Adult Medical Surgical ATI

Adult Medical Surgical ATI Related

Review Adult Medical Surgical ATI related questions and content

A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

  • A. Liver biopsy
  • B. Magnetic resonance cholangiopancreatography
  • C. Hepatitis B surface antigen and hepatitis C RNA assay
  • D. Colonoscopy with biopsies
Correct Answer: B

Rationale: The correct answer is B: Magnetic resonance cholangiopancreatography (MRCP). Given the patient's clinical presentation of right upper quadrant pain, fever, jaundice, and abnormal liver function tests, MRCP is the next diagnostic test of choice to evaluate the biliary tree and pancreatic ducts for possible obstruction or structural abnormalities. This would help identify the cause of the patient's symptoms, such as biliary obstruction or choledocholithiasis.

Choice A: Liver biopsy is not the next step in this scenario as the patient's symptoms are suggestive of a biliary or pancreatic etiology rather than a primary liver pathology.

Choice C: Hepatitis B surface antigen and hepatitis C RNA assay may be relevant for evaluating viral hepatitis, but in this case, the patient's symptoms and lab results are more indicative of a biliary or pancreatic issue.

Choice D: Colonoscopy with biopsies is not the next appropriate step as the patient's symptoms and lab results are not

You may also like to solve these questions

What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?

  • A. Proton-pump inhibitor
  • B. Endoscopic balloon dilatation
  • C. Sucralfate
  • D. Esophageal resection
Correct Answer: B

Rationale: The correct answer is B: Endoscopic balloon dilatation. This is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR because these symptoms suggest achalasia, a motility disorder of the esophagus. Endoscopic balloon dilatation helps to disrupt the lower esophageal sphincter muscle, relieving symptoms and improving esophageal emptying. Proton-pump inhibitors (A) are used for acid-related conditions, not for achalasia. Sucralfate (C) is a mucosal protective agent and not indicated for achalasia. Esophageal resection (D) is a more invasive option and usually reserved for severe cases or when other treatments have failed.

A 45-year-old woman presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?

  • A. Hypothyroidism
  • B. Hyperthyroidism
  • C. Thyroiditis
  • D. Thyroid cancer
Correct Answer: B

Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate overproduction of thyroid hormones, leading to symptoms like fatigue, weight gain, and constipation. Low TSH is a result of negative feedback due to high T4 levels. Hyperthyroidism is characterized by an overactive thyroid gland, resulting in excess thyroid hormone production. Other choices are incorrect because hypothyroidism would show high TSH levels, thyroiditis typically presents with thyroid tenderness and inflammation, and thyroid cancer usually does not cause these hormonal imbalances.

A client with a history of myocardial infarction (MI) is prescribed nitroglycerin (Nitrostat) for chest pain. Which instruction should the nurse provide?

  • A. Take the medication with food.
  • B. Swallow the tablet whole.
  • C. Take the medication at bedtime.
  • D. Place the tablet under your tongue.
Correct Answer: D

Rationale: The correct answer is D: Place the tablet under your tongue. Nitroglycerin is a vasodilator used to relieve chest pain in patients with MI. Placing the tablet under the tongue allows for rapid absorption through the oral mucosa, providing quick relief. Taking it with food (A) may delay absorption. Swallowing the tablet whole (B) would result in slower absorption through the GI tract. Taking it at bedtime (C) is not necessary for immediate relief of chest pain.

A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

  • A. Hepatitis B
  • B. Primary biliary cirrhosis
  • C. Primary sclerosing cholangitis
  • D. Autoimmune hepatitis
Correct Answer: C

Rationale: The most likely diagnosis is primary sclerosing cholangitis (PSC) based on the patient's symptoms of fatigue, pruritus, jaundice, and elevated bilirubin and alkaline phosphatase levels. PSC is commonly associated with inflammatory bowel disease, such as ulcerative colitis. The characteristic findings of elevated alkaline phosphatase and bilirubin levels are indicative of cholestasis, which is a key feature of PSC. Additionally, PSC is characterized by fibrosis and inflammation of the bile ducts, leading to bile duct strictures and subsequent liver damage. Hepatitis B would present with viral hepatitis symptoms and different lab findings. Primary biliary cirrhosis typically presents with elevated alkaline phosphatase and antimitochondrial antibodies. Autoimmune hepatitis would have elevated transaminases and autoantibodies. Therefore, based on the clinical presentation and lab results, PSC is the most likely diagnosis.

When assessing a client with a chest tube connected to suction, which observation indicates that the chest tube is functioning properly?

  • A. Continuous bubbling in the water seal chamber.
  • B. Intermittent bubbling in the suction control chamber.
  • C. No fluctuation in the water seal chamber.
  • D. Steady bubbling in the suction control chamber.
Correct Answer: D

Rationale: The correct answer is D: Steady bubbling in the suction control chamber. This indicates proper functioning as it shows that the suction is maintaining a consistent pressure, which is essential for effective drainage and lung re-expansion. Continuous bubbling in the water seal chamber (choice A) indicates an air leak. Intermittent bubbling in the suction control chamber (choice B) could suggest fluctuating pressure. No fluctuation in the water seal chamber (choice C) indicates either a blockage or disconnection. Steady bubbling in the suction control chamber (choice D) indicates the suction is working consistently, ensuring proper drainage and lung re-expansion.

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