Chapter 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. applying direct pressure with a dry, sterile dressing. B. administering 100% oxygen via a nonrebreathing mask. C. covering the avulsion with moist, sterile dressings. D. requesting a paramedic to administer pain medication.

A. applying direct pressure with a dry, sterile dressing.

Contraction or tensing of the abdominal muscles to ease pain is called: Select one: A. guarding. B. flexing. C. withdrawing. D. referring.

A. guarding.

A sign of kidney damage after blunt trauma is: Select one: A. hematuria. B. hemoptysis. C. hematochezia. D. hematemesis.

A. hematuria.

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. 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. might decrease the amount of blood that returns to the heart.

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

B. It is often discovered when the patient is jarred or moved suddenly.

The mesentery is: Select one: A. the point of attachment between the small and large intestines. B. a membranous fold that attaches the intestines to the walls of the body. C. a layer of thick skeletal muscles that protects the abdominal organs. D. a complex network of blood vessels that supply blood to the liver.

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

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. 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 bag valve mask. 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 ventilations with a bag valve mask.

When documenting a call involving a female patient who was sexually assaulted, the EMT should: Select one: A. include a description of the suspected perpetrator. B. include the results of the internal vaginal exam. C. avoid speculation and document only factual data. D. theorize as to why the sexual assault occurred.

C. avoid speculation and document only factual data.

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: Select one: A. forgo the hospital radio report because of his condition. B. perform a comprehensive secondary assessment. C. closely monitor him and reassess him frequently. D. begin documenting the call on the patient care form.

C. 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: Select one: A. gently irrigate the exposed bowel with sterile saline and then cover the wound with a dry sterile dressing. B. cover the bowel with a dry sterile dressing, elevate his lower extremities, and cover him with a blanket. C. cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage. D. make one attempt to replace the bowel back into the abdomen and then cover the wound with a sterile dressing.

C. 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: Select one: A. diffuse bruising. B. nausea or vomiting. C. distention. D. referred pain.

C. distention.

Bruising to the right upper quadrant of the abdomen after blunt trauma is mostsuggestive of injury to the: Select one: A. kidney. B. stomach. C. liver. D. spleen.

C. liver.

Early bruising following abdominal trauma often manifests as: Select one: A. localized pain. B. gross distention. C. red areas of skin. D. dark purple marks.

C. red areas of skin.

The presence of tachycardia following a significant abdominal injury: Select one: 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. should be assumed to be a sign of shock.

All of the following are hollow abdominal organs, except the: Select one: A. ureters. B. bladder. C. spleen. D. stomach.

C. spleen.

Which of the following organs would most likely bleed profusely when injured? Select one: A. Stomach B. Intestine C. Bladder D. Liver

D. Liver

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

D. The absence of abdominal pain does not rule out intra-abdominal bleeding.

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. Liver or spleen D. Urinary bladder

D. Urinary bladder

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: Select one: A. rapid vehicle deceleration. B. failure to wear seat belts. C. airbag deployment. D. a poorly placed lap belt.

D. a poorly placed lap belt.

Difficulty breathing and a sunken appearance of the anterior abdominal wall is mostindicative of a ruptured: Select one: A. stomach. B. aorta. C. spleen. D. diaphragm.

D. diaphragm.

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. administering supplemental oxygen. B. promptly transporting him to the hospital. C. covering him with a warm blanket. D. giving him small sips of plain water.

D. giving him small sips of plain water.

Peritonitis usually occurs when: Select one: A. bacteria or viruses invade the walls of the gastrointestinal tract. B. the vessels that supply the abdominal organs become inflamed. C. solid abdominal organs bleed secondary to penetrating trauma. D. hollow abdominal organs are damaged and spill their contents.

D. hollow abdominal organs are damaged and spill their contents.

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 severe liver laceration. C. a ruptured spleen. D. intra-abdominal bleeding.

D. intra-abdominal bleeding.

When a hollow organ is punctured during a penetrating injury to the abdomen: Select one: 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 might not develop for several hours.

D. peritonitis might not develop for several hours.

Because the depth of an open abdominal wound is often difficult to determine: Select one: A. vital signs should be monitored frequently. B. the abdomen must be vigorously palpated. C. the EMT must perform a thorough exam. D. prompt transport to the hospital is essential.

D. prompt transport to the hospital is essential.