Chapter 18 - Gastrointestinal and Urologic Emergencies

A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to:
A.
transport him in a supine position.
B.
be alert for signs and symptoms of shock.
C.
assess his blood pressure to determine perfusion adequacy.
D.
determine the exact location and cause of his pain.

B. be alert for signs and symptoms of shock.

2.
A strangulated hernia is one that:
A.
spontaneously reduces without any surgical intervention.
B.
can be pushed back into the body cavity to which it belongs.
C.
is reducible if surgical intervention occurs within 2 hours.
D.
loses its blood supply due to compression by local tissues.

D. loses its blood supply due to compression by local tissues.

3.
In the presence of ileus, the only way the stomach can empty itself is by:
A.
diarrhea.
B.
vomiting.
C.
muscular contraction.
D.
spontaneous rupture.

B. vomiting.

4.
Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called:
A.
referred pain.
B.
radiating pain.
C.
visceral pain.
D.
remote pain.

A. referred pain.

5.
Injury to a hollow abdominal organ would MOST likely result in:
A.
pain secondary to blood in the peritoneum.
B.
profound shock due to severe internal bleeding.
C.
impairment in the blood's clotting abilities.
D.
leakage of contents into the abdominal cavity.

D. leakage of contents into the abdominal cavity.

6.
Elderly patients with abdominal problems may not exhibit the same pain response as younger patients because of:
A.
chronic dementia, which inhibits communication.
B.
interactions of the numerous medications they take.
C.
progressive deterioration of abdominal organ function.
D.
age-related deterioration of their sensory systems.

D. age-related deterioration of their sensory systems.

7.
Which of the following organs lies in the retroperitoneal space?
A.
liver
B.
spleen
C.
gallbladder

C. gallbladder

8.
Esophageal varices MOST commonly occur in patients who:
A.
drink a lot of alcohol.
B.
have severe diabetes.
C.
have a history of esophagitis.
D.
have weak immune systems.

A. drink a lot of alcohol.

9.
Patients with acute abdominal pain should not be given anything to eat or drink because:
A.
it will create referred pain and obscure the diagnosis.
B.
food will rapidly travel through the digestive system.
C.
substances in the stomach increase the risk of aspiration.
D.
digestion prevents accurate auscultation of bowel sounds.

C. substances in the stomach increase the risk of aspiration.

10.
Which of the following conditions is more common in women than in men?
A.
cystitis
B.
hepatitis
C.
pancreatitis
D.
cholecystitis

A. cystitis

11.
You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying high-flow oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should:
A.
leave him in a sitting position, keep him warm, and prepare for immediate transport.
B.
place him in a supine position, elevate his lower extremities, and transport at once.
C.
treat for shock and request a paramedic unit to respond to the scene and assist you.
D.
perform a detailed secondary assessment and then transport him to a dialysis center.

A. leave him in a sitting position, keep him warm, and prepare for immediate transport.

12.
Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and anorexia are MOST indicative of:
A.
pancreatitis.
B.
appendicitis.
C.
cholecystitis.
D.
gastroenteritis.

B. appendicitis.

13.
Chronic renal failure is a condition that:
A.
can be reversed with prompt treatment.
B.
occurs from conditions such as dehydration.
C.
is often caused by hypertension or diabetes.
D.
causes dehydration from excessive urination.

C. is often caused by hypertension or diabetes.

14.
A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?
A.
liver
B.
kidney
C.
pancreas
D.
gallbladder

B. kidney

15.
The parietal peritoneum lines the:
A.
retroperitoneal space.
B.
lungs and chest cavity.
C.
walls of the abdominal cavity.
D.
surface of the abdominal organs.

C. walls of the abdominal cavity.

16.
Most patients with abdominal pain prefer to:
A.
lie on their side with their knees drawn into the abdomen.
B.
sit in a semi-Fowler position with their knees slightly bent.
C.
lie in a supine position with their knees in a flexed position.
D.
sit fully upright because it helps relax the abdominal muscles.

A. lie on their side with their knees drawn into the abdomen.

17.
A 59-year-old male presents with a sudden onset of severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should:
A.
vigorously palpate the abdomen to establish pain severity.
B.
administer oxygen and prepare for immediate transport.
C.
place the patient in a sitting position and transport at once.
D.
request a paramedic unit to give the patient pain medication.

B. administer oxygen and prepare for immediate transport.

18.
You are dispatched to an apartment complex for a young male with abdominal pain. Your priority upon arriving at the scene should be to:
A.
quickly gain access to the patient.
B.
notify the dispatcher of your arrival.
C.
assess the scene for potential hazards.
D.
place a paramedic ambulance on standby.

C. assess the scene for potential hazards.

19.
Solid abdominal organs include the:
A.
stomach and small intestine.
B.
spleen, kidneys, and pancreas.
C.
gallbladder and large intestine.
D.
urinary bladder, colon, and ureters.

B. spleen, kidneys, and pancreas.

20.
An important aspect in the treatment of a patient with severe abdominal pain is to:
A.
provide emotional support en route to the hospital.
B.
administer analgesic medications to alleviate pain.
C.
encourage the patient to remain in a supine position.
D.
give 100% oxygen only if signs of shock are present.

A. provide emotional support en route to the hospital.

21.
Peritonitis may result in shock because:
A.
intra-abdominal hemorrhage is typically present.
B.
fluid shifts from the bloodstream into body tissues.
C.
abdominal distention impairs cardiac contractions.
D.
severe pain causes systemic dilation of the vasculature.

B. fluid shifts from the bloodstream into body tissues.

22.
The MOST common and significant complication associated with an acute abdomen is:
A.
peritonitis.
B.
high fever.
C.
severe pain.
D.
internal bleeding.

A. peritonitis.

23.
A 35-year-old mildly obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is:
A.
acute cystitis.
B.
acute cholecystitis.
C.
appendicitis.
D.
pancreatitis.

B. acute cholecystitis.

24.
Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces antibodies?
A.
liver
B.
kidney
C.
spleen
D.
pancreas

C. spleen

25.
A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:
A.
protect her airway from aspiration.
B.
keep her supine and elevate her legs.
C.
rapidly transport her to the hospital.
D.
give her high-flow supplemental oxygen.

A. protect her airway from aspiration.

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Chapter 18 – Gastrointestinal and Urologic Emergencies

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A 47-year-old male presents with severe abdominal pain of 3 hours’ duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to:
A.
transport him in a supine position.
B.
be alert for signs and symptoms of shock.
C.
assess his blood pressure to determine perfusion adequacy.
D.
determine the exact location and cause of his pain.

B. be alert for signs and symptoms of shock.

2.
A strangulated hernia is one that:
A.
spontaneously reduces without any surgical intervention.
B.
can be pushed back into the body cavity to which it belongs.
C.
is reducible if surgical intervention occurs within 2 hours.
D.
loses its blood supply due to compression by local tissues.

D. loses its blood supply due to compression by local tissues.

3.
In the presence of ileus, the only way the stomach can empty itself is by:
A.
diarrhea.
B.
vomiting.
C.
muscular contraction.
D.
spontaneous rupture.

B. vomiting.

4.
Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called:
A.
referred pain.
B.
radiating pain.
C.
visceral pain.
D.
remote pain.

A. referred pain.

5.
Injury to a hollow abdominal organ would MOST likely result in:
A.
pain secondary to blood in the peritoneum.
B.
profound shock due to severe internal bleeding.
C.
impairment in the blood’s clotting abilities.
D.
leakage of contents into the abdominal cavity.

D. leakage of contents into the abdominal cavity.

6.
Elderly patients with abdominal problems may not exhibit the same pain response as younger patients because of:
A.
chronic dementia, which inhibits communication.
B.
interactions of the numerous medications they take.
C.
progressive deterioration of abdominal organ function.
D.
age-related deterioration of their sensory systems.

D. age-related deterioration of their sensory systems.

7.
Which of the following organs lies in the retroperitoneal space?
A.
liver
B.
spleen
C.
gallbladder

C. gallbladder

8.
Esophageal varices MOST commonly occur in patients who:
A.
drink a lot of alcohol.
B.
have severe diabetes.
C.
have a history of esophagitis.
D.
have weak immune systems.

A. drink a lot of alcohol.

9.
Patients with acute abdominal pain should not be given anything to eat or drink because:
A.
it will create referred pain and obscure the diagnosis.
B.
food will rapidly travel through the digestive system.
C.
substances in the stomach increase the risk of aspiration.
D.
digestion prevents accurate auscultation of bowel sounds.

C. substances in the stomach increase the risk of aspiration.

10.
Which of the following conditions is more common in women than in men?
A.
cystitis
B.
hepatitis
C.
pancreatitis
D.
cholecystitis

A. cystitis

11.
You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying high-flow oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should:
A.
leave him in a sitting position, keep him warm, and prepare for immediate transport.
B.
place him in a supine position, elevate his lower extremities, and transport at once.
C.
treat for shock and request a paramedic unit to respond to the scene and assist you.
D.
perform a detailed secondary assessment and then transport him to a dialysis center.

A. leave him in a sitting position, keep him warm, and prepare for immediate transport.

12.
Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and anorexia are MOST indicative of:
A.
pancreatitis.
B.
appendicitis.
C.
cholecystitis.
D.
gastroenteritis.

B. appendicitis.

13.
Chronic renal failure is a condition that:
A.
can be reversed with prompt treatment.
B.
occurs from conditions such as dehydration.
C.
is often caused by hypertension or diabetes.
D.
causes dehydration from excessive urination.

C. is often caused by hypertension or diabetes.

14.
A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?
A.
liver
B.
kidney
C.
pancreas
D.
gallbladder

B. kidney

15.
The parietal peritoneum lines the:
A.
retroperitoneal space.
B.
lungs and chest cavity.
C.
walls of the abdominal cavity.
D.
surface of the abdominal organs.

C. walls of the abdominal cavity.

16.
Most patients with abdominal pain prefer to:
A.
lie on their side with their knees drawn into the abdomen.
B.
sit in a semi-Fowler position with their knees slightly bent.
C.
lie in a supine position with their knees in a flexed position.
D.
sit fully upright because it helps relax the abdominal muscles.

A. lie on their side with their knees drawn into the abdomen.

17.
A 59-year-old male presents with a sudden onset of severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should:
A.
vigorously palpate the abdomen to establish pain severity.
B.
administer oxygen and prepare for immediate transport.
C.
place the patient in a sitting position and transport at once.
D.
request a paramedic unit to give the patient pain medication.

B. administer oxygen and prepare for immediate transport.

18.
You are dispatched to an apartment complex for a young male with abdominal pain. Your priority upon arriving at the scene should be to:
A.
quickly gain access to the patient.
B.
notify the dispatcher of your arrival.
C.
assess the scene for potential hazards.
D.
place a paramedic ambulance on standby.

C. assess the scene for potential hazards.

19.
Solid abdominal organs include the:
A.
stomach and small intestine.
B.
spleen, kidneys, and pancreas.
C.
gallbladder and large intestine.
D.
urinary bladder, colon, and ureters.

B. spleen, kidneys, and pancreas.

20.
An important aspect in the treatment of a patient with severe abdominal pain is to:
A.
provide emotional support en route to the hospital.
B.
administer analgesic medications to alleviate pain.
C.
encourage the patient to remain in a supine position.
D.
give 100% oxygen only if signs of shock are present.

A. provide emotional support en route to the hospital.

21.
Peritonitis may result in shock because:
A.
intra-abdominal hemorrhage is typically present.
B.
fluid shifts from the bloodstream into body tissues.
C.
abdominal distention impairs cardiac contractions.
D.
severe pain causes systemic dilation of the vasculature.

B. fluid shifts from the bloodstream into body tissues.

22.
The MOST common and significant complication associated with an acute abdomen is:
A.
peritonitis.
B.
high fever.
C.
severe pain.
D.
internal bleeding.

A. peritonitis.

23.
A 35-year-old mildly obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is:
A.
acute cystitis.
B.
acute cholecystitis.
C.
appendicitis.
D.
pancreatitis.

B. acute cholecystitis.

24.
Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces antibodies?
A.
liver
B.
kidney
C.
spleen
D.
pancreas

C. spleen

25.
A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:
A.
protect her airway from aspiration.
B.
keep her supine and elevate her legs.
C.
rapidly transport her to the hospital.
D.
give her high-flow supplemental oxygen.

A. protect her airway from aspiration.

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