Chapter 22: Abdominal Emergencies

You are treating a​ 38-year-old female patient with abdominal distress. She is presenting with guarding of the abdomen. To properly examine this​ patient, you need​ to: A. palpate the lower quadrants well below the waistline by loosening clothing. B. palpate the lower quadrants by feeling inside the waistline of the​ patient's clothing. C. palpate only the upper quadrants. D. palpate the lower quadrants as far as the waistline of the​ patient's clothing.

A. palpate the lower quadrants well below the waistline by loosening clothing.

Which of the following structures is NOT located in the abdominal​ cavity? A. Spleen B. Aorta C. Liver D. Stomach

B. Aorta

What type of GI bleeding is most likely to threaten the​ airway? A. Intestinal B. Esophageal C. Aortic D. Stomach

B. Esophageal

For a patient complaining of severe abdominal​ pain, what would be a late sign of​ shock? A. Increased pulse and respirations B. Falling blood pressure C. Anxiety D. ​Pale, moist skin

B. Falling blood pressure

Which of the following organs is located in the retroperitoneal​ space? A. Small intestine B. Kidneys C. Stomach D. Uterus

B. Kidneys

Pain felt in the epigastric region of the abdomen is of concern because of the possibility of which of the​ following? A. Kidney stones B. Myocardial infarction C. Influenza D. Extreme diarrhea with dehydration

B. Myocardial infarction

You are called to the scene of a​ 16-year-old female patient complaining of severe lower right quadrant abdominal pain. The patient states she is sexually active but that her menstruation seems normal and her last period was not late. The pain began in the umbilicus. Upon​ palpation, you observe rebound tenderness in the right lower quadrant. You​ suspect: A. cholecystitis. B. appendicitis. C. ectopic pregnancy. D. renal colic.

B. appendicitis.

You are called to the scene of a patient with abdominal pain. Upon​ arrival, you find a​ 38-year-old Asian man on the floor next to his desk writhing in pain. He is complaining of severe​ right-sided flank pain. His blood pressure is​ 140/90, pulse​ 100, and his skin is ashen and diaphoretic. You​ suspect: A. myocardial infarction. B. GI bleeding. C. cholecystitis. D. renal colic.

D. renal colic.

You arrive on the scene to find an approximately​ 60-year-old male patient writhing on the floor. He is complaining of a tearing pain radiating to his lower back. He has absent femoral pulses and has a pulsatile mass just superior to his umbilicus. You suspect which of the following​ conditions? A. Abdominal aortic aneurysm B. Myocardial infarction C. Acute pancreatitis D. Ruptured appendix

A. Abdominal aortic aneurysm

The detection of a bulging mass through the belly button that is not pulsating should make the EMT suspicious that the patient may be suffering from which of the​ following? A. Umbilical hernia B. Pancreatitis C. Ulcer D. Abdominal aortic aneurysm

A. Umbilical hernia

You are called to a​ 25-year-old male complaining of right lower quadrant​ (RLQ) pain. His other symptoms are nausea and​ vomiting, fever, and decreasing pain in the umbilicus area. As an​ EMT, you feel this patient might​ have: A. appendicitis. B. cholecystitis. C. pancreatitis. D. peritonitis.

A. appendicitis.

You respond to a​ 75-year-old female who is complaining of epigastric pain that feels like heartburn. The pain radiates to the right shoulder. Her vital signs are stable and she has a previous history of a myocardial infarction. She has prescription nitroglycerin tablets. She is most likely suffering​ from: A. cholecystitis. B. abdominal aortic aneurysm. C. renal colic. D. hernia.

A. cholecystitis.

You respond to a​ 75-year-old female who is complaining of epigastric pain that feels like heartburn and radiates to the right shoulder. Her vital signs are stable and she has a previous history of myocardial infarction. She has a prescription for nitroglycerine tablets. An ALS unit is en route. After performing a physical examination and applying oxygen by nasal​ cannula, you​ should: A. transport the patient in the Trendelenburg position for shock. B. contact medical control regarding the administration of the​ patient's nitroglycerin. C. not wait for ALS but apply an AED and prepare for imminent cardiac arrest from a myocardial infarction. D. cancel the ALS​ unit: this is just gallstones and BLS can transport.

B. contact medical control regarding the administration of the​ patient's nitroglycerin.

You respond to a​ 65-year-old patient complaining of abdominal pain. Your physical exam reveals a nonpulsating mass in the lower left quadrant. You​ suspect: A. appendicitis. B. hernia. C. splenic rupture. D. aortic abdominal aneurysm.

B. hernia.

You are called to a nursing home for an​ 85-year-old patient complaining of abdominal pain. The patient has a history of dementia and cannot describe the pain to you. The nurse states the patient has been vomiting dark coffee ground emesis for about an hour. His blood pressure is​ 90/40, pulse​ 100, and respiratory rate of 24. Auscultating this​ patient's bowel​ sounds: A. could take up to 3 minutes per quadrant. B. is not recommended in a prehospital environment. C. should take 1 minute per quadrant. D. should take roughly 10 seconds per quadrant.

B. is not recommended in a prehospital environment.

You respond to the scene of a​ 50-year-old male complaining of severe abdominal pain. He has a history of alcohol and drug abuse. His vital signs are stable and he presents with epigastric pain that radiates to the back. He has guarding and point tenderness in the upper quadrants. You​ suspect: A. cholecystitis. B. pancreatitis. C. peritonitis. D. appendicitis.

B. pancreatitis.

Ulcers in the stomach can cause tearing pain as they tear​ open, or: A. intubate. B. perforate. C. auscultate. D. aerate.

B. perforate.

Most organs of the abdomen are enclosed within​ the: A. retroperitoneal space. B. peritoneum. C. extraperitoneal space. D. midline.

B. peritoneum.

You are called to a residence for a​ 48-year-old male patient. He is lying in​ bed, groaning in pain and curled into a fetal position. His blood pressure is​ 88/50, pulse​ 136, and respiratory rate of 32. His wife states that he complained of lower right abdominal pain for several days that got progressively worse until about an hour ago when it became suddenly unbearable. The wife states the husband had been refusing to see a​ doctor, but she finally called 911. You suspect appendicitis and are concerned about the subsequent onset​ of: A. splenic rupture. B. peritonitis. C. renal colic. D. GI bleeding.

B. peritonitis.

You are called to a residential neighborhood at​ 12:30 A.M. Your patient has just finished eating a​ super-sized meal of deep fried fish. He is now complaining of a​ "crampy" pain in the right upper quadrant and has had two episodes of nausea and vomiting with a green emesis. If the patient does not have a cardiac​ complaint, what condition do you suspect that your patient is​ experiencing? A. GI bleeding B. Pancreatitis C. Cholecystitis D. Peritonitis

C. Cholecystitis

Which of the following is the main decision point of the​ EMT's assessment and history taking of the patient with abdominal​ pain? A. Determining the​ patient's level of comfort B. Determining the possible need for immediate surgery C. Determining the presence of shock D. Determining the cause of the pain

C. Determining the presence of shock

You are examining a​ 24-year-old female patient with lower quadrant abdominal pain. What is the MOST LETHAL possibility this​ suggests? A. Cholecystitis B. Pelvic inflammatory disease C. Ectopic pregnancy D. General abdominal distress

C. Ectopic pregnancy

You respond to a​ 48-year-old female having a syncopal episode in the bathroom. You find the patient sitting on the commode vomiting into the trash can. The vomitus appears to look like coffee grounds and has a foul smell. The patient is pale and has been weak for the past few days. She​ has: A. abdominal aortic aneurysm. B. peritonitis. C. GI bleeding. D. hernia.

C. GI bleeding.

When treating a patient with acute abdominal​ pain, you should do which of the​ following? A. Have him drink milk to coat the stomach and reduce the pain B. Administer sips of water if patient complains of thirst C. Have the patient lie still and assume a position of comfort D. Have him take antacids in an attempt to decrease the pain

C. Have the patient lie still and assume a position of comfort

Which of the following is a characteristic of referred​ pain? A. It is caused by psychological stress. B. It is only felt in hollow organs. C. It is felt in a location other than the organ causing it. D. It is usually described as​ "crampy" or​ "colicky."

C. It is felt in a location other than the organ causing it.

Your patient is a​ 40-year-old female who has been experiencing abdominal pain and vomiting for 2 days. She is now responsive to verbal​ stimulus; has​ cool, dry​ skin; a heart rate of​ 116; respirations of​ 24; and a blood pressure of​ 100/70. Which of the following is the BEST position for transporting this​ patient? A. Supine with the knees bent B. Sitting up at a​ 45-degree angle C. Left lateral recumbent with the legs bent D. Sitting up at a​ 90-degree angle

C. Left lateral recumbent with the legs bent

Which of the following is NOT a cause of parietal​ pain? A. Inflammation B. Infection C. Muscle spasm D. Bleeding into the abdominal cavity

C. Muscle spasm

In an abdominal aortic aneurysm​ (AAA), decreased perfusion of an extremity with a decreased or absent pulse is most likely caused by​ what? A. The aorta swells. B. The aorta leaks. C. The aorta dissects. D. The aorta ruptures.

C. The aorta dissects.

Which of the following statements BEST describes the difference between the parietal peritoneum and the visceral​ peritoneum? A. The parietal peritoneum contracts during​ digestion, whereas the visceral peritoneum retracts during digestion. B. The parietal peritoneum is an inner​ membrane, whereas the visceral peritoneum is an outer membrane. C. The parietal peritoneum lines the abdominal​ cavity, whereas the visceral peritoneum covers the organs within it. D. The parietal peritoneum guards the​ esophagus, whereas the visceral peritoneum guards the viscera.

C. The parietal peritoneum lines the abdominal​ cavity, whereas the visceral peritoneum covers the organs within it.

With the exception of the​ ________, most abdominal organs are not able to sense tearing sensations. A. liver B. colon C. aorta D. ovaries

C. aorta

All epigastric abdominal​ pain, until proven​ otherwise, should be suspected of​ having: A. an aortic cause. Your answer is not correct.B. been caused by infection. C. cardiac involvement. D. an origin in the GI system.

C. cardiac involvement.

Parietal pain​ is: A. dull. B. mild. C. localized. D. diffuse.

C. localized.

Organs of the right upper quadrant​ include: A. ​pancreas, spleen, and part of the liver. B. small​ intestine, stomach, and spleen. C. most of the​ liver, gallbladder, and part of the large intestine. D. most of the​ liver, spleen, and gallbladder.

C. most of the​ liver, gallbladder, and part of the large intestine.

The​ Wong-Baker scale helps children rate their​ pain: A. by pointing to the region where the pain is. B. without using subjective criteria. C. on a visual scale. D. from 1 to​ 20, with 20 being the worst.

C. on a visual scale.

An ectopic pregnancy is​ a: A. rupture of the ovarian cysts. B. pelvic inflammatory disease. C. pregnancy that develops outside the uterus. D. menstrual irregularity.

C. pregnancy that develops outside the uterus.

When the gallbladder is​ diseased, the pain is not only felt in the right upper quadrant​ (RUQ) but also in the right shoulder. This is known​ as: A. tearing pain. B. parietal pain. C. referred pain. D. visceral pain.

C. referred pain.

Which patient is MOST likely experiencing visceral​ pain? A. ​19-year-old female complaining of severe cramps in the lower abdominal quadrants Your answer is not correct.B. ​28-year-old male with rebound tenderness C. ​45-year-old female complaining of abdominal pain​ "all over" D. ​24-year-old male complaining of severe left flank pain

C. ​45-year-old female complaining of abdominal pain​ "all over"

What is a​ dead-ended sac of bowel rich in lymphatic tissue that has no function in​ digestion? A. Small intestine B. Pancreas C. Colon D. Appendix

D. Appendix

You are responding to a​ 52-year-old male patient complaining of heartburn with epigastric pain. The​ patient's vital signs are stable and he does not have any pain upon palpation. He has a history of reflux disease and is on several medications for heartburn and acid reflux. What is your greatest concern with this​ patient? A. He will aspirate on vomit. B. He will develop peritonitis. C. His appendix will rupture. D. He is suffering from a myocardial infarction.

D. He is suffering from a myocardial infarction.

Which of the following is TRUE concerning parietal​ pain? A. It is usually intermittent in nature. B. It arises from the organs within the abdomen. C. It is often described as​ "crampy" or​ "colicky." D. It is generally localized to a particular area.

D. It is generally localized to a particular area.

Your patient is a​ 34-year-old male complaining of pain​ "in his right​ side." He is pale and diaphoretic with a heart rate of 90 beats per​ minute, a respiratory rate of 28 breaths per​ minute, and a blood pressure of​ 132/80 mmHg. The patient is very agitated and anxious. Which approach is most​ appropriate? A. Try to determine the cause of his pain. B. Tell the patient that you cannot transport him unless he calms down and lies still. C. Insert an oropharyngeal airway. D. Reassure him that you will make him as comfortable as possible and get him to the hospital for additional care.

D. Reassure him that you will make him as comfortable as possible and get him to the hospital for additional care.

What is a consideration for a geriatric patient with abdominal​ pain? A. This patient is less likely to have a serious cause for the abdominal pain than a younger patient. B. This patient will be more likely than a younger patient to be resilient with respect to the causes of abdominal pain. C. Geriatric patients will frequently be taking medications that increase the heart rate and mimic a rising pulse from shock. D. This patient may not be able to perceive pain as well as a younger patient.

D. This patient may not be able to perceive pain as well as a younger patient.

Your patient is a​ 17-year-old with a history of asthma. She is complaining of pain in her lower abdomen. Assessment reveals that her breath sounds are clear and​ equal, she has a respiratory rate of 28 breaths per​ minute, a heart rate of 96 beats per​ minute, and a blood pressure of​ 112/74 mmHg. Which of the following is the MOST appropriate next​ step? A. Insert a nasopharyngeal airway in the​ patient's nose. B. Have the patient breathe into a paper bag to rebreathe some of her carbon dioxide. C. Assist the patient in the administration of her​ metered-dose inhaler. D. Transport the patient for further evaluation.

D. Transport the patient for further evaluation.

Which of the following questions is inappropriate when taking the history of a female patient with abdominal​ pain? A. If you are​ menstruating, is the flow​ normal? B. Are you having vaginal bleeding or discharge​ now? C. Have you had sexual intercourse since your last menstrual​ period? D. What is your sexual​ orientation?

D. What is your sexual​ orientation?

Visceral pain​ is: A. sharp. B. concentrated. C. limited to the cranial area. D. poorly localized.

D. poorly localized.

Pain that the patient feels in a body part or area of the body that has nothing to do with a diseased organ is​ termed: A. retroperitoneal pain. B. epigastric pain. C. abdominal pain. D. referred pain.

D. referred pain.