chapter 8 extended

Question 1

Which of the following patients may have trauma to abdominal organs?
1. A 30-year-old construction worker who fell from a second-story roof but managed to land on
his feet
2. A 17-year-old male with a gunshot wound to the right buttock
3. A 50-year-old male with a stab wound 4 cm inferior to the right scapula
4. A 45-year-old female restrained driver of an SUV with a moderate-speed frontal impact
A) 1, 2, 3, 4
B) 3, 4
C) 4
D) 1, 3, 4

Answer 1

1,2,3,4,

Question 2

) Which of the following changes is NOT of concern in the pregnant trauma patient?
A) Disproportionate increase in vascular volume as compared to red blood cells
B) The high likelihood of trauma to the uterus in the first trimester
C) Compression of the inferior vena cava
D) Rupture of the urinary bladder

Answer 2

the high likelihood of trauma to the uterus in the first semester

Question 3

The \_\_\_\_\_\_\_\_ is a double peritoneal fold containing blood vessels, lymphatic vessels, nerves, 
and fatty tissue.
A) retroperitoneal space
B) pancreas
C) peritoneum
D) mesentery

Answer 3

mesentery

Question 4

Which of the following best describes shear injuries to the abdominal organs?
A) Sudden compression of gas-containing hollow organs, resulting in their rupture
B) Sudden decompression of solid or hollow organs
C) Tearing of the organ in which the organ is fixed at its point of attachment but free to move
otherwise
D) Impact of solid organs with the abdominal wall in rapid deceleration

Answer 4

tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise

Question 5

The liver is injured \_\_\_\_\_\_\_\_ percent of the time with penetrating abdominal trauma.
A) 10
B) 40
C) 25
D) 75

Answer 5

40

Question 6

Your patient is a 30-year-old pregnant woman at 36 weeks’ gestation. She was injured in a fall
from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over
the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The
patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is
92, and her respirations are 24. Which of the following statements best describes this situation?
A) The mechanism and patient complaints are suspicious for abruptio placentae. The mother’s
condition is not life threatening, but fetal demise has most likely already occurred.
B) The mechanism and patient complaints are consistent with placenta previa. The mother is
stable, but the fetus is in jeopardy.
C) The mechanism and patient complaints are consistent with uterine rupture. Both the mother
and fetus are in jeopardy.
D) The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother
and the fetus are in jeopardy.

Answer 6

the mechanism and patient complaints are suspicious for abrupto placentae both the mother and the fetus are in jeopardy

Question 7

Which of the following can reduce the potential for abdominal injury?
A) Proper placement of automobile lap belts in adults
B) Side-impact airbags
C) Proper placement of automobile lap belts in children
D) All of the above

Answer 7

all of the above

Question 8

Which of the following is TRUE of abdominal trauma?
A) A soft, non-tender, non-distended abdomen with intact bowel sounds reliably rules out hollow
organ injury.
B) Due to the vascular nature of abdominopelvic organs, the onset of signs and symptoms is
abrupt and severe.
C) A soft, non-tender, non-distended abdomen reliably rules out solid organ injury.
D) A significant amount of blood can accumulate in the abdominal cavity before signs and
symptoms of abdominal injury appear.

Answer 8

a significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear

Question 9

) Which of the following describes definitive care of the patient with traumatic intraabdominal
hemorrhage?
A) Admission to the ICU for observation
B) Aggressive oxygenation and fluid resuscitation
C) Administration of blood or blood products
D) Rapid surgical intervention

Answer 9

rapid surgical intervention

Question 10

) The suspicion of blunt abdominal trauma should be based primarily on:
A) the mechanism of injury.
B) distension of the abdomen on palpation.
C) the patient’s complaint of abdominal pain.
D) the presence of contusions.

Answer 10

the mechanism of injury

Question 11

Which of the following is a special consideration when managing the pregnant trauma
patient?
A) She is at increased risk for vomiting and aspiration.
B) She may have a 30 percent blood volume loss before experiencing signs and symptoms of
shock.
C) Placing her supine may decrease cardiac output.
D) All of the above are special considerations.

Answer 11

all of the above are special considerations

Question 12

Your patient is a 17-year-old male driver of a vehicle that received a lateral impact at the
driver’s side door. There are no side-impact airbags, and there is about 8 inches of intrusion into
the passenger compartment at the left door. Your patient is complaining of left shoulder pain and
pain “in his left side.” He has a contusion on the left shoulder and deformity of the left clavicle.
He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation.
Which of the following injuries should you suspect?
1. Blunt trauma to the spleen
2. Blunt trauma to the liver
3. Penetrating trauma to the spleen
4. Penetrating trauma to the liver
5. Left pneumothorax
6. Fracture of the left clavicle
A) 1, 2, 6
B) 2, 4, 6
C) 1, 5, 6
D) 2, 5, 6

Answer 12

1,5,6

Question 13

) Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive
patients with intraabdominal hemorrhage?
A) In most cases, fluid administration should be limited to 3 liters.
B) IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in
the prehospital setting.
C) Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg.
D) IV access is necessary only if the use of PASG fails to improve the patient’s clinical
condition.

Answer 13

in most cases fluid administration should be limited to 3 liters

Question 14

Which of the following organs is NOT part of the digestive system?
A) Liver
B) Spleen
C) Stomach
D) Pancreas

Answer 14

spleen

Question 15

Damage to which of the following organs is MOST likely to induce severe infection in the 
abdominal cavity?
A) Urinary bladder
B) Colon
C) Stomach
D) Ureter

Answer 15

colon

Question 16

Your patient is an 18-year-old man who was slashed across the abdomen with a machete. He
has a mass of omentum and small bowel protruding from the wound. Which of the following is
your primary concern with this patient?
A) Immediately covering the wound with an occlusive dressing, using your gloved hand if
nothing else is available
B) Irrigating the exposed organs with sterile saline to remove debris and gently tucking them
back into the opening to keep them warm and moist and to prevent further contamination
C) Covering the wound with a sterile, saline-moistened dressing covered by an occlusive
dressing
D) Having the patient hold the omentum and placing him on the stretcher in a position of
comfort to transport rapidly

Answer 16

covering the wound with a sterile saline-moistened dressing covered by an occlusive dressing

Question 17

Which of the following may affect the pattern of injury in abdominal trauma?
A) A full-term uterus
B) A full stomach
C) A full bladder
D) All of the above

Answer 17

all of the above

Question 18

) Which of the following is TRUE of the epidemiology of abdominal trauma?
A) Morbidity and mortality due to blunt trauma are decreasing, but morbidity and mortality due
to penetrating trauma are increasing.
B) Morbidity and mortality due to blunt trauma are increasing, but morbidity and mortality due
to penetrating are decreasing.
C) Morbidity and mortality due to blunt and penetrating trauma are both increasing.
D) Mortality and morbidity due to blunt and penetrating trauma are both decreasing.

Answer 18

morbidity and mortality due to blunt trauma decreasing but morbidity and mortality due to penetrating trauma increasing

Question 19

Which of the following organs is LEAST likely to be injured in penetrating trauma to the 
abdomen?
A) Spleen
B) Kidney
C) Pancreas
D) Small intestine

Answer 19

pancreas

Question 20

The injury in which abdominal organs protrude through a large, deep laceration of the 
abdominal wall is best described as:
A) disimpaction.
B) a gutting injury.
C) herniation.
D) evisceration.

Answer 20

eviceration

Question 21

Your patient is a 60-year-old female restrained driver involved in a moderate-speed frontal
impact collision. When you arrive at the scene, she is sitting up in the driver’s seat with a chief
complaint of a burning sensation in her face. You note abrasions from deployment of the airbag.
After immobilizing the patient on a long backboard, you begin transport. As you perform a
detailed examination, the patient complains of developing right shoulder pain. Which of the
following should you suspect?
A) Myocardial contusion
B) Intraabdominal bleeding
C) Exacerbation of the patient’s arthritis due to immobilization on the backboard
D) Shoulder contusion or possible clavicle fracture due to restraint by the shoulder harness

Answer 21

intraabdominal bleeding

Question 22

How much blood loss can occur in a third-trimester pregnant female before she will show 
signs or symptoms of hypovolemia?
A) 30 percent
B) 25 percent
C) 40 percent
D) 15 percent

Answer 22

30 percent

Question 23

Which of the following is MOST likely to occur as a result of rapid deceleration without
actual contact between the patient’s body and the interior of the vehicle?
A) Blunt trauma to the pancreas
B) Rupture of the colon
C) Kidney contusion
D) Shearing injury of the liver

Answer 23

shearing injury of the liver

Question 24

Which of the following is TRUE of the patient with a suspected penetrating injury to or
rupture of the diaphragm?
A) This is the only abdominal injury for which removal of an impaled object is recommended.
B) This is one of the primary indications for the use of PASG.
C) Shallow respirations may be due to abdominal contents in the thorax.
D) Breathing is not impaired unless abdominal organs migrate into the thoracic cavity.

Answer 24

shallow respirations may be due to abdominal contents in the thorax

Question 25

Which of the following is NOT part of the prehospital examination of the patient with
suspected abdominal trauma?
A) Asking the patient about abdominal pain first, then palpating the abdomen in all four
quadrants
B) Checking for blood in the urine
C) Checking for stability of the pelvis
D) Assessment of the thorax for injury

Answer 25

checking for blood in the urine