Question 1

You have completed the initial assessment on a 62-year-old male complaining of the sudden onset of epigastric pain. His airway is patent, his breathing is fast but adequate, and his radial pulse is weak and thready. His pulse rate is 124 beats per minute and his skin is cool and moist to the touch. Your next action would be to:

Accepted Answer

The patient is showing signs of shock, with a weak and thready pulse, fast but adequate breathing, and cool, moist skin. Applying supplemental oxygen can help improve oxygenation and alleviate the patient's symptoms while further assessment and treatment is provided. Obtaining a blood pressure and performing a secondary assessment are important steps, but providing oxygen is the priority in this situation. Moving the patient to the ambulance can wait until the patient is stabilized.

Question 2

When he enters the room of a 62-year-old female with an unknown medical complaint, which of the following clues observed during the scene size-up would most increase the EMT's suspicion that the patient is suffering from an acute abdominal condition?

Accepted Answer

The patient's position, lying on her side with her knees drawn to her chest, is indicative of abdominal pain and may suggest peritonitis, appendicitis, or other acute abdominal condition. The other clues such as the patient's clothing, the presence of a commode, and the administration of oxygen are not as specific to abdominal issues.

Question 3

A 42-year-old female is crying and she states that she has sharp abdominal pain that she localizes to her right lower quadrant. When assessing the patient's abdomen, the EMT would:

Accepted Answer

Starting palpation in the left upper quadrant (LUQ) is a standard approach to avoid causing immediate discomfort or pain in a patient who is presenting with symptoms suggestive of acute abdominal issues, such as appendicitis, which typically presents with pain in the right lower quadrant (RLQ). This method allows the healthcare provider to gradually approach the area of greatest discomfort, thereby minimizing patient discomfort and potentially eliciting a more accurate assessment of the abdominal pain's nature and location.

Question 4

Assessment of a 21-year-old female reveals her to have severe abdominal pain localized to the right upper quadrant. She is alert and oriented and her vital signs are stable. After placing her supine on the stretcher, she quickly assumes a lateral recumbent position with her knees drawn up to her chest. Which response from the EMT would be appropriate?

Accepted Answer

The patient's choice of position, especially in cases of abdominal pain, is often the most comfortable for them. The lateral recumbent position with knees drawn up can help alleviate abdominal pain. It's important to prioritize patient comfort and safety, and in this scenario, allowing the patient to remain in a position that they find comfortable is appropriate.

Question 5

During transport, a 27-year-old female drug addict with acute abdominal pain tells you that she is scared and starts crying. Your best response would be:

Accepted Answer

This response acknowledges the patient's pain and fear while also providing reassurance that medical help is close by and that the healthcare provider has already taken action to ensure proper care upon arrival at the hospital. This can help to ease the patient's anxiety and promote a sense of trust in the healthcare provider. Option A trivializes the patient's pain and does not address their fear. Option C could be seen as judgmental and may not be helpful in calming the patient. Option D also does not provide any reassurance or comfort to the patient.

Question 6

While assessing a patient with acute abdominal pain, you note that his abdomen is very rigid. When asked to relax his stomach muscles, he does. The EMT would recognize:

Accepted Answer

Voluntary guarding occurs when a patient consciously tenses their abdominal muscles, often in response to pain or anticipation of pain, but can relax them upon request or when distracted. This is in contrast to involuntary guarding, where the muscle tension cannot be consciously controlled by the patient.

Question 7

You have been dispatched for a patient with abdominal pain. On scene you find the patient lying supine complaining of severe pain to his lower abdomen. He is pale and has a look of distress on his face. Which of the following actions would the EMT do first?

Accepted Answer

Checking the patient's pulse is the first action the EMT should take as it is an essential part of the initial assessment and can help determine the severity of the patient's condition. If the patient is unstable or has a weak or irregular pulse, immediate intervention may be required. Inspecting, palpating, and obtaining a blood pressure are important components of the assessment but should come after checking the patient's pulse.

Question 8

Which of the following assessment findings is of most concern regarding a 36-year-old male with severe abdominal pain?

Accepted Answer

A blood pressure of 90/64 mmHg indicates hypotension, which can be a sign of shock and is a concerning finding in a patient with severe abdominal pain. The other assessment findings may also be important to note, but the presence of hypotension requires immediate attention.

Question 9

Which of the following assessment findings on a patient complaining of abdominal and back pain would the EMT be most concerned about?

Accepted Answer

A pulsating mass above the umbilicus indicates an abdominal aortic aneurysm (AAA) which can be a life-threatening condition. This finding requires immediate transport to the hospital. The other answer choices may be concerning but are not as immediately life-threatening.

Question 10

You are providing continuing education for a group of EMTs. The topic is acute abdominal pain. What point would you stress when discussing the EMT's treatment of the patient with acute abdominal pain?

Accepted Answer

The EMT should stress that definitive care for patients with abdominal pain is hospital evaluation and possible surgical intervention. It is important for the EMT to provide supportive care en route to the hospital, but ultimately the patient will need evaluation and treatment by a physician. Spending extended time on scene may delay necessary care and transport. Patients complaining of nausea and vomiting without pain should still be transported by ambulance, as they may have underlying medical conditions that require attention. However, the EMT should prioritize transport of patients with severe, worsening, or potentially life-threatening symptoms. Identifying the cause of the abdominal pain can be helpful, but it is not always possible or necessary for the EMT to do so.

Question 11

Which statement indicates that the EMT correctly understands the goal of assessing a patient with abdominal pain?

Accepted Answer

The correct understanding is that the main goal is to recognize a possible abdominal emergency and initiate appropriate treatment, rather than trying to identify the exact cause of the pain. The cause can be determined later by a physician through further evaluation and testing.

Question 12

A patient with a history of upper gastrointestinal bleeding is complaining of weakness and abdominal pain. He informs you that he vomited 5 minutes before you arrived. Which of the following questions is it most important that the EMT ask first regarding the vomit?

Accepted Answer

The most important question to ask regarding the vomit is whether it was red or looked like coffee grounds, as this can indicate upper gastrointestinal bleeding. This information will help the EMT determine the severity of the patient's condition and plan appropriate treatment.

Question 13

An alert but confused patient called 911 with the complaint of abdominal pain. Assessment reveals her to be nauseated with pain that she localizes to the right lower quadrant of the abdomen. She states that she was not able to take her blood pressure medication this morning and wants to take it now with a small glass of juice. You would:

Accepted Answer

Given the patient's symptoms, particularly the localization of pain to the right lower quadrant of the abdomen, there is a concern for appendicitis or another acute abdominal condition. Allowing her to ingest anything, including medication with juice or water, could potentially complicate surgical intervention if needed. Therefore, it's best to advise against taking any oral substances until further medical evaluation.

Question 14

Your medical director is providing an in-service on abdominal pain. He states there are several different categories of pain and asks if anyone can identify and describe visceral pain. Which response made by the EMT would be correct?

Accepted Answer

Visceral pain is typically described as aching, dull, or cramping, and is caused by stimulation of the nerve fibers of the organs in the abdomen. It can be difficult for the patient to pinpoint the exact location of the pain. Nausea, vomiting, and other symptoms may also be present.

Question 15

While you are transporting a 44-year-old female with abdominal pain in a low Fowler's position, she starts to vomit. Your immediate action would be to:

Accepted Answer

Placing the patient in a left lateral recumbent position allows any vomit to exit the mouth and prevents aspiration of vomit into the lungs. This position also helps to protect the airway and prevent further vomiting.

Question 16

On arrival for a patient with severe abdominal pain, an Emergency Medical Responder tells you that he is concerned because the blood pressure they obtained was 146/88 mmHg and the patient states no history of high blood pressure. He states that it may be a good idea to treat the patient for hypertension as well as the abdominal pain. Your best response would be:

Accepted Answer

It is important to take another blood pressure reading to compare the two values and check if the patient's blood pressure is consistently elevated. Pain and anxiety can temporarily increase blood pressure, so it is important to rule out these potential causes before considering treatment for hypertension. If the blood pressure remains elevated, further medical evaluation may be necessary. Calling for ALS assistance or assuming the patient needs to be transported with lights and sirens based purely on one blood pressure reading can be premature and may not be the best course of action. Option B is also not appropriate as it is dangerous to give medications without proper evaluation and diagnosis.

Question 17

When an EMT is inspecting the abdomen of a patient with pain to his right upper quadrant, it appears large and possibly distended. To determine if it is indeed distended, the EMT would ask:

Accepted Answer

Asking if the belly is normally this size will help determine if there is indeed distention present as compared to the patient's baseline or usual abdominal size. The other answer options are not relevant to determining if the abdomen is distended.

Question 18

You are called to a long-term care facility for a patient with abdominal pain. On location, you find an 81-year-old female who staff said complained of abdominal pain and then began to vomit several times. The patient has advanced dementia and is confused and lethargic, which staff says is her normal status. Assessment reveals her to be confused, breathing 22 times a minute with a pulse rate of 88 beats per minute. Her blood pressure is 118/68 mmHg and she has an SpO₂ of 97 percent on room air. Staff states that her temperature is 100.8°F and she did not get her medication for dementia today. When treating and transporting this patient, which of the following represents the EMT's greatest concern?

Accepted Answer

The greatest concern for the EMT when treating and transporting this patient is the risk for vomiting, as it can lead to aspiration, which is a significant and immediate threat to the patient's airway and breathing.

Question 19

When assessing a patient with abdominal pain, you note that his abdomen feels rigid. Which of the following would the EMT do next?

Accepted Answer

Asking the patient to take a deep breath and re-palpate the rigid area is the correct action because it helps to differentiate between voluntary guarding and involuntary rigidity.

Question 20

Which of the following assessment findings would increase the EMT's suspicion of a gastrointestinal bleed?

Accepted Answer

Black, tarry, or semisolid stool (melena) can indicate a gastrointestinal bleed, as it is caused by digestion of blood in the intestinal tract. Sudden onset of constipation, watery and foul-smelling diarrhea, and sharp left lower quadrant pain are not specific enough to indicate a gastrointestinal bleed.

Quiz 23: Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies