Exam (elaborations)
A 50-year-old female complains of severe pain to the right lower quadrant of her abdomen.
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A 50-year-old female complains of severe pain to the right lower quadrant of her abdomen.
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A 50-year-old female complains of severe pain to the rightlower quadrant of her abdomen. You should:
• A:palpate the left upper quadrant of her abdomen first.
• B:keep her supine with her legs fully extended.
• C:quickly palpate that area first to assess for rigidity.
• D:suspect that she has an acute problem with her liver. -
CORRECT ANSWER-You selected A; This is correct!
Reason:When assessing a patient with abdominal pain,
determine where the pain is most severe (in this case, the
right lower quadrant) and then palpate the quadrant furthest
from that area first (in this case, the left upper quadrant). If
you palpate the painful area first, the patient is less likely to
allow you to assess the remainder of his or her abdomen; it
also causes the patient unnecessary pain. Pain to the right
lower quadrant suggests a problem with the appendix (eg,
appendicitis), not the liver. Patients with abdominal pain
commonly prefer to lie on their side with their legs drawn
into their abdomen; this position often provides pain relief by
taking pressure off of the abdominal muscles. If the patient
prefers this position, do not discourage it.
A 30-year-old man with a history of schizophrenia cut his
wrists and is bleeding profusely. He is confused, combative,
,and has slurred speech. With the assistance of law
enforcement personnel, you and your partner physically
restrain him in order to provide care and transport. In this
situation, a court of law would MOST likely:
• A:conclude that you should have had a court order to
restrain.
• B:determine that the patient had decision-making
capacity.
• C:agree that you and your partner are guilty of assault and
battery.
• D:consider your actions in providing care to be
appropriate. - CORRECT ANSWER-You selected D; This is
correct!
Reason:An adult with decision-making capacity (ie, a
mentally competent adult) has the legal right to refuse
medical treatment, even if that treatment involves lifesaving
care. In psychiatric cases, however, a court of law would
likely consider your actions in providing lifesaving care to be
appropriate, particularly if you have a reasonable belief that
the patient would harm him- or herself or others without
your intervention. In addition, a patient who is in any way
impaired, whether by mental illness, medical condition, or
intoxication, may not be considered competent to refuse
treatment and transport. If you are unsure of a patient's
,decision-making capacity, err on the side of treatment and
transport. Few would argue that it would be easier to defend
why you treated a patient than to justify or defend why you
abandoned a patient.
A 48-year-old male became acutely hypoxic, experienced a
seizure, and is now postictal. The MOST effective way to
prevent another seizure is to:
• A:dim the lights in the back of the ambulance.
• B:place him in the recovery position.
• C:administer high-flow supplemental oxygen.
• D:give him oral glucose if he can swallow. - CORRECT
ANSWER-You selected C; This is correct!
Reason:You should administer high-flow oxygen to all
patients who are actively seizing and to patients who
experienced a seizure and are postictal. This is especially
true if the seizure was caused by hypoxia. Increasing the
oxygen content of the blood, which minimizes hypoxia, may
prevent another seizure. The recovery position is appropriate
for uninjured patients with a decreased level of
consciousness and adequate breathing; it will help maintain
the airway and facilitate drainage of secretions from the
mouth, but will not prevent another seizure. Oral glucose
, may prevent another seizure if hypoglycemia was the cause
of the seizure. You should dim the lights in the back of the
ambulance to help prevent any seizure, not just those that
are caused by hypoxia.
A 29-year-old woman, who is 38 weeks pregnant, presents
with heavy vaginal bleeding, a blood pressure of 70/50 mm
Hg, and a heart rate of 130 beats/min. She is pale and
diaphoretic, and denies abdominal cramping or pain. Her
signs and symptoms are MOST consistent with a/an:
• A:placenta previa.
• B:abruptio placenta.
• C:ruptured ectopic pregnancy.
• D:ruptured ovarian cyst. - CORRECT ANSWER-The correct
answer is A;
Reason:Of the conditions listed, placenta previa would be
the least likely to present with abdominal pain, although
some patients may have pain or cramping. Placenta previa is
a condition in which the placenta develops over and covers
some or all of the cervix. As the cervix dilates, the
vasculature that attaches the placenta to the uterine wall
tears, resulting in vaginal bleeding that is often severe
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