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Free NREMT practice questionsFree AEMT practice questions · Medical/Obstetrics/Gynecology

10 free AEMT practice questions: Diabetic Emergencies and Glucometry

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

Work through all 10, then move on to the next topic. When you want the full picture, the free AEMT diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

A 71-year-old patient is found confused and unsteady at a senior center. The airway is patent and breathing is unlabored. The vital signs are BP 138/82, P 92, R 18, SpO₂ 97% on room air, and T 98°F. There is no known history of diabetes and no medical identification jewelry. Which assessment step is indicated next?

Show the answer and rationale

Correct answer · Check a blood glucose level

This patient has an altered mental status, and every patient with an altered mental status gets a blood glucose check. The patient is confused and unsteady at a senior center. Low blood sugar is common, and it can kill quickly. Low blood sugar is also one of the few causes of confusion you can fix on scene as an AEMT. A first episode of low blood sugar can happen in a patient nobody has called diabetic yet. The missing diabetic history and the missing medical jewelry do not tell you anything useful. Check the sugar first. Then keep working through the other causes of altered mental status.

Why the others are wrong

Defer glucose testing pending a history: Waiting for a history can feel organized. With no diabetic history and no medical jewelry, nothing here seems to point at sugar. You check the glucose because of how the patient is acting, not because of what the chart says. Plenty of patients with low blood sugar have never been diagnosed with diabetes.

Request a point-of-care lactate level: Lactate is a useful number in a sick patient, and the hospital will look at it. A lactate level comes from a point-of-care panel. Panels for electrolytes, lactate, kidney function, or blood gases are paramedic tools. As an AEMT, your lab testing stops at the glucometer.

Draw venous tubes for hospital analysis: Drawing venous tubes is in AEMT scope, and it is worth doing when your system asks for it. Those tubes get run at the hospital. The results do nothing for a patient who is confused in front of you right now.

Question 2 of 10

A 68-year-old patient with type 2 diabetes is confused and difficult to redirect. The skin is cool and moist. The vital signs are BP 142/86, P 74, R 16, and SpO₂ 96% on room air. The blood glucose level is 48 mg/dL. The medication list includes metoprolol. Which best explains the pulse in this patient?

Show the answer and rationale

Correct answer · A beta blocker is blunting the compensatory tachycardia

This patient has hypoglycemia, and the metoprolol is hiding the fast pulse. The blood glucose is 48 mg/dL, the patient is confused, and the skin is cool and moist. Low blood sugar normally sets off a sympathetic surge, which is the body's fight or flight response. You would expect a fast pulse along with the shakiness, pale skin, and sweating. Metoprolol is a beta blocker. A beta blocker blocks the fast heart rate part of that response. Sweating runs on a different nerve pathway, called a cholinergic pathway, that the beta blocker does not touch. That's why the skin is still cool and moist while the pulse is only 74. Do not let a normal heart rate talk you out of a glucose of 48 mg/dL in a confused patient.

Why the others are wrong

The low reading is a meter error: Glucose meters do fail, and a fingertip with poor blood flow can read falsely low. Nothing in this question points at the meter, though. The confusion and the cool, moist skin are exactly what a glucose of 48 predicts.

The patient is compensating with vasoconstriction: The body does tighten its blood vessels as part of the same fight or flight response. That tightening, called vasoconstriction, would show up along with a fast pulse. Vasoconstriction does not explain why the fast heart rate alone is missing.

The hypoglycemia is too mild to raise the pulse: A glucose of 48 mg/dL in a confused patient is not mild. How low the sugar goes does not decide whether the pulse goes up. Whether the body can mount the response decides that, and the beta blocker is blocking the response.

Question 3 of 10

An AEMT is called for a 59-year-old patient with a history of diabetes who has become altered. Which finding best supports hypoglycemia rather than hyperglycemia?

Show the answer and rationale

Correct answer · Cool moist skin with onset over minutes

Cool, moist skin with an onset over minutes points to hypoglycemia. A high sugar and a low sugar both make a patient altered, so the mental status does not tell them apart. What tells them apart is the onset, the skin, and the breathing. A low sugar comes on over minutes to an hour. The body responds with a sympathetic surge, and the skin turns cool and moist. A high sugar builds over hours to days and dries the patient out. In ketoacidosis, the high sugar also brings deep rapid breathing with a fruity odor. If you have a glucometer, the reading settles the question. If you do not, judge by the onset, the skin, and the breathing.

Why the others are wrong

Deep rapid respirations with a fruity odor: the signs of diabetic ketoacidosis. Ketoacidosis is a high sugar problem. The body burns fat because sugar cannot get into the cells, and the acid from burning fat makes the breathing deep and rapid.

Dry mucous membranes after days of thirst: Dry mucous membranes come from water loss. Days of thirst fit a high sugar pulling water out of the body. A low sugar comes on in minutes to an hour, so a low sugar never has time to dry the patient out.

Warm dry skin with frequent urination: Frequent urination happens when the sugar is high enough to spill into the urine. The sugar pulls water out with it. Warm, dry skin points to a high sugar too.

Question 4 of 10

An AEMT performs a capillary blood glucose test on a patient's fingertip, but the reading seems inconsistent with the patient's clinical presentation. The patient has poor peripheral perfusion with cool, pale extremities. What is the most appropriate action?

Show the answer and rationale

Correct answer · Repeat the test at a better-perfused site or use an alternate testing method

This reading is off because of poor peripheral perfusion. The fingertips are cool and pale. The body has pulled blood away from the small vessels in the hands. The blood sitting in the fingertip is moving slowly. Its glucose level lags behind the real level in the rest of the body. That's why the number does not match how the patient looks. Retest at a warmer site with better blood flow, or use another testing method. Do the retest before you treat the number. Treating low or high blood sugar off a bad sample can lead you to give the wrong treatment.

Why the others are wrong

Accept the capillary reading as accurate regardless of the patient's perfusion status: A glucometer number is usually something you can act on. This question tells you the reading does not fit how the patient looks. Cool, pale fingers are a known cause of a wrong capillary reading, so you cannot trust that number.

Assume the glucometer is malfunctioning and discontinue glucose testing: A broken glucometer would be a reason to stop using that glucometer. A mismatched reading in a patient with poor perfusion points to a bad sample, not a bad machine. Stopping glucose testing leaves you with no glucose value for a patient who still needs one.

Use the palm of the hand instead, since it is unaffected by perfusion status: The palm is not a validated testing site in AEMT protocols. Poor perfusion also affects the whole periphery, not just the fingertips. Moving to the palm does not fix the blood flow problem.

Question 5 of 10

A patient with a known history of diabetes presents with gradual onset confusion over the past two days, warm/dry skin, and deep, rapid respirations with a fruity odor on the patient's breath. This presentation is most consistent with...?

Show the answer and rationale

Correct answer · Diabetic ketoacidosis

This patient is in diabetic ketoacidosis, or DKA. The patient has two days of slowly worsening confusion, warm and dry skin, and deep, rapid breathing with a fruity odor on the breath. Without insulin, glucose builds up in the blood but cannot get into the cells. The cells starve and start burning fat. Burning fat makes ketones, and ketones are acids. The body makes up for the acid by blowing off CO2 with deep, rapid Kussmaul respirations. One of the ketones, acetone, gets breathed out, and acetone is the fruity smell. The high blood sugar also pulls water out through the kidneys. The patient gets dehydrated, and that's why the skin is warm and dry instead of sweaty. DKA builds over days, which matches the two days in this question.

Why the others are wrong

Hypoglycemia: belongs on the list for any diabetic patient with an altered mental status. Check for hypoglycemia first, because you can fix low sugar right away. Hypoglycemia comes on over minutes to hours and gives you cool, moist skin. This patient got confused slowly over two days and has warm, dry skin.

Hyperosmolar hyperglycemic state: also comes on slowly, causes dehydration, and changes the mental status. The fruity breath and the deep, rapid breathing come from ketoacidosis. Hyperosmolar hyperglycemic state usually causes neither one.

Salicylate toxicity: also causes deep, rapid breathing. The fruity odor does not fit salicylate toxicity. Nothing in this patient's history points to an ingestion.

Question 6 of 10

An AEMT responds for a 24-year-old patient with type 1 diabetes who had a generalized seizure witnessed by a coworker. The seizure lasted about 90 seconds and stopped on its own roughly 12 minutes ago. The patient now lies still, opens the eyes only to a painful stimulus, does not answer questions, and cannot swallow on command. The coworker states the patient has had seizures before and is usually talking again within a few minutes. There is no sign of injury. The skin is pale and damp. The vital signs are BP 118/74, P 118, R 20, and SpO₂ 96% on room air, and the chest rises equally with each breath. What should the AEMT do next?

Show the answer and rationale

Correct answer · Measure the blood glucose level and establish intravenous access

Suspect hypoglycemia in this patient with type 1 diabetes who is not waking up after a seizure. A seizure burns glucose. In a patient with diabetes, all that muscle activity can push the blood glucose level down. A low blood glucose level can also cause a seizure. How fast the patient wakes up tells you whether this is an ordinary postictal state or hypoglycemia. After an ordinary seizure, mental status comes back soon after the shaking stops. The coworker says this patient is usually talking again within a few minutes. Twelve minutes later, this patient still opens the eyes only to pain and cannot swallow. A hypoglycemic patient does not get better, even after several minutes. Check the blood glucose level and start an IV. The IV is the route for dextrose in a patient who cannot swallow, and IV access is inside AEMT scope.

Why the others are wrong

Continue airway positioning and monitor for postictal recovery: A slow wake-up after a seizure is the postictal state, and a postictal patient is managed by positioning the airway and waiting. This patient is usually talking within a few minutes. Twelve minutes after a 90-second seizure, this patient still responds only to pain. A postictal patient improves soon after the seizure stops, and a hypoglycemic patient does not.

Request a paramedic intercept for an anticonvulsant medication: An anticonvulsant is for a patient who is still seizing. This seizure lasted about 90 seconds and stopped on its own, so there is no seizure to treat now. A low blood glucose level also has not been ruled out yet.

Assist ventilations with a bag-mask device and reassess the chest rise: Assisted ventilations are for a patient who is not breathing well enough. This patient's respirations are 20, the chest rises equally with each breath, and the SpO₂ is 96% on room air. The rate and depth are adequate. Responding only to pain does not mean the breathing needs to be taken over.

Question 7 of 10

An AEMT is called for a 44-year-old patient with a long history of diabetes who is confused and unsteady but awake, follows commands, and swallows a sip of water without difficulty. The skin is damp. The vital signs are BP 138/86, P 108, R 18, and SpO₂ 98% on room air. Both glucometers on the ambulance fail their startup check and no reading can be obtained. A family member cannot say whether the patient took insulin today or has eaten. Transport time is 25 minutes. What should the AEMT do?

Show the answer and rationale

Correct answer · Administer oral glucose under the service's protocol

This patient is having a diabetic emergency, and with both glucometers down you cannot tell if the blood glucose level is low or high. Without a number, you compare the harms. A low blood glucose level that goes untreated can cause loss of consciousness and permanent brain damage within minutes. A high blood glucose level is not made meaningfully worse by one tube of glucose gel. That's why the standard is to give glucose when you cannot tell which direction the blood glucose level has gone. This patient is awake, follows commands, and swallows a sip of water without difficulty. Those are the conditions for giving glucose by mouth. Give the oral glucose under protocol, reassess closely, and transport.

Why the others are wrong

Withhold glucose until a blood glucose level can be measured: Getting a number before you treat is the normal rule. When no reading can be obtained, the risks are not even. An untreated low blood glucose level causes loss of consciousness and permanent brain damage quickly. The amount of sugar given in the field is unlikely to make a high blood glucose level much worse.

Begin an isotonic fluid infusion for suspected hyperglycemia: Fluid is the treatment for the high side of a diabetic emergency. Nothing in the question points toward a high blood glucose level. The patient is awake with damp skin and a normal blood pressure, and there is no history of thirst or frequent urination. When you cannot tell the direction, the standard is to give glucose.

Offer a sugar-free drink to avoid raising a high blood glucose level: A sugar-free drink avoids raising a blood glucose level that might already be high. Drinks made with saccharin or other artificial sweeteners have little or no effect on the blood glucose level. A sugar-free drink treats neither a low nor a high blood glucose level.

Question 8 of 10

An AEMT gave oral glucose to a 34-year-old patient with type 1 diabetes whose blood glucose level read 48 mg/dL. Ten minutes later the patient is alert and oriented, speaks normally, and swallows without difficulty, and a repeat blood glucose level reads 96 mg/dL. The patient has agreed to transport and says the last meal was breakfast, more than eight hours ago. The vital signs are BP 124/78, P 88, R 16, and SpO₂ 98% on room air. What should the AEMT do next?

Show the answer and rationale

Correct answer · Offer a snack containing carbohydrate and protein and keep reassessing

This patient's hypoglycemia is corrected for now, and a snack keeps the blood glucose level from dropping again. Oral glucose is a simple sugar. The body absorbs simple sugar fast and uses it up fast. This patient has not eaten in more than eight hours, so nothing is behind that glucose to hold the level up. A snack with carbohydrate and protein gives a quick source of sugar and a slower one. The slower source keeps the blood glucose level up during transport. This patient is alert, oriented, speaks normally, and swallows without difficulty. The usual reason to withhold food does not apply here. Keep reassessing along the way. A patient who got better quickly after glucose can get worse just as quickly.

Why the others are wrong

Give a second tube of oral glucose gel before arrival: A second tube of glucose sounds like a safer margin for a patient who was just hypoglycemic. The repeat blood glucose level is 96 mg/dL, inside the normal range of 80 to 120 mg/dL, and the patient is alert and speaking normally. A second dose treats a problem that is already fixed.

Withhold food and fluids until the hospital evaluates the patient: Nothing by mouth is the usual habit for a patient going to the hospital. This patient is alert, speaks normally, and swallows without difficulty. The last meal was more than eight hours ago, and the glucose already given does not last long. Food is what keeps the blood glucose level from falling again before you arrive.

Defer further blood glucose measurement to the receiving facility: A normal repeat reading can look like the end of the episode. A patient whose mental status came back after glucose is one of the most important patients to keep checking. A fast recovery can be followed by a fast drop, so keep measuring the blood glucose level on the way in.

Question 9 of 10

An AEMT is caring for a 52-year-old patient with type 1 diabetes who is confused, opens the eyes to voice, and swallows a sip of water without difficulty. The blood glucose level reads 42 mg/dL. Oral glucose gel is prepared, but before it is given, the patient stops responding to voice and only withdraws a limb from a painful stimulus. Peripheral intravenous access has not yet been attempted. What should the AEMT do next?

Show the answer and rationale

Correct answer · Establish intravenous access and administer dextrose

This patient is hypoglycemic, with a blood glucose of 42 mg/dL, and is getting worse. The patient was confused but could swallow a sip of water. Before the oral glucose was given, the patient stopped responding to voice and now only withdraws from pain. A patient who only withdraws from pain cannot protect the airway, so nothing goes by mouth. IV access has not been tried yet. Start the IV and give dextrose. Glucagon is the backup only when an IV is tried and fails. The low blood sugar is what is causing the drop in responsiveness, and the glucose needs to come up now.

Why the others are wrong

Give the oral glucose gel between the cheek and gum: Oral glucose gel is right for a hypoglycemic patient who is awake enough to swallow. This patient now only withdraws from pain and can no longer protect the airway. The gel would risk aspiration.

Administer glucagon by the intramuscular route: Intramuscular glucagon is the fallback when you cannot get an IV. Nobody has tried an IV on this patient yet. Glucagon waits until an IV is tried and fails.

Reposition the airway and continue to reassess before treating: Repositioning the airway and watching longer can look careful after a sudden change. This patient's responsiveness is dropping from low blood sugar. The glucose needs to come up now, not after more reassessment.

Question 10 of 10

An AEMT administers glucagon by the intramuscular route to a 51-year-old patient with a history of daily heavy alcohol use and little food intake for the past week, found unresponsive with a blood glucose level of 29 mg/dL. Two attempts at intravenous access were unsuccessful before the glucagon was given. Eight minutes later, the blood glucose level is rechecked and reads 31 mg/dL, and the patient remains unresponsive. Why did the glucagon fail to raise this patient's blood glucose level?

Show the answer and rationale

Correct answer · Glucagon releases glucose from glycogen stores, which are likely depleted

The glucagon failed because this patient's glycogen stores are used up. The patient drinks heavily every day and has eaten very little for a week. Glucagon does not make glucose on its own. The hormone tells the liver to break down stored glycogen into glucose. Heavy drinking keeps the liver from building up glycogen. A week of eating almost nothing used up what little was left. The liver had almost nothing to release, so the glucose only went from 29 mg/dL to 31 mg/dL. Glucagon only works when there is glycogen to break down. This patient needs IV dextrose, D10 or D50, as soon as you get access.

Why the others are wrong

Glucagon is effective only by the intravenous route, not intramuscularly: Intramuscular glucagon is the standard field choice when IV access fails, like the two failed attempts here. IM glucagon works fine in a patient who has normal glycogen stores. The route is not the problem.

Glucagon lowers the blood glucose level instead of raising it: Lowering the blood glucose is what insulin does. Glucagon raises the blood glucose. The glucose went from 29 mg/dL to 31 mg/dL, up and not down. Glucagon was working in the right direction, without enough glycogen to break down.

Glucagon needs simultaneous food intake by the patient to take effect: Needing food at the same time mixes glucagon up with oral glucose gel. Glucagon works through glycogen already stored in the liver, not food taken alongside it. This patient is unresponsive and cannot eat anyway.

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