MS 3 Practice Test- Diabetes, Shock, Mods, ACLS, Burns And Cancer

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Questions and Answers
  • 1. 

    Which signs and symptoms are typical of Hyperglycemic hypermolar non-ketonic coma

    • A.

      BS level of 400

    • B.

      65 year old

    • C.

      Keytones in Urine

    • D.

      BS level of 700

    • E.

      25 year old

    • F.

      No keytones in urine

    Correct Answer(s)
    B. 65 year old
    D. BS level of 700
    F. No keytones in urine
    Explanation
    HHNK- BS> 600; more common inindividuals >50 YO with type II diabetes. These pts still produce some insulin so they do not produce keytones in their urine. The other answers are typical of DKA

    Rate this question:

  • 2. 

    What is the purpose of Kussmal Respirations in a patient with DKA?

    • A.

      To blow off CO2 which compensates for the bodies acidic state

    • B.

      To cool off the body reducing glucose metabolism

    • C.

      To hypoventilate which compensates for the bodies acidic state

    Correct Answer
    A. To blow off CO2 which compensates for the bodies acidic state
    Explanation
    Kussmaul respirations are deep and rapid; they blow off CO2 causing hyPERventilation, decreasing carbonic acid, increasing the base compensatory mechanisms to regulate the acidic state caused by DKA

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  • 3. 

    A patient recently diagnosed with DM I asks why she can't just take oral anti-diabetic medications instead of insulin injections. You tell her:

    • A.

      Oral medications are not effective agains DM 1 because they do not stimulate enough insulin production from the pancreas

    • B.

      DM 1 patients can take oral anti-diabetic meds, but would have to take so many it would be too expensive

    • C.

      Oral medications are not effective against DM 1 because the pancrease isn't producing any endogenous insulin to be supplemented

    Correct Answer
    C. Oral medications are not effective against DM 1 because the pancrease isn't producing any endogenous insulin to be supplemented
    Explanation
    The pancreas of a DM 1 patient doesn't produce ANY insulin so it must be provided through insulin injections

    Rate this question:

  • 4. 

    What set of ABG's would be reflective of DKA?

    • A.

      PH- 7.30, CO2- 47, HCO3- 22, O2- 80

    • B.

      PH- 7.32, CO2- 32, HCO3- 20, O2- 82

    • C.

      PH- 7.38, CO2- 47, HCO3- 28, O2- 85

    Correct Answer
    B. PH- 7.32, CO2- 32, HCO3- 20, O2- 82
    Explanation
    The first one is resp acidosis d/t increased CO2 and normal Bicarb; DKA is metabolic acidosis so Bicarb and pH would be below normal

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  • 5. 

    Pick 2 insulins that should be given together to offer 24hour coverage (in one dose) AND coverage for meals (multiple doses) - Choose all options that could apply:

    • A.

      NPH

    • B.

      Regular

    • C.

      Humalog

    • D.

      Lantus

    Correct Answer(s)
    B. Regular
    C. Humalog
    D. Lantus
    Explanation
    Lantus works 24 hours and either Regular OR Humalog can be used to cover meals. NPH covers 10-16 hours so 2 doses would be needed for 24 hours

    Rate this question:

  • 6. 

    What would you advise your DM patient in respect to exercise? (Choose all that apply)

    • A.

      Exercising while positive for Keytones is not recommended

    • B.

      Pt should administer insulin just prior to exercise

    • C.

      Pt should eat a 15 gram carb snack prior to exercise

    • D.

      It is ok to exercise if the patient's BS is less than 300

    Correct Answer(s)
    A. Exercising while positive for Keytones is not recommended
    C. Pt should eat a 15 gram carb snack prior to exercise
    Explanation
    exercise reduces BS so insulin should not be administered prior to exercise- a snack should; pt's BS should be less than 250

    Rate this question:

  • 7. 

    Metformin (Glucophage) works by:

    • A.

      Inhibiting the production of glucose by the liver

    • B.

      Delaying the absorption of glucose in the intestine

    • C.

      Stimulating insulin release from the pancreas

    • D.

      Enhancing insulin action at the receptor sites

    Correct Answer
    A. Inhibiting the production of glucose by the liver
  • 8. 

    When teaching about oral anti-diabetics, you should tell the patient to: (choose all that apply)

    • A.

      Take their medication at the same time every day

    • B.

      Take medication immediately before meals to increase effectiveness

    • C.

      Do not skip meals

    • D.

      This medication may affect the effectiveness of birth control pills

    Correct Answer(s)
    B. Take medication immediately before meals to increase effectiveness
    C. Do not skip meals
    D. This medication may affect the effectiveness of birth control pills
    Explanation
    Taking the meds should be correlaed with meals not times of day; thiazolinide can decrease the effectiveness of BCPs

    Rate this question:

  • 9. 

    One serving of Carbs equals _____grams (enter just the number, not the grams!)

    Correct Answer(s)
    15
  • 10. 

    Your patient is on a daily dose of NPH insulin BID and Humalog SQ before meals. When would you expect to see your patient suffer from symptoms of hypoglycemia? Choose all that apply

    • A.

      Breakfast

    • B.

      Lunch

    • C.

      Dinner

    • D.

      Bedtime

    Correct Answer(s)
    A. Breakfast
    D. Bedtime
    Explanation
    NPH duration is 10-16 hours so would be given probably 7a an 7p. Most diabetic pts are hypoglycemic at breakfast but keep their levels up during the day. The 7am dose of NPH would be running out around bedtime, and then again at breakfast

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  • 11. 

    When teaching your diabetic patient about preventing diabetic retinopathy, you advise them to: (choose all that apply)

    • A.

      Maintain a normal BS

    • B.

      Schedule annual optometrist visits

    • C.

      Control hypertension

    • D.

      Report loss of vision to physician

    Correct Answer(s)
    A. Maintain a normal BS
    C. Control hypertension
    D. Report loss of vision to physician
    Explanation
    opthalmologist visits- NOT optometrist!!!

    Rate this question:

  • 12. 

    What drug is always associated with Diabetic Nephropathy?

    • A.

      ACE inhibitors- prils

    • B.

      Beta-Blockers- lols

    • C.

      CCB

    Correct Answer
    A. ACE inhibitors- prils
  • 13. 

    The most common and effective treatment options for patients with Diabetic Neuropathies are:

    • A.

      Physical Therapy

    • B.

      Bio-feedback

    • C.

      Medications

    • D.

      Hydrotherapy

    Correct Answer
    C. Medications
    Explanation
    Reglan for delayed gastric emptying, non-opiod analgesics, neurontin, viagra

    Rate this question:

  • 14. 

    What diabetic complication accounts for 50% of diabetic deaths?

    • A.

      Diabetic Nephropathy

    • B.

      CAD

    • C.

      PVD

    • D.

      Infections

    Correct Answer
    B. CAD
    Explanation
    CAD causes MI's and Strokes which account for 50% of diabetic deaths

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  • 15. 

    Which of the following complications can contribute to Foot and leg problems/amputations? (check all that apply)

    • A.

      Neuropathy

    • B.

      PVD

    • C.

      Immunocompromise

    • D.

      HTN

    Correct Answer(s)
    A. Neuropathy
    B. PVD
    C. Immunocompromise
  • 16. 

    You have just admitted a burn patient who drove through McDonald's and spilled scalding hot coffee on his lap. His left hand, groin and the tops of both of his thighs have 2nd degree burns. What would his TBSA be?

    • A.

      6%

    • B.

      11%

    • C.

      17%

    Correct Answer
    B. 11%
    Explanation
    1% for groin, 1% for hand (a palmar size burn) and 4.5% for each thigh

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  • 17. 

    A burn victim with 32% TBSA and a weight of 200lbs is admitted to the burn unit. Using the Parkland Formla, how many mL of fluids should this patient receive in the first 8 hours of fluid resuscitation?

    • A.

      11636 mL

    • B.

      5818 mL

    • C.

      364 mL

    Correct Answer
    B. 5818 mL
    Explanation
    The first number is the total 24 hour fluid resuscitation amount; the last number is the weight x 4mL

    Rate this question:

  • 18. 

    The gut should be used within the first 6 hours after a burn patient arrives at the hospital- "use it or lose it" In what circumstances would this be contraindicated?

    • A.

      ETT and mechanical ventilation

    • B.

      Crackels in the lungs r/t fluid resuscitation

    • C.

      Paralytic ileus

    • D.

      Curlings Ulcer

    Correct Answer
    C. Paralytic ileus
  • 19. 

    What type of shock is a burn patient prone to?

    • A.

      Cardiogenic

    • B.

      Anapylactic

    • C.

      Hypovolemic

    Correct Answer
    C. Hypovolemic
  • 20. 

    A burn patient has singed nasal hairs and sooty sputum. They are put on 02 via NC 6 liters but their sats continue to fall. They are intubated and put on what % of oxygen?

    • A.

      25%

    • B.

      50%

    • C.

      100%

    Correct Answer
    C. 100%
    Explanation
    expectoration of carbon (soot) is a cardial sign of inhalation injury. Carbon Monoxide has a higher affinity for Hemoglobin than oxygen so the O2 needs to be at 100% to drive out the carbon monoxide from the hemoglobin molecule

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  • 21. 

    An escharotomy would be used to treat:

    • A.

      Hypovolemia

    • B.

      Paralytic ileus

    • C.

      Compartment syndrome

    Correct Answer
    C. Compartment syndrome
  • 22. 

    Which of the following would be used to prevent Hypertrophic scarring?

    • A.

      Surgery

    • B.

      Pressure garments

    • C.

      Massage

    • D.

      Oral steriods

    Correct Answer(s)
    B. Pressure garments
    C. Massage
    Explanation
    injectible steriods are also used to prevent scarring along with lubrication, splints and manual lymphatic drainage

    Rate this question:

  • 23. 

    What indicators let the burn team know that skin has a better chance of re-growth? (choose all that apply)

    • A.

      Ability to blanch

    • B.

      Presence of hair follicles

    • C.

      Dry appearance

    • D.

      Absence of pain

    Correct Answer(s)
    A. Ability to blanch
    B. Presence of hair follicles
    Explanation
    wet skin has sebaceous glands which increases chances of re-growth; absence of pain indicates loss of nerves which occurs with deeper burns which don't heal as well

    Rate this question:

  • 24. 

    What would indicate a risk of Restrictive Pulmonary system alterations?

    • A.

      Singed nasal hairs

    • B.

      Hoarse voice

    • C.

      Circumferencial burn on thorax

    • D.

      Full thickness burn on face

    Correct Answer
    C. Circumferencial burn on thorax
    Explanation
    Restrictive alterations are caused by circumferencial burns on the neck or thorax that swell and cause tightening decreasing tidal volume

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  • 25. 

    The destruction of RBC's and muscle from heat injuries can cause free hemoglobin and myoglobin to build up in the blood. What organ system would this affect most?

    • A.

      Liver

    • B.

      Kidneys

    • C.

      Spleen

    Correct Answer
    B. Kidneys
    Explanation
    The large molcules get caught in the kidneys filtration system clogging them up and causing kidney failure

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  • 26. 

    What are the s/s of hypovolemic shock? (Choose all that apply)

    • A.

      Flushed, warm skin

    • B.

      Tachypnea

    • C.

      Bradycardia

    • D.

      Anuria

    • E.

      Bounding peripheral pulses

    Correct Answer(s)
    B. Tachypnea
    D. Anuria
    Explanation
    cold, clammy skin; tachycardia and +1 to absent peripheral pulses

    Rate this question:

  • 27. 

    A patient with a known infection begins to experience persistent hypotension. This patient is suffering from:

    • A.

      Sepsis

    • B.

      Severe Sepsis

    • C.

      Septic Shock

    Correct Answer
    C. Septic Shock
  • 28. 

    A patient with pneumonia is on the vent. Their PaO2 is 90 and their FiO2 is set at 35%. This patient is experiencing pulmonary shunting

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Their PaO2/FiO2 ratio is 257. Any value under 300 is considered pulmonary shunting, a sign of Septic Shock

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  • 29. 

    The following lab values are indicative for Septic Shock (Choose all that apply)

    • A.

      Lactate 3.7 mmole/L

    • B.

      WBC 3500

    • C.

      Temp 101.0 F

    • D.

      RR of 24

    Correct Answer(s)
    B. WBC 3500
    C. Temp 101.0 F
    D. RR of 24
  • 30. 

    What is the first step in the Septic Bundle?

    • A.

      Fluid resuscitation

    • B.

      Vasopressors

    • C.

      ATB therapy

    • D.

      Blood, urine, sputum and wound cultures

    Correct Answer
    D. Blood, urine, sputum and wound cultures
    Explanation
    Cultures need to happen before ATB therapy

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  • 31. 

    What is the cause of hypotension in Septic Shock?

    • A.

      Slowing of the heart r/t electrolyte imbalances

    • B.

      Damage to endothelial cells that affect constriction of blood vessels

    • C.

      Hypovolemia

    Correct Answer
    B. Damage to endothelial cells that affect constriction of blood vessels
  • 32. 

    Why would lactate levels be monitored in a patient with Septic Shock?

    • A.

      To monitor kidney function

    • B.

      To determine if aerobic metabolism is replacing anaerobic metabolism

    • C.

      To monitor muscle wasting

    Correct Answer
    B. To determine if aerobic metabolism is replacing anaerobic metabolism
  • 33. 

    Xigris is an antibiotic used as a last resort to treat septic shock d/t it's toxic side effects

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    It isn't an antibiotic- it reduces microvascular injury and enhances microvascular perfusion

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  • 34. 

    MODS or MSOF is defined by the failure of 1 or more organs

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    2 or more organs

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  • 35. 

    Unexplained fevers with negative cultures could indicate the failure of this organ

    • A.

      Liver

    • B.

      Kidney

    • C.

      Gallbladder

    Correct Answer
    C. Gallbladder
  • 36. 

    How can DIC lead to MODS?

    • A.

      DIC causes severe bleeding robbing the organs of oxygen

    • B.

      DIC causes cellular toxins to be released in the blood stream,poisoning the organs

    • C.

      DIC causes microvascular clots which block organ perfusion robbing the organs of oxygen

    Correct Answer
    C. DIC causes microvascular clots which block organ perfusion robbing the organs of oxygen
    Explanation
    Although DIC can cause bleeding d/t lack of clotting factors,that is not why organs lack perfusion- it's because of the clots

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  • 37. 

    When the lungs suffer from an extreme inflammatory response, the pulmonary vascular and alveolar endothelium are damaged; the causes a decrease in surfactant, increased capillary permeability and refractory hypoxemia. What is another name for this pathology?

    Correct Answer
    ARDS
  • 38. 

    What can cause kidney failure in sepsis patients? (Choose all that apply)

    • A.

      The use of nephrotoxic medications

    • B.

      Hypotension

    • C.

      DIC

    • D.

      ARDS

    Correct Answer(s)
    A. The use of nephrotoxic medications
    B. Hypotension
    C. DIC
  • 39. 

    Your patient arrives at the ER complaining he doesn't "feel well"- His Vitals are: T- 99.0, P-51, R-18, BP- 110/65 and 02 98%. He is alert x3 and denies any pain. You should:

    • A.

      Administer oxygen

    • B.

      Continue to monitor

    • C.

      Administer atropine

    • D.

      Administer fluids

    Correct Answer
    B. Continue to monitor
    Explanation
    Even though this patient is bradycardic, his BP, O2 sats and LOC tell you that he is stable and perfusing. He just needs to be monitored.

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  • 40. 

    Your ER patient is being monitored by EKG- you notice her HR has gone from 85 to 120. Her QRS measures .16. When you assess her she says she isn't having any pain but feels like her heart is beating out of her chest. Your first intervention is:

    • A.

      Have her perform vagal manuvers such as bearing down and coughing

    • B.

      Administer adenosine IV (chemical cardioversion)

    • C.

      Administer amiodarone IV

    Correct Answer
    C. Administer amiodarone IV
    Explanation
    stable Tachy with a wide QRS is V-tach- amiodarone is the treatment. The other treatments are for SVT- which has a narrow QRS

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  • 41. 

    Your patient who has a hx of CAD complains of chest pain. You put him on the EKG and his HR is 160 BPM. The treatment for this patient would be:

    • A.

      Amiodarone IV

    • B.

      Adnosine IV (Chemical Cardiovesion)

    • C.

      Synchronized Electric Cardioversion

    Correct Answer
    C. Synchronized Electric Cardioversion
    Explanation
    Since this patient is unstable (chest pain) and tachycardic (regardless of QRS interval) you would immediately cardiovert him (don't forget the versed first!!:)

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  • 42. 

    You go in to check on your patient and they do not have a pulse. This first thing you do is:

    • A.

      Crap your pants

    • B.

      Review their EKG to determine if they have a shockable rhythm

    • C.

      Begin CPR

    • D.

      Administer epinepherine

    Correct Answer
    C. Begin CPR
    Explanation
    ok- maybe this was a no-brainer, but know if you find this patient you better start CPR first and let someone else get the equipment and go from there.

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  • 43. 

    Your patient has 2nd degree heart block and his body has compensated for it keeping him perfused with a good blood pressure. Today after your initial assessment, you notice your patient is not themself- they seem confused, are pale and clammy. Your first intervention would be:

    • A.

      Fluid resucitation

    • B.

      Epinepherine

    • C.

      Atropine

    Correct Answer
    C. Atropine
    Explanation
    Remember APE- heart block=bradycardia and since this patient is not stable and showing signs of shock, begin the APE protocol: atropine, pacemaker and epi

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  • 44. 

    Shock, CPR,epi; shock, CPR, epi; shock, CPR, epi- what type of patient would receive this treatment?

    • A.

      PEA

    • B.

      Pulseless VF/VT

    • C.

      Asystole

    Correct Answer
    B. Pulseless VF/VT
    Explanation
    pts with no shockable rhythm are PEA and Asystole- these patients would receive CPR, epi, CPR, epi (or one time dose of vasopressin)

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  • 45. 

    For a patient with an adequate BP and anaphylactic shock, you would administer between _____mg and ____mg of epinepherine at ______________ concentration (enter answers without mg and following each other with a comma and a space: x, y, x

    Correct Answer
    0.3, 0.5, 1:1000
    Explanation
    If a patient's BP is low, the same dose of Epi is used but in a 1:10,000 concentration IV q 5"

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  • 46. 

    Which type of skin cancer has the best prognosis?

    • A.

      Basal Cell Carcinoma

    • B.

      Squamous Cell Carcinoma

    • C.

      Malignant Melanoma

    Correct Answer
    A. Basal Cell Carcinoma
  • 47. 

    What populations would you find Kaposi's Sarcoma in? (choose all that apply)

    • A.

      Pacific Island

    • B.

      AIDS patients

    • C.

      Mediterranean

    • D.

      European

    • E.

      Eastern African

    Correct Answer(s)
    B. AIDS patients
    C. Mediterranean
    E. Eastern African
  • 48. 

    Your patient has a skin lesion that is rough, scaly ad thickened in appearance. It is most likely a:

    • A.

      Basal Cell Carcinoma

    • B.

      Squamous Cell Carcinoma

    • C.

      Malignant Melanoma

    Correct Answer
    B. Squamous Cell Carcinoma
  • 49. 

    What stage of hypovolemic shock involves the begining of anaeobic metabolism and subsequent respiatory and metabolic acidosis?

    • A.

      Stage 1

    • B.

      Stage 2

    • C.

      Stage 3

    • D.

      Stage 4

    Correct Answer
    C. Stage 3
  • 50. 

    What stage of hypovolemic shock involves the onset of reduced urine output?

    • A.

      Stage 1

    • B.

      Stage 2

    • C.

      Stage 3

    • D.

      Stage 4

    Correct Answer
    B. Stage 2

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Jan 18, 2013
    Quiz Edited by
    ProProfs Editorial Team
  • Oct 23, 2010
    Quiz Created by
    Krispen
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