Chapter 30

Contraction or tensing of the abdominal muscles in an effort to ease pain is called: a. guarding. b. withdrawing. c. referring. d. flexing.

a. guarding

A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert; however, his skin is cool and clammy and his pulse is rapid. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? a. Have you experienced recent abdominal trauma? b. Do you take any over-the-counter medications? c. What does your blood pressure normally run? d. Has blood soaked through your undergarments?

a. have you experienced recent abdominal trauma?

A sign of kidney damage following blunt trauma is: a. hematuria. b. hematochezia. c. hematemesis. d. hemoptysis.

a. hematuria

Placing a pregnant patient in a supine position during the third trimester of pregnancy: a. may decrease the amount of blood that returns to the heart. b. is recommended if the patient has severe abdominal discomfort. c. results in spontaneous urinary incontinence if the bladder is full. d. often causes hypotension secondary to cardiac compression.

a. may decrease the amount of blood that returns to the heart

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: a. air bag deployment. b. a poorly placed lap belt. c. rapid vehicle deceleration. d. failure to wear seatbelts.

b. a poorly placed lap belt

When worn properly, a seat belt should lie: a. across the abdominal wall at the level of the umbilicus and against the hip joints. b. below the anterior superior iliac spines of the pelvis and against the hip joints. c. above the anterior posterior iliac spines of the pelvis and below the hip joints. d. across the abdominal wall at the level of the diaphragm and below the hip joints.

b. below the anterior superior iliac spinesof the pelvis and against the hip joints

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should: a. begin documenting the call on the patient care form. b. closely monitor him and reassess him frequently. c. forgo the hospital radio report because of his condition. d. perform a comprehensive secondary assessment.

b. closely monitor him and reassess him frequently

A man has a large laceration across his lower abdominal wall and a loop of bowel is protruding from the wound. He is conscious and alert and there is minimal bleeding from the wound. You should: a. cover the bowel with a dry sterile dressing, elevate his lower extremities, and cover him with a blanket. b. cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage. c. make one attempt to replace the bowel back into the abdomen and then cover the wound with a sterile dressing. d. gently irrigate the exposed bowel with sterile saline and then cover the wound with a dry sterile dressing.

b. cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage

Accumulation of blood in the abdominal cavity will MOST likely cause: a. diffuse bruising. b. distention. c. referred pain. d. nausea or vomiting.

b. distention

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask, and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should: a. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. b. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM. c. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. d. perform a comprehensive secondary assessment to determine why his clinical status has changed.

b. insert an airway adjunct if he will tolerate it and begin assisting his his ventilations with a BVM

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: a. a severe liver laceration. b. intra-abdominal bleeding. c. rupture of a hollow organ. d. a ruptured spleen.

b. intra-abdominal bleeding

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the: a. stomach. b. liver. c. spleen. d. kidney.

b. liver

Because the depth of an open abdominal wound is often difficult to determine: a. the abdomen must be vigorously palpated. b. prompt transport to the hospital is essential. c. the EMT must perform a thorough exam. d. vital signs should be monitored frequently.

b. prompt transport to the hospital is essential

Early bruising following abdominal trauma often manifests as: a. localized pain. b. red areas of skin. c. gross distention. d. dark purple marks.

b. red areas of skin

The mesentery is: a. the point of attachment between the small and large intestines. b. a layer of thick skeletal muscles that protects the abdominal organs. c. a membranous fold that attaches the intestines to the walls of the body. d. a complex network of blood vessels that supply blood to the liver.

c. a membranous fold that attaches the intestines to the walls of the body

An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should: a. open the patient's airway. b. ventilate the patient with a BVM. c. apply direct pressure to the wound. d. apply oxygen via nonrebreathing mask.

c. apply direct pressure to the wound

A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should: a. transport only if signs of shock begin to develop. b. carefully probe the wound to determine its depth. c. assume that the arrow injured an internal organ. d. clean the wound and apply a dry, sterile dressing.

c. assume that the arrow injured an internal organ

A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic, intensely thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the following, EXCEPT: a. covering him with a warm blanket. b. promptly transporting to the hospital. c. giving him small sips of plain water. d. administering supplemental oxygen.

c. giving him small sips of water

Peritonitis usually occurs when: a. solid abdominal organs bleed secondary to penetrating trauma. b. bacteria or viruses invade the walls of the gastrointestinal tract. c. hollow abdominal organs are damaged and spill their contents. d. the vessels that supply the abdominal organs become inflamed.

c. hollow abdominal organs are damaged and spill their contents

Which of the following statements regarding rebound tenderness is correct? a. The absence of rebound tenderness rules out intra-abdominal injury. b. It should be assessed for by vigorously palpating the abdomen. c. it is often discovered when the patient is jarred or moved suddenly. d. Rebound tenderness is a specific sign found with a spleen injury.

c. it is often discovered when the patient is jarred or moved suddenly

You are dispatched to a residence for a young female who was kicked in the abdomen. While en route to the scene, you should ask the dispatcher if: a. the patient is conscious. b. there are other patients involved. c. law enforcement is at the scene. d. the severity of the injury is known.

c. law enforcement is at the scene

Which of the following statements regarding abdominal eviscerations is correct? a. Adherent material is preferred when covering an evisceration. b. The organs should be replaced carefully to avoid heat loss. c. The protruding organs should be kept warm and moist. d. Most eviscerations occur to the left upper quadrant.

c. protuding organs should be kept warm and moist

Assuming that no obvious signs of intra-abdominal injury are present, which of the following injuries would MOST likely cause an injury to the liver or spleen to be overlooked? a. Femur fracture b. Pelvic fracture c. Shoulder fracture d. Lumbar spine fracture

c. shoulder fracture

Which of the following statements regarding abdominal trauma is correct? a. Most of the vital abdominal organs lie within the retroperitoneal space. b. The liver is well protected and is rarely injured during a traumatic event. c. The absence of abdominal pain does not rule out intra-abdominal bleeding. d. Hollow abdominal organs are vascular and bleed profusely when injured.

c. the absence of abdominal pain does not rule out intra-abdominal bleeding

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: a. allow her to change her clothes and take a shower before you transport. b. visualize the vaginal area and pack the vagina with sterile dressings. c. arrange for a rape crisis center representative to speak with the patient. d. control any external bleeding, administer oxygen, and transport at once.

d. control any external bleeding, administer oxygen, and transport at once

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should: a. perform a head-to-toe assessment while she is in the car. b. carefully assess her upper chest for seatbelt-related injuries. c. extricate her immediately and transport to a trauma center. d. lift the air bag and look for deformity to the steering wheel.

d. lift the air bag and look for deformity to the steering wheel

Which of the following organs would MOST likely bleed profusely when injured? a. Bladder b. Stomach c. Intestine d. Liver

d. liver

When a hollow organ is punctured during a penetrating injury to the abdomen: a. the abdomen will become instantly distended. b. it will bleed profusely and rapidly cause shock. c. it commonly protrudes through the injury site. d. peritonitis may not develop for several hours.

d. peritonitis may not develop for several hours

The presence of tachycardia following a significant abdominal injury: a. is most commonly caused by severe pain. b. is always accompanied by hypotension. c. indicates a state of decompensated shock. d. should be assumed to be a sign of shock.

d. should be assumed to be a sign of shock

Which of the following organs is at MOST risk for injury as the result of a pelvic fracture? a. Liver or spleen b. Fallopian tubes c. Pancreas d. Urinary bladder

d. urinary bladder