ATI LPN
Adult Medical Surgical ATI Questions
Question 1 of 5
An otherwise healthy 45-year-old man presents with severe hematochezia and moderate abdominal cramping since this morning. A barium enema one year ago was normal. On examination, his blood pressure is 120/78 and pulse is 100 while lying; when standing, the blood pressure is 110/76 and pulse is 136. His hematocrit is 34. What is the most likely cause of bleeding?
Correct Answer: B
Rationale: The most likely cause of bleeding in this case is a duodenal ulcer (Choice B). The key clues are severe hematochezia, moderate abdominal cramping, normal barium enema a year ago, and orthostatic changes in blood pressure and pulse. Severe hematochezia suggests a significant upper gastrointestinal bleed. Normal barium enema rules out lower GI sources. Orthostatic changes in blood pressure and pulse are indicative of acute blood loss. Duodenal ulcers are a common cause of upper GI bleeding and can present with hematochezia. In contrast, diverticular bleeds (Choice A) typically present with painless rectal bleeding, inflammatory bowel disease (Choice C) often presents with chronic blood loss and anemia, and vascular ectasia (Choice D) typically causes chronic, slow bleeding.
Question 2 of 5
A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?
Correct Answer: B
Rationale: The correct answer is B: Symptoms will resolve promptly after delivery. The presentation of elevated liver enzymes, pruritus, and jaundice in a pregnant woman at 34 weeks with no signs of severe preeclampsia suggests cholestasis of pregnancy. This condition typically resolves after delivery. The absence of fetal distress and normal maternal blood pressure indicate that immediate delivery is not necessary. There is a risk of recurrence in subsequent pregnancies, so choice C is incorrect. Screening for LCHAD deficiency is not indicated in this scenario, as the presentation is more consistent with cholestasis of pregnancy.
Question 3 of 5
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
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
Question 4 of 5
A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?
Correct Answer: A
Rationale: The correct answer is A: He should be treated with a low-protein diet and lactulose. This patient is presenting with hepatic encephalopathy, as evidenced by his altered mental status, ataxia, slurred speech, hyperreflexia, and normal ammonia level. The management of hepatic encephalopathy involves reducing the production of ammonia in the gut. Lactulose is a non-absorbable disaccharide that helps trap ammonia in the gut and promote its excretion in the feces. A low-protein diet is also recommended to decrease ammonia production. Option B is incorrect because lorazepam is not the drug of choice for managing hepatic encephalopathy; it can worsen the condition. Option C is incorrect because gentamicin is not indicated in this scenario. Option D is incorrect because acetaminophen should be avoided in patients with liver disease due to the risk of hepatotoxicity; nonsteroidal anti-inflammatory drugs
Question 5 of 5
What is/are the possible cause(s) of acute pancreatitis in this patient?
Correct Answer: B
Rationale: The correct answer is B: Cytomegalovirus. Cytomegalovirus is a common cause of acute pancreatitis in immunocompromised patients. The virus can infect the pancreas leading to inflammation. HIV (A) can also cause pancreatitis, but it is typically due to opportunistic infections like CMV rather than the virus itself. Dideoxyinosine (ddI) (C) and Pentamidine (D) are medications that can cause pancreatitis, but they are not the primary cause in this case.