Adult Medical Surgical ATI

Adult Medical Surgical ATI Related

Review Adult Medical Surgical ATI related questions and content

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.

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A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

  • A. Ulcerative colitis
  • B. Irritable bowel syndrome
  • C. Celiac disease
  • D. Diverticulitis
Correct Answer: A

Rationale: The correct answer is A: Ulcerative colitis. This chronic inflammatory condition affects the colon and rectum, leading to symptoms like abdominal pain, diarrhea, and rectal bleeding. The patient's recurrent episodes and history of similar symptoms point towards ulcerative colitis. Irritable bowel syndrome (choice B) typically presents with abdominal pain, bloating, and changes in bowel habits but not rectal bleeding. Celiac disease (choice C) presents with gastrointestinal symptoms after consuming gluten. Diverticulitis (choice D) presents with localized abdominal pain and fever due to inflammation or infection of the diverticula, not typically with rectal bleeding.

A 60-year-old man 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 an overactive thyroid gland, leading to symptoms like fatigue, weight gain, and constipation. The low TSH is due to negative feedback as the high free T4 suppresses TSH production. Hyperthyroidism fits this clinical picture, as opposed to hypothyroidism (choice A) which would have high TSH and low free T4 levels. Thyroiditis (choice C) typically presents with symptoms of both hyperthyroidism and hypothyroidism and is usually transient. Thyroid cancer (choice D) is less likely given the presentation of symptoms and specific lab results.

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.

A client diagnosed with dementia is disoriented, wandering, has a decreased appetite, and is having trouble sleeping. What is the priority nursing problem for this client?

  • A. Disturbed thought processes.
  • B. Altered sleep pattern.
  • C. Imbalanced nutrition: less than.
  • D. Risk for injury.
Correct Answer: D

Rationale: The correct answer is D: Risk for injury. The client's symptoms of disorientation, wandering, decreased appetite, and difficulty sleeping indicate an increased risk for falls, accidents, or getting lost. Ensuring the client's safety and preventing any potential harm is the priority.

A: Disturbed thought processes may contribute to the client's disorientation but do not pose an immediate threat to their safety.
B: Altered sleep pattern is concerning but is secondary to the risk of injury in this scenario.
C: Imbalanced nutrition: less than is important, but the immediate priority is addressing the client's safety due to the risk of injury.

In summary, the priority nursing problem for this client is the risk for injury due to their disorientation and wandering behavior, which could lead to accidents or harm.

A 35-year-old woman presents with abdominal pain, diarrhea, and weight loss. She has a history of recurrent mouth ulcers and a perianal fistula. What is the most likely diagnosis?

  • A. Ulcerative colitis
  • B. Irritable bowel syndrome
  • C. Crohn's disease
  • D. Diverticulitis
Correct Answer: C

Rationale: The most likely diagnosis is Crohn's disease (Choice C). This is supported by the symptoms of abdominal pain, diarrhea, weight loss, mouth ulcers, and perianal fistula, which are characteristic of Crohn's disease. These symptoms are not typically seen in irritable bowel syndrome (Choice B) or diverticulitis (Choice D). While ulcerative colitis (Choice A) may also present with similar symptoms, the presence of perianal fistula and mouth ulcers is more indicative of Crohn's disease. Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, leading to the diverse range of symptoms seen in this patient.

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