Adult Medical Surgical ATI

Adult Medical Surgical ATI Related

Review Adult Medical Surgical ATI related questions and content

A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

  • A. Refer her for an exploratory laparotomy
  • B. Measure serum gastrin in response to secretin infusion
  • C. Treat her for H. pylori
  • D. Obtain a dedicated small bowel series
Correct Answer: B

Rationale: The correct answer is B: Measure serum gastrin in response to secretin infusion. This step is necessary to confirm the diagnosis of gastrinoma. Secretin stimulation test is used to differentiate between Zollinger-Ellison syndrome (gastrinoma) and other causes of hypergastrinemia. If serum gastrin levels remain elevated after secretin infusion, it supports the diagnosis of gastrinoma.

Choice A: Refer her for an exploratory laparotomy - This is an invasive procedure and should not be the first step in the investigation of gastrinoma.

Choice C: Treat her for H. pylori - This is not indicated in the management of suspected gastrinoma. H. pylori infection is not a likely cause of the symptoms described.

Choice D: Obtain a dedicated small bowel series - This test is not typically used in the initial evaluation of gastrinoma. The secretin stimulation test is the preferred method for confirming the diagnosis.

You may also like to solve these questions

The client with gastroesophageal reflux disease (GERD) is being taught about dietary modifications by the nurse. Which instruction should the nurse include?

  • A. Increase your intake of spicy foods.
  • B. Avoid lying down immediately after eating.
  • C. Consume a high-fat diet.
  • D. Drink caffeinated beverages with meals.
Correct Answer: B

Rationale: The correct answer is B: Avoid lying down immediately after eating. This instruction helps prevent acid reflux by allowing gravity to aid in digestion. Lying down can cause stomach acid to flow back up the esophagus, exacerbating GERD symptoms. Increasing intake of spicy foods (A) can irritate the esophagus, consuming a high-fat diet (C) can delay stomach emptying and worsen symptoms, and drinking caffeinated beverages with meals (D) can relax the lower esophageal sphincter, leading to more reflux.

A 50-year-old man presents with severe epigastric pain radiating to his back, nausea, and vomiting. He has a history of heavy alcohol use. Laboratory tests reveal elevated serum amylase and lipase. What is the most likely diagnosis?

  • A. Acute cholecystitis
  • B. Peptic ulcer disease
  • C. Acute pancreatitis
  • D. Gastroesophageal reflux disease
Correct Answer: C

Rationale: The correct answer is C: Acute pancreatitis. The patient's symptoms of severe epigastric pain radiating to the back, along with nausea, vomiting, and a history of heavy alcohol use, are classic for acute pancreatitis. Elevated serum amylase and lipase levels further support this diagnosis, as they are key markers of pancreatic inflammation. Acute cholecystitis (A) typically presents with right upper quadrant pain and fever. Peptic ulcer disease (B) is characterized by burning epigastric pain that improves with food intake. Gastroesophageal reflux disease (D) presents with heartburn and regurgitation, not the severe symptoms seen in this case.

A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?

  • A. Nitrofurantoin (Macrodantin) orally.
  • B. Erythropoietin (Epogen) intravenously.
  • C. Kayexalate retention enema.
  • D. Azathioprine (Imuran) orally.
Correct Answer: C

Rationale: The correct answer is C: Kayexalate retention enema. In acute renal failure with high serum potassium levels, the priority is to lower potassium levels to prevent cardiac complications. Kayexalate works by exchanging sodium ions for potassium ions in the intestines, promoting potassium excretion in the feces. This intervention helps reduce serum potassium levels quickly.

A: Nitrofurantoin is an antibiotic used to treat urinary tract infections, unrelated to managing hyperkalemia.
B: Erythropoietin is a hormone used to stimulate red blood cell production, not indicated for reducing potassium levels.
D: Azathioprine is an immunosuppressant used for various conditions like autoimmune diseases, not for managing hyperkalemia.

In summary, the correct intervention is to administer a Kayexalate retention enema to lower serum potassium levels effectively in acute renal failure. Other options are not appropriate for managing hyperkalemia.

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 55-year-old man presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

  • A. Primary biliary cirrhosis
  • B. Primary sclerosing cholangitis
  • C. Gallstones
  • D. Pancreatic cancer
Correct Answer: A

Rationale: The most likely diagnosis is A: Primary biliary cirrhosis. This condition typically presents with fatigue, pruritus, jaundice, elevated bilirubin, and alkaline phosphatase levels. The imaging findings of dilated intrahepatic bile ducts and a normal common bile duct are classic for primary biliary cirrhosis. It is an autoimmune disease affecting the bile ducts.

Why other choices are incorrect:
B: Primary sclerosing cholangitis presents with strictures and beading of bile ducts, not dilatation.
C: Gallstones usually cause common bile duct obstruction, not intrahepatic dilation.
D: Pancreatic cancer would typically present with different imaging findings and may involve the pancreatic duct, not just intrahepatic bile ducts.

Copyright © 2025 Nokea. All rights reserved.