Chapter 17- Gastrointestinal and Urologic Emergency

Appropriate management for a conscious adult patient with acute abdominal pain, a BP of 80/50 mm Hg, and a pulse rate of 120 beats/min includes:

20 mL/kg IV fluid boluses to maintain perfusion.

A 19-year-old female presents with severe pain to the left lower quadrant of her abdomen. She is restless, tachypneic, and tachycardic. When you inquire about her last menstrual period, she tells you that it was approximately 2 months ago. You should suspect:

a ruptured ectopic pregnancy.

Hypovolemic shock caused by an atraumatic acute abdomen is usually the result of:

abnormal fluid shifts from the bloodstream into the body tissues.

Peritonitis typically causes ileus, which is the result of:

absent peristalsis in the intestine.

Peritonitis is almost always associated with nausea and vomiting because:

absent peristalsis prevents movement of food through the GI tract.

A 77-year-old man presents with hypertension, anuria, generalized edema, and tachypnea. This clinical presentation is MOST consistent with:

acute renal failure.

A 27-year-old male complains of an acute onset of abdominal pain. He is found curled in a fetal position with his right knee drawn up into his abdomen. This position is MOST commonly seen in patients with acute:

appendicitis.

A young female with severe lower abdominal pain presents with a decreased level of consciousness, tachypnea, and shallow breathing. Her blood pressure is 88/48 mm Hg and her pulse is 130 beats/min and weak. You should:

assist her ventilations with a bag-mask device.

The liver secretes ________, which is an enzyme that the body uses to:

bile, dissolve fats into solution.

The liver secretes ________, which is an enzyme that the body uses to:

bile; dissolve fats into solution.

During your assessment of a 39-year-old female with acute abdominal pain, you note the presence of diffuse pain while palpating her abdomen. With this information, you:

cannot identify the underlying organ that is causing the pain.

Shortly following a meal, a 49-year-old female complains of acute pain to the right upper quadrant of her abdomen with referred pain to her right shoulder. This is MOST suggestive of acute:

cholecystitis.

The primary role of the large intestine is to:

complete the reabsorption of water.

All of the following are common signs and symptoms of chronic renal failure, EXCEPT:

hematuria.

In contrast to visceral pain, somatic pain:

is generally well localized.

The _____________ is a retroperitoneal abdominal organ.

kidney

A young female complains of acute pain located in the left lower quadrant of her abdomen. When palpating her abdomen for tenderness, and rigidity, you should FIRST palpate the:

lower right

Signs and symptoms that are MOST commonly associated with an acute abdomen include:

nausea, vomiting, and abdominal pain.

The ____________ is a solid organ.

ovary

You are treating a 50-year-old female with severe abdominal pain. She is conscious but restless, and is begging you for pain medication. Her blood pressure is 136/88 mm Hg, pulse is 120 beats/min and strong, and respirations are 24 breaths/min with adequate tidal volume. After administering 100% oxygen, you should:

start a large-bore IV and set it at a keep the vein open rate.

Which of the following causes of an acute abdomen would be LEAST likely to present with fever?

Appendicitis prior to rupture and abscess formation

Which of the following blood pressure readings indicates orthostatic hypotension?

BP lying down, 112/60 mm Hg; BP sitting up, 100/54 mm Hg

A 67-year-old male complains of burning sensation in his abdomen and hematemesis. During your assessment, you note pain to palpation of his left upper quadrant; his vital signs are suggestive of shock. Which of the following conditions should you suspect?

Bleeding peptic ulcer

Which of the following pain patterns is MOST consistent with kidney stones?

Flank pain that radiates to the groin

A 29-year-old pregnant woman complains of severe vomiting, which has persisted for 2 days. During your assessment, she vomits a large amount of blood and begins to develop signs of shock. You should suspect:

Mallory-Weiss syndrome.

Which of the following statements regarding the geriatric patient with an acute abdomen is correct?

Severe abdominal organ dysfunction may present with mild or absent pain.

Which of the following illnesses or conditions would MOST likely predispose a patient to chronic renal failure?

Strep throat

Which of the following MOST accurately describes an acute abdomen?

Sudden onset of abdominal pain that indicates peritoneal irritation.

Disease or inflammation of organs that lie behind or beneath the abdominal cavity can cause signs of peritonitis because the:

parietal peritoneum is richly supplied with very sensitive nerves.

A 33-year-old female complains of acute intense pain in both lower abdominal quadrants. She is conscious and alert, tachycardic, and has a fever of 102.5ºF. You should suspect:

pelvic inflammatory disease.

When assessing a patient with acute atraumatic abdominal pain, you should:

place the patient supine with his or her knees flexed.

You are dispatched to an office complex for a middle-aged male with acute abdominal pain. Your assessment reveals that he is conscious, restless, and in severe pain. His airway is patent, his breathing is adequate, and his vital signs are stable. Treatment for this patient should include all of the following, EXCEPT:

placing him supine and elevating his legs.

Your general impression of a 50-year-old man with acute abdominal pain reveals that he is confused and has pale, diaphoretic skin. After correcting any problems with airway, breathing, and circulation, your main focus should be on:

prompt transport to hospital

Your general impression of a 50-year-old man with acute abdominal pain reveals that he is confused and has pale, diaphoretic skin. After correcting any problems with airway, breathing, and circulation, your main focus should be on:

prompt transport to the hospital.

Pain to palpation of the costovertebral angle is MOST suggestive of:

pyelonephritis.

Common signs and symptoms associated with an acute abdomen include:

rapid and shallow breathing.

During your assessment of an elderly woman, you note a shunt on her left forearm. This indicates that she:

receives hemodialysis treatments.

A 56-year-old male complains of pain to the right upper quadrant of his abdomen and pain to his right shoulder; however, he denies pain in between his abdomen and shoulder. This is characteristic of:

referred pain.

A 69-year-old male with a history of hypertension and insulin-dependent diabetes complains of an acute onset of tearing pain in the lower quadrants of his abdomen that radiates to the back. His blood pressure is 90/50 mm Hg, pulse is 110 beats/min and thready, and respirations are 24 breaths/min and shallow. This clinical presentation is MOST consistent with:

ruptured or dissecting aortic aneurysm.

Most of the digestive process occurs in the:

small intestine.

A 38-year-old male with an inguinal hernia complains of increased pain and nausea. He tells you that he has been able to reduce the hernia himself in the past, but it will not reduce today. This patient is at GREATEST risk for:

strangulation of the bowel

Disease or inflammation of organs that lie behind or beneath the abdominal cavity can cause signs of peritonitis because:

the parietal peritoneum is richly supplied with very sensitive nerves.

It is important to avoid giving anything by mouth to a patient with acute abdominal pain because:

the stomach must be empty prior to surgical intervention.