Special Populations, Ostomies, and Feeding Tubes Practice Questions

25 multiple-choice questions on Special populations, ostomies, and feeding tubes for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. An 84-year-old woman has vague abdominal discomfort, no fever, and a soft abdomen, but looks unwell. Your approach should be to:

   1. A. Reassure her it is likely gas
   2. B. Keep suspicion high and transport
   3. C. Advise her to wait until tomorrow
   4. D. Treat her pain only and release
   Show answer

   Answer: B. Keep suspicion high and transport

   Older adults often have serious disease with mild findings because pain and fever responses are blunted. Unwell appearance matters.

2. Why may an older adult with peritonitis have no fever?

   1. A. Aging blunts the fever response
   2. B. Peritonitis rarely causes fever
   3. C. They have a higher baseline temperature
   4. D. Their peritonitis is usually viral
   Show answer

   Answer: A. Aging blunts the fever response

   Immune responses weaken with age, and medications such as steroids and NSAIDs mask fever. Older adults tend to have a lower, not higher, baseline temperature, peritonitis usually causes fever in younger patients, and it is bacterial rather than viral.

3. The most common cause of acute abdominal pain needing surgery in children is:

   1. A. Gallstones
   2. B. Diverticulitis
   3. C. Appendicitis
   4. D. Peptic ulcer
   Show answer

   Answer: C. Appendicitis

   Appendicitis is the leading surgical abdominal emergency in children. Young children present atypically and often after rupture.

4. Which finding in a child with vomiting and diarrhea suggests severe dehydration?

   1. A. Lethargy, no tears
   2. B. Crying with tears
   3. C. Moist mouth and lips
   4. D. Normal urine output
   Show answer

   Answer: A. Lethargy, no tears

   Lethargy, sunken eyes, absent tears, dry mucous membranes, and decreased urine output indicate significant fluid loss.

5. A bulge appears around a patient's colostomy when he coughs, and it goes away when he lies down. This is most likely:

   1. A. A prolapsed rectum
   2. B. A blocked feeding tube
   3. C. A stoma infection
   4. D. A parastomal hernia
   Show answer

   Answer: D. A parastomal hernia

   A parastomal hernia is bowel protruding through the abdominal wall beside a stoma, seen when abdominal pressure rises. Like other hernias, it becomes urgent if it becomes firm, painful, or discolored, or if output stops.

6. A healthy stoma should look:

   1. A. Black and dry
   2. B. Pink to red and moist
   3. C. Pale white and cold
   4. D. Dark purple and swollen
   Show answer

   Answer: B. Pink to red and moist

   A dark, dusky, or black stoma suggests poor blood flow. Report changes to the receiving facility.

7. Assessing abdominal tenderness in a patient with severe obesity is harder mainly because:

   1. A. Obese patients feel less pain
   2. B. Obesity causes tenderness at baseline
   3. C. Thick tissue hides masses and guarding
   4. D. Their organs sit higher under the ribs
   Show answer

   Answer: C. Thick tissue hides masses and guarding

   A thick abdominal wall makes masses, distension, and guarding hard to detect, so you must rely more on history and vital signs. Obesity does not reduce pain sensation, cause tenderness at baseline, or move the organs up under the ribs.

8. A G-tube (gastrostomy tube) is used to:

   1. A. Drain urine from the bladder
   2. B. Measure pressure in the heart
   3. C. Remove air from the chest
   4. D. Feed into the stomach
   Show answer

   Answer: D. Feed into the stomach

   G-tubes provide nutrition and medications for patients who cannot swallow safely.

9. A G-tube has fallen out of a child 30 minutes ago. The most appropriate action is to:

   1. A. Cover site, transport promptly
   2. B. Leave it out for several days
   3. C. Force the old tube back in
   4. D. Insert a straw to keep it open
   Show answer

   Answer: A. Cover site, transport promptly

   The opening can begin closing within hours. Cover the site with gauze, bring the tube, and transport for replacement.

10. A patient with a nasogastric tube has new trouble breathing after a feeding. You suspect:

    1. A. Small bowel obstruction
    2. B. Formula allergy
    3. C. Aspiration of feeding
    4. D. High blood sugar from the feed
    Show answer

    Answer: C. Aspiration of feeding

    Feeding can reflux into the airway, especially if the tube is misplaced or the patient lies flat. Sit the patient up and suction. A formula allergy would usually bring hives or swelling, high blood sugar does not cause sudden breathing trouble, and a bowel obstruction causes distension and vomiting first.

11. Why should feeding-tube patients be kept upright during feeds?

    1. A. To speed up digestion
    2. B. To reduce aspiration
    3. C. To prevent constipation
    4. D. To improve kidney function
    Show answer

    Answer: B. To reduce aspiration

    Gravity helps keep feeding in the stomach. Lying flat raises aspiration risk.

12. Two weeks after gastric bypass, a patient has abdominal pain, fever, and HR 128. You should suspect:

    1. A. Normal pain after surgery
    2. B. Dumping syndrome after a meal
    3. C. A leak where the bowel was joined
    4. D. Constipation from the pain medicine
    Show answer

    Answer: C. A leak where the bowel was joined

    Persistent tachycardia (above about 120) after bariatric surgery is a key sign of an anastomotic leak, which causes peritonitis and sepsis. Normal recovery does not cause fever with tachycardia, and dumping syndrome is meal-related.

13. A 90-year-old with advanced dementia is newly agitated and refusing food. Which abdominal causes should you check for?

    1. A. Normal aging changes in her behavior
    2. B. Hunger from too little food
    3. C. Boredom with the meal choices
    4. D. Constipation or urinary retention
    Show answer

    Answer: D. Constipation or urinary retention

    Patients who cannot describe pain often show it as agitation, withdrawal, or refusing food. Fecal impaction and a distended bladder are common, treatable causes; palpate for a suprapubic mass and ask about bowel habits. New agitation is not normal aging.

14. Pregnant patients with abdominal pain need special attention because:

    1. A. Normal changes can hide serious disease
    2. B. Pregnancy protects against appendicitis
    3. C. They always need a cesarean section
    4. D. The uterus shields the bowel from injury
    Show answer

    Answer: A. Normal changes can hide serious disease

    Uterine growth moves organs, and higher heart rate and lower BP are normal, which can mask shock.

15. An adult patient with an intellectual disability is restless and holding his abdomen but cannot describe pain. Best approach is to:

    1. A. Assume he is seeking attention
    2. B. Ask caregivers what has changed
    3. C. Rely on a numeric 0-10 pain scale
    4. D. Leave him home for observation
    Show answer

    Answer: B. Ask caregivers what has changed

    Caregivers know the patient's normal behavior. Changes in eating, behavior, or activity often signal pain.

16. A patient with a colostomy has not had output for 2 days and is vomiting with abdominal distension. This suggests:

    1. A. Normal stoma function
    2. B. Dehydration only
    3. C. Appendicitis
    4. D. Bowel obstruction
    Show answer

    Answer: D. Bowel obstruction

    No output, distension, and vomiting suggest an obstruction. Transport for evaluation.

17. Children with intussusception may appear:

    1. A. Lethargic between episodes
    2. B. Constantly hyperactive
    3. C. Pain-free with a high fever
    4. D. Calm with normal stools
    Show answer

    Answer: A. Lethargic between episodes

    Episodic crying with legs drawn up, followed by lethargy, is a classic pattern.

18. Which elder abuse finding may be seen with abdominal complaints?

    1. A. A single bruise on one shin
    2. B. A healed surgical scar
    3. C. Bruises of different ages
    4. D. Mild indigestion after meals
    Show answer

    Answer: C. Bruises of different ages

    Bruises in different stages of healing, inconsistent stories, or poor hygiene should raise concern. Report per local law. A single shin bruise, an old surgical scar, or indigestion is common and does not by itself suggest abuse.

19. A patient on peritoneal dialysis reports cloudy fluid and abdominal pain. You should suspect:

    1. A. Kidney stone
    2. B. Peritonitis
    3. C. Gallstones
    4. D. Hiatal hernia
    Show answer

    Answer: B. Peritonitis

    Cloudy dialysate is an early sign of infection. Bring the drained fluid bag if possible.

20. A patient has a PEG tube with redness, swelling, and pus at the site. This suggests:

    1. A. Normal healing
    2. B. Bowel obstruction
    3. C. Local infection
    4. D. Allergic reaction to food
    Show answer

    Answer: C. Local infection

    Infection around a tube site needs evaluation and possibly antibiotics. Fever suggests systemic spread.

21. A 3-year-old has painless, large-volume bright red or maroon rectal bleeding. You should suspect:

    1. A. An anal fissure
    2. B. Meckel diverticulum
    3. C. Constipation
    4. D. Acute appendicitis with rupture
    Show answer

    Answer: B. Meckel diverticulum

    A Meckel diverticulum may contain stomach lining that makes acid and ulcerates nearby bowel, causing painless, sometimes massive bleeding in young children. Fissures cause small streaks of blood with painful stooling.

22. A 7-year-old has abdominal pain, fever, and a sore throat without cough. The abdominal pain is most likely related to:

    1. A. A ruptured spleen
    2. B. Gallstones
    3. C. A kidney stone
    4. D. Strep throat
    Show answer

    Answer: D. Strep throat

    Group A strep pharyngitis in school-age children commonly causes abdominal pain, nausea, and vomiting along with fever and sore throat. Children with this pattern need evaluation for strep.

23. A 15-year-old girl with lower abdominal pain says she is not sexually active while her parents are in the room. The best approach is to:

    1. A. Ask her again in private if possible
    2. B. Accept the answer and move on
    3. C. Ask her parents if she is being honest
    4. D. Skip questions about pregnancy
    Show answer

    Answer: A. Ask her again in private if possible

    Adolescents often withhold sexual history in front of family. Asking privately, while explaining confidentiality, gives a more accurate history that matters for ectopic pregnancy, PID, and torsion. Asking parents to vouch for her or skipping the question risks missing a dangerous diagnosis.

24. A 4-year-old with abdominal pain is crying and clinging to his mother. The best way to examine his abdomen is to:

    1. A. Separate him from his mother first
    2. B. Restrain him flat on the cot
    3. C. Examine him on his mother's lap
    4. D. Skip the abdominal exam entirely
    Show answer

    Answer: C. Examine him on his mother's lap

    Keeping a young child with a caregiver reduces fear and crying, so the abdomen is softer and tenderness is easier to interpret. Separation and restraint increase crying and guarding.

25. Which patient with abdominal pain should receive a fingerstick glucose?

    1. A. A healthy teen after a large meal
    2. B. A diabetic patient who is vomiting
    3. C. A patient with a kidney stone history
    4. D. A runner with a muscle strain
    Show answer

    Answer: B. A diabetic patient who is vomiting

    Vomiting in diabetics can come from DKA or hypoglycemia. Check glucose early.