ATI LPN
Adult Medical Surgical ATI Questions
Question 1 of 5
The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
Correct Answer: C
Rationale: The correct answer is C because the urease breath test is the ideal test to document failure of H. pylori eradication. This test directly measures the presence of the H. pylori bacterium in the stomach by detecting the enzyme urease produced by the bacterium. If the patient still has symptoms after treatment, a positive urease breath test would indicate that the bacterium is still present, leading to treatment failure. Choice A is incorrect because a positive antibody test does not indicate low risk for reinfection. Choice B is incorrect because a positive serum IgG may persist even after successful eradication. Choice D is incorrect because dyspepsia can improve after successful H. pylori eradication rather than worsen.
Question 2 of 5
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
Correct Answer: B
Rationale: Step 1: Misoprostol is a prostaglandin analog that helps protect the gastric mucosa by increasing mucus production. This mechanism of action makes it effective in preventing NSAID-related GI toxicity. Step 2: H2-blockers (Choice A) and PPIs are not as effective as misoprostol in preventing NSAID-related GI toxicity. Step 3: Sucralfate (Choice C) is not as effective as misoprostol in preventing NSAID-related GI toxicity due to its different mechanism of action. Step 4: H. pylori infection (Choice D) can increase the risk of NSAID-induced ulcers but is not directly related to the prophylactic treatment with misoprostol.
Question 3 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 4 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 5 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