Chapter 31 Abdominal and Genitourinary Injuries
11. Which of the following organs would most likely bleed profusely when injured? A. Liver B. Stomach C. Bladder D. Intestine
A
13. 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. closely monitor him and reassess him frequently. B. forgo the hospital radio report because of his condition. C. begin documenting the call on the patient care form. D. perform a comprehensive secondary assessment.
A
14. Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. a poorly placed lap belt. B. airbag deployment. C. rapid vehicle deceleration. D. failure to wear seat belts.
A
16. Accumulation of blood in the abdominal cavity will most likely cause: A. distention. B. referred pain. C. nausea or vomiting. D. diffuse bruising.
A
18. When worn properly, a seat belt should lie: A. below the anterior superior iliac spines of the pelvis and against the hip joints. B. above the anterior posterior iliac spines of the pelvis and below the hip joints. C. across the abdominal wall at the level of the umbilicus and against the hip joints. D. across the abdominal wall at the level of the diaphragm and below the hip joints.
A
19. A 40-year-old male presents with severe abdominal pain after 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. giving him small sips of plain water. B. promptly transporting him to the hospital. C. covering him with a warm blanket. D. administering supplemental oxygen.
A
2. The mesentery is: A. a membranous fold that attaches the intestines to the walls of the body. B. a layer of thick skeletal muscles that protects the abdominal organs. C. the point of attachment between the small and large intestines. D. a complex network of blood vessels that supply blood to the liver.
A
22. Which of the following statements regarding abdominal trauma is correct? Select one: A. The absence of abdominal pain does not rule out intra-abdominal bleeding. B. The liver is well protected and is rarely injured during a traumatic event. C. Hollow abdominal organs are vascular and bleed profusely when injured. D. Most of the vital abdominal organs lie within the retroperitoneal space.
A
25. 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: Select one: A. cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage. B. gently irrigate the exposed bowel with sterile saline and then cover the wound with a dry sterile dressing. C. make one attempt to replace the bowel back into the abdomen and then cover the wound with a sterile dressing. D. cover the bowel with a dry sterile dressing, elevate his lower extremities, and cover him with a blanket.
A
26. When a hollow organ is punctured during a penetrating injury to the abdomen: Select one: A. peritonitis might not develop for several hours. B. it commonly protrudes through the injury site. C. the abdomen will become instantly distended. D. it will bleed profusely and rapidly cause shock.
A
3. Peritonitis usually occurs when: A. hollow abdominal organs are damaged and spill their contents. B. solid abdominal organs bleed secondary to penetrating trauma. C. bacteria or viruses invade the walls of the gastrointestinal tract. D. the vessels that supply the abdominal organs become inflamed.
A
32. 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: Select one: A. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a bag valve mask. B. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. 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.
A
34. When documenting a call involving a female patient who was sexually assaulted, the EMT should: Select one: A. avoid speculation and document only factual data. B. theorize as to why the sexual assault occurred. C. include a description of the suspected perpetrator. D. include the results of the internal vaginal exam.
A
35. Because the depth of an open abdominal wound is often difficult to determine: Select one: A. prompt transport to the hospital is essential. B. vital signs should be monitored frequently. C. the EMT must perform a thorough exam. D. the abdomen must be vigorously palpated.
A
36. Placing a pregnant patient in a supine position during the third trimester of pregnancy: Select one: A. might decrease the amount of blood that returns to the heart. B. often causes hypotension secondary to cardiac compression. C. is recommended if the patient has severe abdominal discomfort. D. results in spontaneous urinary incontinence if the bladder is full.
A
7. Bruising to the right upper quadrant of the abdomen after blunt trauma is most suggestive of injury to the: A. liver. B. kidney. C. spleen. D. stomach.
A
9. Which of the following organs is at most risk for injury as the result of a pelvic fracture? A. Urinary bladder B. Liver or spleen C. Fallopian tubes D. Pancreas
A
17. Early bruising following abdominal trauma often manifests as: A. dark purple marks. B. red areas of skin. C. localized pain. D. gross distention.
B
20. 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. clean the wound and apply a dry, sterile dressing. B. assume that the arrow injured an internal organ. C. carefully probe the wound to determine its depth. D. transport only if signs of shock begin to develop.
B
24. A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be most suspicious for: Select one: A. external genitalia injury. B. blunt injury to the kidney. C. a ruptured urinary bladder. D. a lacerated liver or spleen.
B
27. All of the following are hollow abdominal organs, except the: Select one: A. bladder. B. spleen. C. stomach. D. ureters.
B
28. 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? Select one: A. Has blood soaked through your undergarments? B. Have you experienced recent abdominal trauma? C. What does your blood pressure normally run? D. Do you take any over-the-counter medications?
B
29. A sign of kidney damage after blunt trauma is: Select one: A. hemoptysis. B. hematuria. C. hematochezia. D. hematemesis.
B
40. A 40-year-old male presents with severe abdominal pain after 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: Select one: A. promptly transporting him to the hospital. B. giving him small sips of plain water. C. administering supplemental oxygen. D. covering him with a warm blanket.
B
15. The presence of tachycardia following a significant abdominal injury: A. indicates a state of decompensated shock. B. is most commonly caused by severe pain. C. should be assumed to be a sign of shock. D. is always accompanied by hypotension.
C
30. Which of the following statements regarding abdominal eviscerations is correct? Select one: A. The organs should be replaced carefully to avoid heat loss. B. Most eviscerations occur to the left upper quadrant. C. The protruding organs should be kept warm and moist. D. Adherent material is preferred when covering an evisceration.
C
31. A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The most appropriate treatment for this patient includes: Select one: A. requesting a paramedic to administer pain medication. B. covering the avulsion with moist, sterile dressings. C. applying direct pressure with a dry, sterile dressing. D. administering 100% oxygen via a nonrebreathing mask.
C
33. During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: Select one: A. rupture of a hollow organ. B. a ruptured spleen. C. intra-abdominal bleeding. D. a severe liver laceration.
C
37. Which of the following organs is at most risk for injury as the result of a pelvic fracture? Select one: A. Pancreas B. Fallopian tubes C. Urinary bladder D. Liver or spleen
C
38. Which of the following statements regarding rebound tenderness is correct? Select one: 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
1. 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. Lumbar spine fracture B. Pelvic fracture C. Femur fracture D. Shoulder fracture
D
10. Difficulty breathing and a sunken appearance of the anterior abdominal wall is mostindicative of a ruptured: A. aorta. B. stomach. C. spleen. D. diaphragm.
D
12. 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. arrange for a rape crisis center representative to speak with the patient. B. allow her to change her clothes and take a shower before you transport. C. visualize the vaginal area and pack the vagina with sterile dressings. D. control any external bleeding, administer oxygen, and transport at once.
D
21. An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should: Select one: A. open the patient's airway. B. apply oxygen via a nonrebreathing mask. C. ventilate the patient with a bag-mask device. D. apply direct pressure to the wound.
D
23. 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: Select one: A. there are other patients involved. B. the severity of the injury is known. C. the patient is conscious. D. law enforcement is at the scene.
D
39. The mesentery is: Select one: 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 complex network of blood vessels that supply blood to the liver. D. a membranous fold that attaches the intestines to the walls of the body.
D
4. While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her airbag deployed. You should: A. extricate her immediately and transport to a trauma center. B. perform a head-to-toe assessment while she is in the car. C. carefully assess her upper chest for seatbelt-related injuries. D. lift the airbag and look for deformity to the steering wheel.
D
5. A 22-year-old male was kicked in the abdomen several times. You find him lying on his left side with his knees drawn up. He is conscious and alert and complains of increased pain and nausea when he tries to straighten his legs. His blood pressure is 142/82 mm Hg, his pulse rate is 110 beats/min and strong, and his respirations are 22 breaths/min and regular. In addition to administering high-flow oxygen, you should: A. apply full spinal motion restriction precautions. B. place him supine but allow him to keep his knees bent. C. keep him on his side but gently straighten his legs. D. transport him in the position in which you found him.
D
6. Which of the following statements regarding rebound tenderness is correct? A. It should be assessed for by vigorously palpating the abdomen. B. The absence of rebound tenderness rules out intra-abdominal injury. C. Rebound tenderness is a specific sign found with a spleen injury. D. It is often discovered when the patient is jarred or moved suddenly.
D
8. Contraction or tensing of the abdominal muscles to ease pain is called: A. referring. B. withdrawing. C. flexing. D. guarding.
D