Chapter 19 Workbook Flashcards by Tom Bowl

Paralysis of the bowel

Ileus

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Pain felt in an area of the body other than the actual source

Referred pain

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Protective, involuntary abdominal muscle contractions

Guarding

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Inflammation of the gallbladder

Cholecystitis

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Behind the peritoneum

Retroperitoneal

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Vomiting

Emesis

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A condition of sudden onset of pain within the abdomen

Acute abdomen

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A membrane lining the abdomen

Peritoneum

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Swelling or enlargement of a weakened arterial wall

Aneurysm

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A buildup of waste products in the blood as a result of kidney failure

Uremia

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A protrusion of a loop of an organ or tissue through an abnormal body opening

Hernia

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An obstruction of blood circulation resulting from compression or entrapment of organ tissue

Strangulation

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Erosion of the stomach or small intestinal lining

Ulcer

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(Location of Pain)
Inflammation of the bladder

Cystitis

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(Location of Pain)
Inflammation of the peritoneum

Peritonitis

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(Location of Pain)
Lower midabdomen (retropubic)

Cystitis

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(Location of Pain)
Right upper quadrant (direct); right shoulder (referred)

Cholecystitis

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(Location of Pain)
Upper abdomen (both quadrants); back

Ulcer

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(Location of Pain)
Costovertebral angle

Diverticulitis

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(Location of Pain)
Low part of back and lower quadrants

Abdominal aortic aneurysm

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(Location of Pain)
Right lower quadrant (direct); around navel (referred); rebounding pain

Appendicitis

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(Location of Pain)
Anywhere in the abdominal area

Kidney infection

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(Location of Pain)
Right or left flank, radiating to genitalia

Kidney stone

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(Location of Pain)
Left lower quadrant

Pancreatitis

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(Location of Pain) Upper midabdomen or upper part of back

Peritonitis

Peritonitis, with associated fluid loss, is the result of: A. abnormal shift of fluid from body tissue into the bloodstream B. abnormal shift of fluid from the bloodstream into body tissue C. normal shift of fluid from body tissue into the bloodstream D. normal shift of fluid from the bloodstream into body tissue

B. abnormal shift of fluid from the bloodstream into body tissue

Distention of the abdomen is gauged by: A. visualization B. auscultation C. palpation D. the patient's complaint of pain around the umbilicus

A. visualization

A hernia that returns to its proper body cavity is said to be: A. reducible B. extractable C. incarcerated D. replaceable

A. reducible

A patient who presents with vomiting, signs of shock, and history of eating disorder is likely to be suffering from: A. diverticulitis B. Mallory-Weiss syndrome C. appendicitis D. cholecystitis

B. Mallory-Weiss syndrome

When an organ of the abdomen is enlarged, rough palpation may cause ______ of the organ. A. distention B. nausea C. swelling D. rupture

D. rupture

Severe back pain may be associated with which of the following conditions? A. Abdominal aortic aneurysm B. Pelvic inflammatory disease (PID) C. Appendicitis D. Mittelschmerz

A. Abdominal aortic aneurysm

The ______ are found in the retroperitoneal space. A. stomach and gallbladder B. kidneys, ovaries, and pancreas C. liver and pancreas D. adrenal glands and uterus

B. kidneys, ovaries, and pancreas

______ can be caused by an obstructing gallstone, alcohol abuse, and other diseases. A. Appendicitis B. A peptic ulcer C. Pancreatitis D. Diverticulitis

C. Pancreatitis

______ commonly produces symptoms about 30 minutes after a particularly fatty meal and usually at night. A. A peptic ulcer B. Cholecystitis C. Appendicitis D. Pancreatitis

B. Cholecystitis

You have been dispatched to the home of a 52-year-old woman with severe flank pain. Which of the following is NOT a common disease that produces signs of an acute abdomen? A. Diverticulitis B. Cholecystitis C. Acute appendicitis D. Glomerulonephritis

D. Glomerulonephritis

You have been dispatched to the home of a 52-year-old woman with severe flank pain. __________ occur(s) when there is excess pressure within the portal system and surrounding vessels; it may lead to life threatening bleeding. A. Esophageal rupture B. Esophageal varices C. Esophageal ulcers D. Esophageal reflux

B. Esophageal varices

You have been dispatched to the home of a 52-year-old woman with severe flank pain. Which of the following would NOT be pertinent regarding the pain? A. Do you have a headache? B. Do you feel nauseous? C. Is the pain constant or intermittent? D. Have you been urinating more or less?

A. Do you have a headache?

You have been dispatched to the home of a 52-year-old woman with severe flank pain. The patient tells you that she has right flank pain that radiates into her groin. What is the most likely cause of her condition? A. Cholecystitis B. Ileus C. Appendicitis D. Kidney stone

D. Kidney stone

You have been dispatched to the home of a 52-year-old woman with severe flank pain. In addition to the patient’s presentation, which of the following would NOT be an additional expected sign or symptom? A. Diarrhea B. Hematuria C. Nausea D. Vomiting

A. Diarrhea

You have been dispatched to the home of a 52-year-old woman with severe flank pain. You should transport her: A. in a position of comfort B. supine C. left lateral recumbent D. in the recovery position

A. in a position of comfort

You have been dispatched to the home of a 52-year-old woman with severe flank pain. Which of the following is NOT a function of the liver? A. It filters toxic substances. B. It creates glucose stores. C. It acts as a reservoir for bile. D. It produces substances for blood clotting.

C. It acts as a reservoir for bile.

A patient presents with lower quadrant abdominal pain, tenderness above the pubic bone, and frequent urination with urgency. What is the most likely underlying condition? A. Cholecystitis B. Cystitis C. Gastroenteritis D. Diverticulitis

B. Cystitis

Infected pouches in the lining of the colon are described as: A. cholecystitis B. cystitis C. gastroenteritis D. diverticulitis

D. diverticulitis

Pregnancy, straining at stool, and chronic constipation cause increased pressure that could result in: A. Mallory Weiss syndrome B. diverticulitis C. hemorrhoids D. gallstones

C. hemorrhoids

Diarrhea is the principal symptom in: A. gastroenteritis B. esophagitis C. pancreatitis D. peptic ulcers

A. gastroenteritis

Bowel inflammation, diverticulitis, and hemorrhoids are common causes of bleeding in the: A. upper gastrointestinal (GI) tract B. middle GI tract C. lower GI tract D. urinary tract

C. lower GI tract

A patient complains of heartburn, pain with swallowing, and feeling like an object is stuck in the throat. Which of the following is the most likely cause? A. Esophageal varices B. Esophagitis C. Peptic ulcer D. Gastroenteritis

B. Esophagitis

Pain that initially starts in the umbilical area and then later moves to the lower right quadrant is typically associated with: A. gastroenteritis B. pancreatitis C. appendicitis D. diverticulitis

C. appendicitis

When the abdominal muscles become rigid in an effort to protect the abdomen from further irritation, this is referred to as: A. guarding B. tenderness C. rebound tenderness D. referred pain

A. guarding

If a patient misses a dialysis treatment, weakness and edema can be the first in a series of conditions that can become progressively more serious. A. diarrhea B. rhinorrhea C. hearing loss D. edema

D. edema

_______ regulates the amount of glucose in the bloodstream. A. Bicarbonate B. Amylase C. Insulin D. Bile

C. Insulin

Regulation of acidity and blood pressure is largely attributed to the: A. liver B. kidneys C. gallbladder D. pancreas

B. kidneys

Which of the following organs is part of the lymphatic system and plays a role in the regulation of red blood cells and the immune system? A. Bladder B. Liver C. Spleen D. Pancreas

C. Spleen

Which of the following is NOT part of the male reproductive system? A. Epididymis B. Prostate gland C. Seminal vesicles D. Fallopian tubes

D. Fallopian tubes

________ is responsible for the breakdown of starches into sugar. A. Insulin B. Bile C. Amylase D. Bicarbonate

C. Amylase

True/False Referred pain is a result of the connection between ligaments in the abdominal and chest cavities.

False

True/False The adverse effects of dialysis include hypotension, muscle cramps, nausea and vomiting, and hemorrhage and infection at the access site.

True

True/False Questioning about bowel habits and flatulence is not necessary and considered unprofessional.

False

True/False If a female is of childbearing age, you should question her about her last menstrual period.

True

True/False The parietal peritoneum lines the walls of the abdominal cavity.

True

True/False Peritonitis is associated with a loss of blood from the abdominal cavity.

False

True/False When palpating the abdomen, always start with the quadrant where the patient complains of the most severe pain.

False

True/False Massive hemorrhaging is associated with rupture of an abdominal aortic aneurysm.

True

True/False Peptic ulcer disease affects both men and women equally.

True

True/False Patients with abdominal pain should be transported in a position of comfort.

False

Solid Organs A. Liver B. Spleen C. Pancreas D. Kidney E. Kidney F. Ovaries

Hollow Organs A. Gallbladder B. Stomach C. Ureter D. Small intestine E. Large intestine F. Fallopian tubes G. Urinary bladder H. Uterus

Urinary System A. Kidney B. Ureter C. Bladder D. Prostate gland E. Ureter opening F. Urethra G. Penis H. External urethral opening

Short Answer Explain the phenomenon of referred pain.

Occurs because of connections between the body’s two nervous systems. The abdominal organs are supplied by autonomic nerves that, when irritated, stimulate close‑lying sensory (somatic) nerves.

Short Answer List questions to ask yourself when reassessing a patient with abdominal pain.

1. Has the patient’s level of consciousness changed 2. Has the patient become more anxious 3. Have the skin signs started to change 4. Has the pain gotten better or worse 5. Has the bleeding become worse or better 6. Is current treatment improving the patient’s condition 7. Has an already identified problem gotten better or worse 8. What is the nature of any newly identified problem

Short Answer Why does abdominal distention accompany ileus?

Paralysis of muscular contractions in the bowel results in retained gas and feces. Nothing can pass through.

Short Answer Explain the steps used to physically assess the abdomen.

1. Explain to the patient what you are going to do in terms of assessing the abdomen. 2. Place the patient in a supine position with the legs drawn up and flexed at the knees to relax the abdominal muscles, unless there is trauma. Determine whether the patient is restless or quiet and whether motion causes pain. 3. Expose the abdomen and visually assess it. Look for distention, pulsating masses, bruising, or surgical scars. 4. Ask the patient where the pain is most intense. Palpate in a clockwise direction, beginning with the quadrant after the one the patient indicates is tender or painful; end with the painful quadrant. 5. Be very gentle when palpating the abdomen. 6. Palpate all four quadrants to determine whether each is tense (guarded) or soft. 7. Note whether the pain is localized or diffuse. 8. Palpate and wait for the patient to respond, watching for facial grimace or verbal reaction. Do not ask “Does it hurt here” while palpating. 9. Determine whether the patient exhibits rebound tenderness. 10. Determine whether the patient can relax the abdominal wall on command. Guarding and rigidity may be detected.

Ambulance Calls You are called to the local high school nurse’s office for a 16 year old girl complaining of fever and abdominal pain that started around the umbilicus but now is localized to the right lower quadrant. The patient also complains of nausea and vomiting. How would you best manage this patient?

Appendicitis is a possibility. Place the patient in a position of comfort. Consider oxygen if appropriate. Keep the patient warm, be prepared to manage shock, provide rapid transport, obtain a SAMPLE history, document OPQRST, and monitor closely.

Ambulance Calls You are dispatched to a long term care facility for a geriatric man with abdominal pain. On arrival, a staff member tells you that this patient has been bedridden and taking pain medications for the past few weeks. Recently, he’s had problems passing a normal bowel movement. He now has a distended, tender abdomen with nausea, vomiting, and tachycardia. How would you best manage this patient?

This patient is likely experiencing a bowel obstruction secondary to an ileus. Explain your assessment steps, position with knees slightly flexed, gently palpate all quadrants, palpate the painful area last, move and transport gently, apply oxygen if needed, allow a position of comfort, and do not delay transport.

Ambulance Calls You are dispatched to the home of another responder for “severe back pain.” You arrive to find your coworker writhing in pain on the floor. He tells you that when he tried to urinate (unsuccessfully), he immediately experienced a sharp, cramping sensation in his right side. As you are talking to him, he vomits. After vomiting, he tells you the pain is worse and is now spreading to his groin. How would you best manage this patient?

Kidney stones are extremely painful. Provide prompt, gentle transport. Monitor airway, breathing, and circulation. Be prepared for vomiting. Apply low‑flow oxygen, obtain vital signs, give nothing by mouth, keep the patient comfortable, and document all findings and treatments. Follow local protocols.

You respond to the home of a 46 year old male complaining of severe back pain. You find the patient in the fetal position in obvious pain. He tells you that his pain is along his right flank and radiates to his groin. What will you NOT be able to determine during the primary assessment A. The priority of care B. The patient’s level of consciousness C. Finding and treating any life threats D. Patient history

D. Patient history

You respond to the home of a 46 year old male complaining of severe back pain. You find the patient in the fetal position in obvious pain. He tells you that his pain is along his right flank and radiates to his groin. Your partner obtains a SAMPLE history. Which question(s) should she ask A. “Do you know what medications you are currently taking?” B. “Where is your wife?” C. “Have you traveled out of the country recently?” D. “Rate your pain on a scale from 1 to 10.”

A. “Do you know what medications you are currently taking?”

You respond to the home of a 46 year old male complaining of severe back pain. You find the patient in the fetal position in obvious pain. He tells you that his pain is along his right flank and radiates to his groin. Which of the following questions would be appropriate given the patient’s presentation A. “Do you have a headache?” B. “Do you have pain when you urinate?” C. “How long have you lived here?” D. “When was your last tetanus shot?”

B. “Do you have pain when you urinate?”

You respond to the home of a 46 year old male complaining of severe back pain. You find the patient in the fetal position in obvious pain. He tells you that his pain is along his right flank and radiates to his groin. On examination of the abdomen, you should A. expose the abdomen and visually assess it B. palpate the painful area first C. place the patient in a semi Fowler’s position D. palpate without watching the patient’s face

A. expose the abdomen and visually assess it

You respond to the home of a 46 year old male complaining of severe back pain. You find the patient in the fetal position in obvious pain. He tells you that his pain is along his right flank and radiates to his groin. During your reassessment, you should do all of the following EXCEPT A. repeat the primary assessment B. repeat the secondary assessment C. reassure the patient D. make your initial transport decision

D. make your initial transport decision

Chapter 19 Workbook Flashcards

(80 cards)