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Ch 20 - Abdominal and Gastrointestinal Emergencies
Terms in this set (53)
Which of the following behaviors does NOT place a person at risk for gastrointestinal disease?
C) High-fiber diet
D) Salicylate ingestion
The portal vein transports venous blood from the gastrointestinal tract directly to the:
Peristalsis is defined as:
A) the churning of food.
B) rhythmic contraction.
C) turbulent blood flow.
D) passive regurgitation.
The ___________ controls the amount of food that moves back up the esophagus.
B) cardiac sphincter
C) gastric mucosa
D) pyloric sphincter
Drinking alcohol with a fatty meal:
A) delays gastric emptying.
B) slows duodenal absorption.
C) increases gastric absorption.
D) rapidly increases blood alcohol levels.
The pancreas, liver, and gallbladder connect to the digestive system at the:
Bile is stored in the _________ and is released into the __________, where it helps to _______.
A) liver, gallbladder, break down fats
B) duodenum, gallbladder, digest food
C) gallbladder, duodenum, emulsify fats
D) liver, gallbladder, metabolize proteins
The conversion of glycogen to glucose occurs in the:
Which of the following is NOT a function of the liver?
A) Storage of bile
B) Drug detoxification
C) Storage of vitamins and minerals
D) Completion of red and white blood cell breakdown
Most of the digestive process occurs in the:
D) small intestine.
If water is not reabsorbed in the colon:
A) diarrhea occurs.
B) constipation occurs.
C) the appendix may rupture.
D) waste material is solidified.
The exocrine function of the pancreas produces:
Filtering of blood and recycling of dead red blood cells are functions of the:
Pain over the suprapubic region is MOST suggestive of injury to the:
D) iliac arteries.
When forming your general impression of a patient with gastrointestinal distress, which of the following observations would provide the MOST information regarding what happened?
A) Resting blood pressure
B) Skin condition and temperature
C) The patient's facial expression
D) Body posture or position
Patients with an extremely advanced bowel obstruction may have feculent breath, which is the odor of:
Hypotension during an episode of dehydration indicates that the body is:
A) decompensating due to an excessive loss of blood as well as water and key electrolytes.
B) shifting water from inside the cells to the interstitial space in an attempt to maintain perfusion.
C) compensating by releasing epinephrine and norepinephrine from the sympathetic nervous system.
D) no longer capable of effectively pulling fluid from the interstitial space and the cellular area.
When diarrhea contains more water than it does fecal material:
A) the body loses an equal amount of electrolytes and water.
B) the concentration of electrolytes that are lost increases significantly.
C) the body's key electrolytes are spared and are not passed in the diarrhea.
D) smaller amounts of electrolytes are lost compared to the amount of lost water.
Common signs and symptoms of acute gastroenteritis include all of the following, EXCEPT:
B) chest pain.
C) severe diarrhea.
D) abdominal pain.
Which of the following conditions would be the LEAST likely to result in peritonitis?
A) Stomach rupture
B) Splenic laceration
C) Acute appendicitis
D) Bowel perforation
In contrast to a patient with peritonitis, a patient with hepatitis would MOST likely initially experience:
B) diffuse abdominal pain.
C) right upper quadrant pain.
D) referred pain to the left shoulder.
Dunphy sign is observed when:
A) right upper quadrant pain is referred to the right shoulder.
B) coughing causes severe right lower quadrant pain.
C) the patient's abdominal pain radiates to the shoulder.
D) pressure on the abdominal wall is suddenly released.
Esophageal varices are a direct result of:
A) esophageal erosion.
B) alcohol consumption.
C) portal hypertension.
D) cirrhosis of the liver.
Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:
B) esophageal varices.
C) acute gastroenteritis.
D) peptic ulcer disease.
Common signs of bleeding in the upper gastrointestinal tract include all of the following, EXCEPT:
D) dark, tarry stools.
An obese 52-year-old woman who presents with severe pain in the right upper quadrant of her abdomen and pain in her right shoulder is MOST likely experiencing:
B) acute hepatitis.
C) Crohn disease.
D) Mallory-Weiss syndrome.
The MOST likely cause of Crohn disease is:
A) autoantibody destruction of the intestinal wall.
B) precancerous lesions in the lower intestinal tract.
C) chronically high triglyceride levels in the blood.
D) infection of the gastrointestinal tract with Helicobacter pylori.
Which of the following statements regarding Grey Turner sign is correct?
A) Grey Turner sign is characterized by bruising around the umbilicus.
B) The presence of Grey Turner sign should make you suspicious for hepatitis.
C) Grey Turner sign is the cessation of inspiration during abdominal palpation.
D) Grey Turner sign is characterized by flank bruising and indicates retroperitoneal hemorrhage.
Pyloric stenosis is the most common cause of:
A) Mallory-Weiss syndrome.
B) infantile intestinal obstruction.
C) gastrointestinal bleeding in adults.
D) mesenteric ischemia.
Intestinal adhesions would MOST likely result in:
C) bowel obstruction.
D) ulcerative colitis.
An incarcerated hernia is one that:
A) causes immediate bowel necrosis.
B) cannot be reduced and becomes trapped.
C) spontaneously returns to its normal location.
D) protrudes through an incision from a recent surgery.
A patient with an advanced bowel obstruction would MOST likely present with:
A) a feculent breath odor.
B) black, tarry stools.
C) bright red hematemesis.
D) deep, rapid respirations.
Which of the following assessment findings or techniques would prove MOST useful when determining the extent of internal volume loss?
A) Resting blood pressure
B) Temperature of the skin
C) Duration of the illness
D) Orthostatic vital signs
A patient with orthostatic vital sign changes:
A) often requires atropine.
B) is severely hypotensive.
C) may faint upon standing.
D) has intra-abdominal bleeding.
During your examination of a patient's abdomen, you note the presence of striae. This finding is MOST indicative of:
A) pregnancy within the previous 24 to 36 months.
B) abdominal surgery within the previous 12 to 24 months.
C) a change in the size of the abdomen over a short period of time.
D) a significant decrease in weight over a long period of time.
A protuberant abdomen would MOST likely be encountered in a patient with:
A) an abdominal evisceration.
B) peritoneal fluid accumulation.
C) decreased abdominal volume.
D) an acutely inflamed appendix.
When auscultating bowel sounds, borborygmi is characterized by:
A) absent sounds after 2 minutes of auscultation.
B) quiet sounds, occurring at less than 1/sec.
C) soft gurgles or clicks occurring at 5-30/min.
D) loud gurgles occurring greater than 30/min.
If a patient complains of left lower quadrant abdominal pain, you should FIRST palpate the:
A) right upper quadrant.
B) right lower quadrant.
C) left lower quadrant.
D) left upper quadrant.
Hepatic encephalopathy is a condition in which:
A) liver disease causes reduced brain function.
B) the liver is acutely inflamed from a virus.
C) acute hypoglycemia results from liver failure.
D) alcohol progressively destroys the liver tissue.
In contrast to somatic pain, visceral pain:
A) is well localized.
B) indicates peritonitis.
C) is difficult to localize.
D) increases with movement.
Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in ___________ pain.
A patient with pancreatitis would MOST likely present with pain that:
A) radiates around to the right side of the back and angle of the scapula.
B) is severe and radiates from the flank to the groin and external genitalia.
C) is localized to the left upper quadrant and referred pain to the left shoulder.
D) goes straight through to the back in the midline of the lower thoracic area.
A positive Murphy sign is characterized by:
A) slow, shallow breathing in an attempt to reduce the severe pain associated with cholecystitis.
B) a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant.
C) ecchymosis to the flank area, indicative of free blood in the retroperitoneal compartment.
D) periumbilical ecchymosis and is a late, but highly suggestive sign of blood in the peritoneum.
Blood that has been digested by stomach acids manifests as:
B) bright red vomitus.
C) gray-colored stool.
D) coffee-ground emesis.
A sudden onset of discomfort in the throat, severe dysphagia, and vomiting bright red blood are MOST indicative of:
A) ruptured esophageal varices.
B) gastroesophageal reflux disease.
C) a malignancy in the esophagus.
D) hemorrhage from a peptic ulcer.
The presentation of Mallory-Weiss syndrome is linked to _________ and is caused by _________.
A) eating spicy foods, erosion of the lining of the gastrointestinal tract
B) spastic coughing, rupture of esophageal veins due to portal hypertension
C) severe vomiting, a tear at the junction between the esophagus and stomach
D) blunt trauma, rupture of hollow organs with resultant peritoneal inflammation
Icteric sclera and acholic stools are clinical manifestations of:
A 52-year-old man complains of severe abdominal pain but denies nausea or vomiting. He is conscious and alert, has a blood pressure of 130/70 mm Hg, a heart rate of 120 beats/min and strong, and respirations of 20 breaths/min and regular. In addition to providing supplemental oxygen, you should start an IV line and give:
A) ondansetron, 4 mg.
B) a 20-mL/kg fluid bolus.
C) diphenhydramine, 25 mg.
D) nalbuphine, 10 mg.
You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should:
A) apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution.
B) administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.
C) apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg.
D) administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give 1 µg/kg of fentanyl for pain.
A 52-year-old man complains of vomiting and diarrhea for the past day. He is conscious and alert, has a blood pressure of 130/70 mm Hg, has a heart rate of 120 beats/min and strong, and has respirations of 20 breaths/min and regular. His past medical history is significant for anemia and congestive heart failure. Prior to administering isotonic crystalloid solutions to this patient, it is MOST important to:
A) check his blood sugar.
B) apply a pulse oximeter.
C) obtain a 12-lead ECG.
D) auscultate his lung sounds.
A 38-year-old man presents with an acute onset of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 22 breaths/min and regular. In addition to administering supplemental oxygen, you should:
A) start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer 4 mg of morphine and 12.5 mg of promethazine.
B) encourage him to remain supine to relieve his pain, monitor his oxygen saturation level, and administer 10 to 20 mg of Nubain via the IM route.
C) establish vascular access with a large-bore catheter, administer a 500-mL normal saline bolus, and avoid analgesics due to the potential for intra-abdominal bleeding.
D) perform a comprehensive abdominal exam, start at least one large-bore IV line, infuse normal saline at 125 mL/hr, and consider giving him an antiemetic medication.
A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should:
A) assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus.
B) perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer's boluses to maintain a systolic blood pressure of at least 90 mm Hg.
C) turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.
D) suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted.
You are dispatched to a residence for a 33-year-old woman with excruciating pain to the right lower quadrant of her abdomen. She is conscious and alert and tells you that she has been experiencing pain to the same area for the past few days. Her blood pressure is 110/66 mm Hg, pulse rate is 118 beats/min and strong, and respirations are 22 breaths/min with adequate depth. Her skin is warm and moist. The MOST appropriate treatment for this patient involves:
A) high-flow oxygen, two large-bore IV lines, a 20-mL/kg normal saline bolus, and rapid transport to an appropriate medical facility.
B) oxygen via nonrebreathing mask, an IV of isotonic crystalloid set to keep the vein open, morphine or fentanyl, and prompt transport.
C) ventilation assistance with a bag-mask device, immediate transport, and establishment of vascular access en route to the closest hospital.
D) supplemental oxygen via nasal cannula, 25 mg of Phenergan IM, an IV of normal saline set to keep the vein open, and prompt transport.
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