.

Answer 25

alcohol intoxication