Ch. 39

Question 1

You are treating a patient with an abdominal evisceration. You should:

A) Replace the protruding organs, cover with a dry sterile dressing, and an occlusive dressing.
B) Not replace the protruding organs, cover with a dry sterile dressing, and an occlusive dressing.
C) Replace the protruding organs, cover with a sterile dressing moistened with sterile saline, and an occlusive dressing.
D) Not replace the protruding organs, cover with a sterile dressing moistened with sterile saline, and an occlusive dressing.

Answer 1

D) Not replace the protruding organs, cover with a sterile dressing moistened with sterile saline, and an occlusive dressing.

Page Ref: 882
Objective: 39.1 Define key terms introduced in this chapter; 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 2

A patient has referred pain to her left shoulder. Which one of the following should the AEMT suspect?

A) Damage to the gall bladder
B) Ecchymosis around the umbilicus known as Cullen’s sign
C) Kehr’s sign caused by the presence of blood
D) Ecchymosis around the flanks known as Grey Turner’s sign

Answer 2

C) Kehr’s sign caused by the presence of blood

Page Ref: 880
Objective: 39.1 Define key terms introduced in this chapter; 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 3

Ecchymosis around the umbilicus indicative of retroperitineal bleeding is referred to as:

A) Grey Turner’s sign.
B) Cullen’s sign.
C) Kehr’s sign.
D) Murphy’s sign.

Answer 3

B) Cullen’s sign.

Page Ref: 880
Objective: 39.1 Define key terms introduced in this chapter; 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 4

Ecchymosis around the flanks indicative of retroperitineal bleeding is referred to as:

A) Grey Turner’s sign.
B) Cullen’s sign.
C) Kehr’s sign.
D) Murphy’s sign.

Answer 4

A) Grey Turner’s sign.

Page Ref: 880
Objective: 39.1 Define key terms introduced in this chapter; 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 5

Referred pain to the left shoulder caused by diaphragmatic irritation, which is caused by the presence of blood and may indicate splenic injury is known as:

A) Grey Turner’s sign.
B) Cullen’s sign.
C) Kehr’s sign.
D) Murphy’s sign.

Answer 5

C) Kehr’s sign.

Page Ref: 880
Objective: 39.1 Define key terms introduced in this chapter; 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 6

A patient has been stabbed in the right upper quadrant of the abdomen. Which one of the following organs or structures should the AEMT be concerned about being injured?

A) Liver
B) Spleen
C) Pancreas
D) Small intestine

Answer 6

A) Liver

Page Ref: 878
Objective: 39.2 Describe the gross anatomy of the abdominal cavity and its contents; 39.3 Differentiate between the characteristics of solid and hollow organs in the abdomen.

Question 7

The AEMT recognizes that the division between the thoracic and abdominal cavities lies approximately:

A) at the level of the diaphragm.
B) above the twelfth thoracic vertebrae.
C) below the twelfth rib.
D) at the fifth intercostal space.

Answer 7

A) at the level of the diaphragm.

Page Ref: 883-884
Objective: 39.2 Describe the gross anatomy of the abdominal cavity and its contents.

Question 8

Which structure, when injured, causes the most rapid death?

A) Spleen
B) Vena cava
C) Large intestine
D) Stomach

Answer 8

B) Vena cava

Page Ref: 878-879
Objective: 39.2 Describe the gross anatomy of the abdominal cavity and its contents; 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage.

Question 9

A patient suffering blunt trauma to the abdomen has a lacerated liver. Which one of the following represents the MOST immediate threat to life?

A) Pain
B) Infection
C) Peritonitis
D) Hemorrhage

Answer 9

D) Hemorrhage

Page Ref: 884
Objective: 39.2 Describe the gross anatomy of the abdominal cavity and its contents; 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage.

Question 10

A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given this finding, the AEMT should assume which of the following organs may have been injured?

A) Stomach, gall bladder
B) Liver, gall bladder, left kidney
C) Liver, gall bladder, right kidney, small intestine
D) Liver, gall bladder, right kidney, small intestine, spleen

Answer 10

C) Liver, gall bladder, right kidney, small intestine

Page Ref: 878
Objective: 39.2 Describe the gross anatomy of the abdominal cavity and its contents.

Question 11

You have been called for a male patient who has been impaled by a metal rod. Which one of the following should you do?

A) Remove the object.
B) Stabilize the object in place.
C) Auscultate the patient’s breath sounds.
D) Apply a dressing to the entrance.

Answer 11

B) Stabilize the object in place.

Page Ref: 882
Objective: 39.3 Differentiate between the characteristics of solid and hollow organs in the Abdomen; 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage.

Question 12

Which one of the following injuries is MOST likely to cause peritonitis?

A) Blunt trauma to the spleen
B) Stab wound to the small intestine
C) Contusion to the pancreas
D) Bullet injury to the liver

Answer 12

B) Stab wound to the small intestine

Page Ref: 879
Objective: 39.3 Differentiate between the characteristics of solid and hollow organs in the abdomen; 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 13

When a moderate or serious MOI is found and the patient does NOT present with the signs and symptoms of shock, you should:

A) rule out the possibility of shock.
B) act in anticipation of shock.
C) assume the lack of internal bleeding.
D) increase the time spent on in-field management.

Answer 13

B) act in anticipation of shock.

Page Ref: 877
Objective: 39.4 Give examples of both blunt and penetrating mechanisms of abdominal trauma; 39.9 Explain the process and elements of reassessment of patients with abdominal injuries.

Question 14

Your patient with suspected abdominal trauma should be treated with:

A) treatment for shock, IV access during transport, position of comfort.
B) lateral recumbent positioning with knees to chest, oxygen, intravenous therapy.
C) semi-seated position, oxygen, IV, blanket for warmth.
D) prone positioning, oxygen, IV, cardiac monitoring, rapid transport.

Answer 14

A) treatment for shock, IV access during transport, position of comfort.

Page Ref: 880
Objective: 39.5 Recognize signs and symptoms associated with injuries to the abdomen; 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage; 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 15

Abdominal evisceration injuries are:

A) not life threatening without associated injuries.
B) always life-threatening.
C) closed wounds.
D) caused by blunt trauma.

Answer 15

A) not life threatening without associated injuries.

Page Ref: 882
Objective: 39.5 Recognize signs and symptoms associated with injuries to the abdomen; 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 16

You have arrived on the scene for a patient assaulted with a baseball bat. As you approach, which one of the following positions seems to indicate that he was struck and suffered injury to the abdomen?

A) On his side with knees drawn to the chest
B) Supine with legs extended and toes pointed
C) Prone with hands on the back
D) Standing with restless movement and pacing

Answer 16

A) On his side with knees drawn to the chest

Page Ref: 880
Objective: 39.5 Recognize signs and symptoms associated with injuries to the abdomen.

Question 17

Which of the following is helpful in determining the severity of abdominal injury?

A) Clinical exam findings
B) Mechanism of injury
C) Patients complaint
D) All of the above

Answer 17

D) All of the above

Page Ref: 880-881
Objective: 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage.

Question 18

A 45-year-old woman was at a family reunion and fell off a trampoline. She impacted a picnic table with the left side of her lower rib cage and is very anxious and confused. Her airway is open, and her breathing is adequate. Her radial pulse is rapid and weak and her skin is cool and diaphoretic. Vital signs are: pulse 132, respirations 20, blood pressure 102/78 mmHg, and SpO2 at 97 percent. She has ecchymosis to the left lower rib area as well as tenderness and instability. She also has a superficial abrasion to her forehead. Given these findings, you should suspect and treat her for what condition?

A) Shock
B) Hypoxia
C) Closed head injury
D) Skull fracture

Answer 18

A) Shock

Page Ref: 880
Objective: 39.6 Describe the association between abdominal injury and the potential for life-threatening hemorrhage; 39.8 Explain the special considerations for airway management in the care of patients with abdominal injuries.

Question 19

You are treating a patient who has been stabbed in the abdomen and now has abdominal contents protruding from the site of the wound. The BEST way to treat this injury is to:

A) cover contents with moist gauze and use an occlusive dressing such as plastic from a trauma dressing package and tape in place.
B) elevate patient’s shoulders and cover abdominal contents with bulky, wet dressing.
C) carefully replace abdominal contents after rinsing with saline and cover with bulky, dry dressing.
D) dressing and bandage wound as any other, careful transport.

Answer 19

A) cover contents with moist gauze and use an occlusive dressing such as plastic from a trauma dressing package and tape in place.

Page Ref: 882
Objective: 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 20

A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should:

A) check the patient’s respirations.
B) obtain a full set of vital signs.
C) examine the abdomen for specific injuries.
D) administer oxygen with a nonrebreather face mask.

Answer 20

A) check the patient’s respirations.

Page Ref: 880
Objective: 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects; 39.8 Explain the special considerations for airway management in the care of patients with abdominal injuries.

Question 21

A patient has suffered an abdominal evisceration. There is no evidence of spinal injury. How should you place the patient on the stretcher?

A) Semi-Fowler’s, to promote adequate breathing
B) Prone, to maintain pressure on the abdomen
C) Lateral recumbent with legs extended
D) Supine, with knees flexed to his chest

Answer 21

D) Supine, with knees flexed to his chest

Page Ref: 882
Objective: 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects; 39.9 Explain the process and elements of reassessment of patients with abdominal injuries.

Question 22

An industrial worker has sustained a laceration to his abdomen. On closer inspection, you note what appear to be fat tissue and a portion of intestine protruding through the wound. Which one of the following is MOST appropriate for treating this injury?

A) Occlusive dressing applied over saline soaked gauze
B) Dry sterile dressing applied over the wound
C) Direct pressure using gloved palms to the injury
D) One attempt at replacement using sterile gloves

Answer 22

A) Occlusive dressing applied over saline soaked gauze

Page Ref: 882
Objective: 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 23

AEMT care for an open chest wound and an abdominal evisceration are similar in that:

A) occlusive dressings are placed over both wounds.
B) moist dressings are placed over both wounds.
C) air must be periodically released from both wounds.
D) both wounds can cause the trapping of air in the body.

Answer 23

A) occlusive dressings are placed over both wounds.

Page Ref: 882
Objective: 39.7 Demonstrate an assessment-based approach to management of the patient with open and closed abdominal injury, including evisceration and impaled objects.

Question 24

You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive 21-year-old man reveals him to have sustained multiple lacerations to the arms and abdomen, with a section of his intestine protruding through a large laceration to the area around the umbilicus. He has lost a significant amount of blood. His airway is open and he is breathing shallowly at a rate of 28. His radial pulse is weak, and his skin is cool and pale. Which one of the following should the AEMT do FIRST?

A) Start positive pressure ventilation.
B) Check the blood pressure.
C) Cover the intestine with saline soaked gauze.
D) Immobilize to a long board.

Answer 24

A) Start positive pressure ventilation.

Page Ref: 880
Objective: 39.8 Explain the special considerations for airway management in the care of patients with abdominal injuries.

Question 25

A 74-year-old woman is complaining of abdominal pain after falling down five stairs and hitting her abdomen and left hand on a mailbox at the bottom. She also states pain to her left wrist and right ankle, both of which show obvious deformity. She is alert and oriented, and her abdomen is free of bruising but is tender to the left upper and lower quadrant. Her vital signs are: pulse 132, respirations 22, blood pressure 106/86, and SpO2 at 96 percent. Oxygen has been applied, and she is fully immobilized. Advanced life support has been requested and is 18 minutes away. What is your next action?

A) Immobilize the wrist and ankle.
B) Monitor the patient and wait for ALS assistance.
C) Initiate immediate transport.
D) Apply ice to the wrist and ankle.

Answer 25

C) Initiate immediate transport.

Page Ref: 880
Objective: 39.8 Explain the special considerations for airway management in the care of patients with abdominal injuries; 39.9 Explain the process and elements of reassessment of patients with abdominal injuries.

Question 26

An unrestrained male struck the steering wheel with his abdomen. Currently, he is complaining of generalized abdominal pain and rates it a 3/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 128, respirations 18, blood pressure 128/92, and SpO2 at 98 percent. Which one of the following is MOST appropriate when providing oxygen to this patient?

A) 15 liters per minute through nonrebreather
B) Oxygen can be withheld due to the SpO2 reading
C) 2 liters per minute through a nasal cannula
D) 8 liters per minute through a simple face mask

Answer 26

B) Oxygen can be withheld due to the SpO2 reading

Page Ref: 880
Objective: 39.8 Explain the special considerations for airway management in the care of patients with abdominal injuries.

Question 27

When discussing the epithelial lining, which of the following is the layer that adheres to the abdominal organs?

A) Visceral peritoneum
B) Parietal peritoneum
C) Retroperitoneal space
D) Peritoneal lining

Answer 27

A) Visceral peritoneum

Page Ref: 878
Objective: 39.1 Define key terms introduced in this chapter.