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Emergency Care, 13e (Limmer et al.)
Chapter 19 Diabetic Emergencies and Altered Mental Status
1) The medical term for fainting is:
A) syncope.
B) altered RAS status.
C) dehydration.
D) vertigo.
Objective: 19.1
2) Which of the following BEST describes status epilepticus?
A) A seizure involving convulsions on only one side of the body
B) A seizure that occurs without a known cause
C) A period of drowsiness following tonic-clonic seizures
D) Two or more seizures with tonic-clonic activity without an intervening period of
consciousness
Objective: 19.1
1
3) Your patient is waking up from a seizure; it was the patient's first seizure ever. When you ask
what happened, the patient tells you she had the smell of fresh mown grass just before she
seized. This sensation is known as a(n):
A) tonic phase.
B) postictal phase.
C) clonic phase.
D) aura.
Objective: 19.1
4) The death of brain tissue due to deprivation of oxygen because of a blocked or ruptured artery
in the brain is known as which of the following?
A) Transient ischemic attack
B) Stroke
C) Aphasia
D) Seizure
Objective: 19.1
2
5) A hormone called insulin is secreted by the:
A) islets of Langerhans in the liver.
B) gallbladder found in the pancreas.
C) islets of Langerhans in the pancreas.
D) None of the above.
Objective: 19.1
6) There are two types of seizures; if your patient is having a seizure that affects only one body
part and does not cause her to lose consciousness, it is called a:
A) tonic-clonic seizure.
B) generalized seizure.
C) postictal seizure.
D) partial seizure.
Objective: 19.1
7) The condition in which there is an insufficient amount of sugar in the blood is called:
A) diabetic coma.
B) hypoglycemia.
C) hyperglycemia.
D) diabetic ketoacidosis.
Objective: 19.1
3
8) Your patient is a 25-year-old female with a history of diabetes. She is confused, agitated, and
verbally abusive to you, and she is very sweaty. Although she refuses to give a history of the
present illness, you should suspect which of the following as the likely cause of the patient's
presentation?
A) Failure to take her insulin
B) A nondiabetic-related problem, such as a head injury or mental illness
C) Failure to intake sufficient sugar
D) Excessive intake of foods high in sugar, such as soda or candy
Objective: 19.2
9) For the reticular activating system (RAS) to work correctly, what three substances are needed?
A) Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and sodium to keep the brain
hydrated
B) Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and water to keep the brain
hydrated
C) Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and sodium to keep the brain
hydrated
D) Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and water to keep the brain
hydrated
Objective: 19.3
4
10) Normal consciousness is regulated by a series of neurologic circuits in the brain that
comprise the reticular activating system (RAS). The RAS has simple requirements to function
properly. Which one of the following items is NOT one of those requirements?
A) Oxygen
B) Glucose
C) Water
D) Sodium
Objective: 19.3
11) During your primary assessment you find your patient has an altered mental status. This
could indicate which of the following?
A) Failing respiratory system
B) Problems with the RAS due to hypertension
C) The need for suctioning of the airway
D) The need to complete a secondary assessment
Objective: 19.4
12) Which of the following is the role of glucose in the body?
A) It assists the pancreas in the manufacture of insulin.
B) It provides energy for brain cells and other cells in the body.
C) It allows the body to use insulin.
D) It is an essential building block for body tissues, such as muscle and bone.
Objective: 19.5
5
13) Which of the following is an action of insulin?
A) It increases the transfer of sugar from the stomach and small intestine to the bloodstream.
B) It increases the movement of sugar from the bloodstream to the cell.
C) It increases the circulating level of glucose in the blood.
D) It blocks the uptake of sugar by the body's cells.
Objective: 19.5
14) If the blood sugar level is very high, which of the following may result?
A) Excessive urination, excessive thirst, and excessive hunger
B) Polyuria and hyperactivity
C) Excessive insulin, excessive glucose, and excessive urination
D) Hyperactivity, excessive thirst, and polyuria
Objective: 19.5
15) Which of the following is characteristic of a patient with hyperglycemia?
A) Use of excessive amounts of insulin or lack of adequate food intake
B) A "fruity" odor of the breath
C) Cool, moist skin, agitated behavior, and increased heart rate
D) Sudden onset of altered mental status
Objective: 19.5
6
16) As an EMT, you will be called on frequently to treat diabetic emergencies. Diabetic
emergencies are usually caused by:
A) poor management of the patient's diabetes.
B) falls.
C) hypoxia.
D) pancreatitis.
Objective: 19.5
17) The most common medical emergency for the diabetic is hypoglycemia, or low blood sugar.
Which one of the factors below is NOT a cause of hypoglycemia?
A) Takes too much insulin
B) Reduces sugar intake by eating too much
C) Overexercises or overexerts himself
D) Vomits a meal
Objective: 19.5
18) Which of the following is NOT a sign of a hypoglycemic diabetic emergency?
A) Combativeness
B) Slow heart rate
C) Anxiety
D) Cold, clammy skin
Objective: 19.5
7
19) Looking at the following list, which of the items does NOT correctly compare the signs and
symptoms of hypoglycemia and hyperglycemia?
A) Hyperglycemia usually has a slower onset than hypoglycemia.
B) Hyperglycemic patients often have warm, red, dry skin, whereas hypoglycemic patients have
cold, pale, moist, or clammy skin.
C) The hyperglycemic patient often has acetone breath, whereas the hypoglycemic patient does
not.
D) The hypoglycemic patient is usually complaining of a headache, whereas the hyperglycemic
patient is not.
Objective: 19.5
20) When someone is experiencing hypoglycemia, the body attempts to compensate by using the
fight-or-flight mechanism of the autonomic nervous system. Which one of the statements below
is NOT one of the fight-or-flight responses?
A) Blood vessels constrict.
B) The heart pumps faster.
C) Breathing accelerates.
D) The skin is hot and dry.
Objective: 19.5
8
21) Most of the diabetic emergencies that you will be called to deal with will be related to
hypoglycemia. However, occasionally you will experience an instance of hyperglycemia. In the
list below, which item is NOT likely to be a sign or symptom of hyperglycemia?
A) Chronic thirst
B) Excessive urination
C) Reduced rate of breathing
D) Nausea
Objective: 19.5
22) Which of the following may result in hypoglycemia in the diabetic patient?
A) Failure to take insulin or oral diabetes medications
B) Lack of exercise
C) Vomiting after eating a meal
D) Overeating
Objective: 19.5
23) Compared to hypoglycemia, which of the following is true of hyperglycemia?
A) Its onset is more sudden.
B) Its onset is more gradual.
C) Its onset is preceded by an aura, such as hallucinations or detecting unusual odors.
D) It is more easily treated in the prehospital environment than hypoglycemia.
Objective: 19.5
9
24) Which of the following blood glucose levels is considered normal for an adult?
A) 80 mg/dL
B) 40 mg/dL
C) 180 mg/dL
D) 150 mg/dL
Objective: 19.6
25) Your patient is a 44-year-old male with a history of diabetes. He is lying on the living room
floor, unresponsive to all stimuli. He has a respiratory rate of 12 breaths per minute, heart rate of
112 beats per minute, and is pale and sweaty. Which of the following should you do to treat this
patient?
A) Encourage the patient's family to administer his insulin.
B) Apply oral glucose solution to a tongue depressor and insert it between the patient's cheek and
gums.
C) Place the patient in the recovery position to protect the airway and place oral glucose solution
under the patient's tongue.
D) Place the patient in the recovery position, administer oxygen, and monitor his airway status.
Objective: 19.7
10
