Chapter 29- Abdominal and Genitourinary Injuries

Which of the following seatbelt positions will MOST likely result in severe intraabdominal injuries when a vehicle suddenly decelerates? Select one: A. Shoulder harness and lap belt placed superior to the iliac crest B. Use of the lap belt only with the shoulder harness behind the back C. Shoulder harness used and lap belt across the anterior iliac crest D. Shoulder harness not used and lap belt across the anterior iliac crest

A. Shoulder harness and lap belt placed superior to the iliac crest

In addition to controlling bleeding and immobilizing the spine as needed, appropriate care for a patient with a penetrating abdominal wound and signs of shock includes: Select one: A. ensuring adequate ventilation, maintaining adequate perfusion with IV fluids, and transporting to the most appropriate facility. B. assisting ventilations, infusing normal saline to increase the systolic blood pressure, and transporting to the closest hospital. C. administering high-flow oxygen, limiting IV fluids to a maximum of 500 mL, and transporting to a regional trauma center. D. starting two large-bore IV lines, running the IVs wide open, and promptly transporting to the closest, most appropriate facility.

A. ensuring adequate ventilation, maintaining adequate perfusion with IV fluids, and transporting to the most appropriate facility.

Patients with a significant abdominal injury: Select one: A. have increased pain with movement. B. develop hypotension as an early sign. C. most commonly have an injured spleen. D. become tachycardic after severe blood loss.

A. have increased pain with movement.

Approximately 80% of all injuries to the genitourinary system involve the: Select one: A. kidneys. B. bladder. C. ureters. D. genitalia.

A. kidneys.

In addition to providing 100% oxygen and controlling external bleeding, the MOST appropriate management for a patient with a knife impaled in the abdomen includes: Select one: A. stabilizing the knife in place and infusing crystalloids to maintain adequate perfusion. B. covering the knife with a protective barrier and administering 2 liters of normal saline. C. carefully removing the knife and administering 20 mL/kg boluses of normal saline. D. stabilizing the knife and increasing the blood pressure with 20 mL/kg saline boluses.

A. stabilizing the knife in place and infusing crystalloids to maintain adequate perfusion.

While transporting a pregnant trauma patient who is immobilized on a backboard, you note a sudden decrease in her blood pressure and a decrease in her mental status. You should: Select one: A. tilt the backboard to the left. B. infuse 20 mL/kg of normal saline. C. elevate the foot of the backboard. D. apply and fully inflate the PASG.

A. tilt the backboard to the left.

A 56-year-old male caught the foreskin of his penis in a long segment of the zipper of his pants. He is in extreme pain, his blood pressure is 150/88 mm Hg, his pulse rate is 120 beats/min and strong, and his respirations are 22 breaths/min with adequate depth. The closest hospital is 40 miles away. You should: Select one: A. attempt to unzip the pants and request a paramedic unit to give morphine. B. carefully cut the zipper out of the pants, control any bleeding, and transport. C. provide prompt transport to the hospital while providing emotional support. D. allow the patient's wife to transport him to the hospital since he is not unstable.

B. carefully cut the zipper out of the pants, control any bleeding, and transport.

Increasing the blood pressure with IV crystalloids in a patient with intraabdominal bleeding would MOST likely: Select one: A. result in clinical improvement. B. exacerbate the internal bleeding. C. facilitate the hemostatic process. D. improve perfusion to vital organs.

B. exacerbate the internal bleeding.

Blunt or penetrating trauma can be especially lethal in pregnant patients because the: Select one: A. fetus can sustain serious injury. B. gravid uterus is highly vascular. C. uterus descends into the pelvis. D. vital signs usually remain normal.

B. gravid uterus is highly vascular.

Signs of a ruptured urinary bladder include all of the following, EXCEPT: Select one: A. hematuria. B. hematemesis. C. perineal bruising. D. urethral bleeding.

B. hematemesis.

Diffuse (global) swelling of the abdomen is MOST suggestive of: Select one: A. acute bowel obstruction. B. intraabdominal bleeding. C. peritoneal inflammation. D. perforation of the liver.

B. intraabdominal bleeding.

In the absence of obvious external trauma, an abdominal injury would be MOST difficult to assess for in a/an: Select one: A. intoxicated patient. B. unresponsive patient. C. hypovolemic patient. D. patient in severe pain

B. unresponsive patient.

Which of the following medications or medical devices may inhibit the body's tachycardic response during shock? Select one: A. Aspirin B. Anticoagulant C. Beta-blocker D. Implanted defibrillator

C. Beta-blocker

During your assessment of a 48-year-old female with localized blunt abdominal trauma, you should: Select one: A. immobilize her spinal column. B. palpate the most painful area first. C. be prepared for the patient to vomit. D. vigorously palpate the entire abdomen.

C. be prepared for the patient to vomit.

Priority management for a patient with an amputated penis and stable vital signs includes: Select one: A. locating the amputated part. B. rapid transport to a trauma center. C. controlling any active hemorrhage. D. placing moist dressings on the wound

C. controlling any active hemorrhage.

When assessing a patient who experienced blunt abdominal trauma, you note bruising around the umbilicus. This is called ____________ sign and indicates: Select one: A. Kehr sign; ruptured hollow organs. B. Grey Turner sign; injury to the liver. C. Murphy sign; gallbladder rupture. D. Cullen sign; significant internal bleeding.

D. Cullen sign; significant internal bleeding.

Which of the following organs lie in the right upper quadrant of the abdomen? Select one: A. Spleen and liver B. Pancreas and liver C. Gallbladder and spleen D. Liver and gallbladder

D. Liver and gallbladder

A 29-year-old female had a glass bottle inserted into her vagina during a sexual assault. She is conscious and alert and has stable vital signs, but she is in severe pain. How should you manage this patient? Select one: A. Carefully remove the bottle, monitor her vital signs, provide emotional support, and promptly transport. B. Stabilize the bottle, place dressings in the vagina, provide emotional support, and promptly transport. C. Make one attempt to remove the bottle, start an IV of normal saline, provide emotional support, and transport promptly. D. Stabilize the bottle with bulky dressings, monitor her vital signs, provide emotional support, and transport promptly.

D. Stabilize the bottle with bulky dressings, monitor her vital signs, provide emotional support, and transport promptly.

The absence of pain when palpating a trauma patient's abdomen does not rule out the possibility of intraabdominal bleeding because: Select one: A. the liver and spleen are both well protected by the lower ribcage. B. the strong abdominal musculature becomes tense following blunt trauma. C. most cases of intraabdominal hemorrhage occur in the retroperitoneal space. D. blood within the peritoneal cavity does not provoke an inflammatory response.

D. blood within the peritoneal cavity does not provoke an inflammatory response.

Blunt abdominal trauma may result in tearing of the mesentery, which is/are: Select one: A. multiple bands of thick muscle that protect the abdominal organs. B. the main supporting structure of the descending abdominal aorta. C. a vascular network that provides exclusive blood supply to the liver. D. membranous folds that attach the intestines to the abdominal wall.

D. membranous folds that attach the intestines to the abdominal wall.