Med-Surg Week 8 GI and Hepatobiliary Exam
100 Practice Questions with Rationales for Nursing
Students
Section 1: Upper GI Disorders (GERD, PUD, Gastritis)
Questions 1–15
1. A nurse is teaching a client with gastroesophageal reflux disease (GERD)
about dietary management. Which statement by the client indicates a need for
further teaching?
• A) "I will avoid peppermint and chocolate."
• B) "I should wait 3 hours after eating before lying down."
• C) "I can have a glass of orange juice with my breakfast."
• D) "I will elevate the head of my bed on 6-inch blocks."
Answer: C) "I can have a glass of orange juice with my breakfast."
Rationale: Citrus juices (orange, grapefruit) are acidic and can exacerbate GERD
symptoms by irritating the esophagus and increasing acid reflux. Peppermint,
chocolate, and caffeine relax the lower esophageal sphincter (LES). Waiting to lie
down and elevating the head of bed promote gravity-assisted clearance of acid.
, 2. A client with peptic ulcer disease (PUD) reports epigastric pain that is
relieved by eating. The nurse suspects which type of ulcer?
• A) Gastric ulcer
• B) Duodenal ulcer
• C) Stress ulcer
• D) Esophageal ulcer
Answer: B) Duodenal ulcer
Rationale: Duodenal ulcers typically present with pain that occurs 2–3 hours after
meals (hunger pain) and is relieved by food or antacids due to the buffering effect.
Gastric ulcers often worsen with food.
3. A client is prescribed omeprazole (Prilosec) for GERD. The nurse should
instruct the client to take this medication at which time?
• A) With meals
• B) At bedtime
• C) 30–60 minutes before breakfast
• D) When symptoms occur
Answer: C) 30–60 minutes before breakfast
Rationale: Proton pump inhibitors (PPIs) like omeprazole are most effective when
taken 30–60 minutes before the first meal of the day. This timing maximizes
inhibition of the proton pump, which is most active with food intake.
4. A client with a history of peptic ulcer disease is admitted with sudden, severe
upper abdominal pain. The abdomen is rigid and board-like. What is the nurse's
priority action?
,• A) Administer prescribed antacid
• B) Insert a nasogastric tube
• C) Prepare the client for emergency surgery
• D) Obtain a stool sample for occult blood
Answer: C) Prepare the client for emergency surgery
Rationale: Sudden, severe pain with a rigid, board-like abdomen indicates
perforation of the ulcer, which is a surgical emergency. Perforation allows gastric
contents to spill into the peritoneal cavity, causing peritonitis. Surgery is required to
repair the perforation.
5. A client with chronic gastritis is at risk for which long-term complication?
• A) Esophageal varices
• B) Pernicious anemia
• C) Pancreatitis
• D) Cholelithiasis
Answer: B) Pernicious anemia
Rationale: Chronic gastritis, particularly autoimmune gastritis, destroys parietal cells
in the stomach. Parietal cells produce intrinsic factor, which is necessary for vitamin
B12 absorption. Deficiency leads to pernicious anemia.
6. A nurse is providing discharge teaching to a client with peptic ulcer disease.
Which statement indicates correct understanding?
• A) "I will take ibuprofen if I have pain."
• B) "I should avoid drinking alcohol."
• C) "I can continue smoking cigarettes."
• D) "Stress is the primary cause of my ulcer."
, Answer: B) "I should avoid drinking alcohol."
Rationale: Alcohol irritates the gastric mucosa and can delay ulcer healing. NSAIDs
like ibuprofen should be avoided as they inhibit prostaglandins that protect the
gastric lining. Smoking increases acid secretion and impairs healing. Most ulcers are
caused by H. pylori or NSAIDs, not stress alone.
7. A client reports a burning sensation in the chest after eating, especially when
lying down. Which additional assessment finding would support a diagnosis of
GERD?
• A) Diarrhea
• B) Regurgitation of sour liquid
• C) Constipation
• D) Fever
Answer: B) Regurgitation of sour liquid
Rationale: Regurgitation of gastric contents into the mouth is a classic symptom of
GERD, often accompanied by heartburn. Diarrhea, constipation, and fever are not
typical presenting symptoms of GERD.
8. A client with a duodenal ulcer is prescribed sucralfate (Carafate). The nurse
should instruct the client to take this medication at which time?
• A) With meals
• B) 1 hour before meals and at bedtime
• C) Immediately after meals
• D) At bedtime only
Answer: B) 1 hour before meals and at bedtime
Rationale: Sucralfate forms a protective barrier over the ulcer site. It should be taken
100 Practice Questions with Rationales for Nursing
Students
Section 1: Upper GI Disorders (GERD, PUD, Gastritis)
Questions 1–15
1. A nurse is teaching a client with gastroesophageal reflux disease (GERD)
about dietary management. Which statement by the client indicates a need for
further teaching?
• A) "I will avoid peppermint and chocolate."
• B) "I should wait 3 hours after eating before lying down."
• C) "I can have a glass of orange juice with my breakfast."
• D) "I will elevate the head of my bed on 6-inch blocks."
Answer: C) "I can have a glass of orange juice with my breakfast."
Rationale: Citrus juices (orange, grapefruit) are acidic and can exacerbate GERD
symptoms by irritating the esophagus and increasing acid reflux. Peppermint,
chocolate, and caffeine relax the lower esophageal sphincter (LES). Waiting to lie
down and elevating the head of bed promote gravity-assisted clearance of acid.
, 2. A client with peptic ulcer disease (PUD) reports epigastric pain that is
relieved by eating. The nurse suspects which type of ulcer?
• A) Gastric ulcer
• B) Duodenal ulcer
• C) Stress ulcer
• D) Esophageal ulcer
Answer: B) Duodenal ulcer
Rationale: Duodenal ulcers typically present with pain that occurs 2–3 hours after
meals (hunger pain) and is relieved by food or antacids due to the buffering effect.
Gastric ulcers often worsen with food.
3. A client is prescribed omeprazole (Prilosec) for GERD. The nurse should
instruct the client to take this medication at which time?
• A) With meals
• B) At bedtime
• C) 30–60 minutes before breakfast
• D) When symptoms occur
Answer: C) 30–60 minutes before breakfast
Rationale: Proton pump inhibitors (PPIs) like omeprazole are most effective when
taken 30–60 minutes before the first meal of the day. This timing maximizes
inhibition of the proton pump, which is most active with food intake.
4. A client with a history of peptic ulcer disease is admitted with sudden, severe
upper abdominal pain. The abdomen is rigid and board-like. What is the nurse's
priority action?
,• A) Administer prescribed antacid
• B) Insert a nasogastric tube
• C) Prepare the client for emergency surgery
• D) Obtain a stool sample for occult blood
Answer: C) Prepare the client for emergency surgery
Rationale: Sudden, severe pain with a rigid, board-like abdomen indicates
perforation of the ulcer, which is a surgical emergency. Perforation allows gastric
contents to spill into the peritoneal cavity, causing peritonitis. Surgery is required to
repair the perforation.
5. A client with chronic gastritis is at risk for which long-term complication?
• A) Esophageal varices
• B) Pernicious anemia
• C) Pancreatitis
• D) Cholelithiasis
Answer: B) Pernicious anemia
Rationale: Chronic gastritis, particularly autoimmune gastritis, destroys parietal cells
in the stomach. Parietal cells produce intrinsic factor, which is necessary for vitamin
B12 absorption. Deficiency leads to pernicious anemia.
6. A nurse is providing discharge teaching to a client with peptic ulcer disease.
Which statement indicates correct understanding?
• A) "I will take ibuprofen if I have pain."
• B) "I should avoid drinking alcohol."
• C) "I can continue smoking cigarettes."
• D) "Stress is the primary cause of my ulcer."
, Answer: B) "I should avoid drinking alcohol."
Rationale: Alcohol irritates the gastric mucosa and can delay ulcer healing. NSAIDs
like ibuprofen should be avoided as they inhibit prostaglandins that protect the
gastric lining. Smoking increases acid secretion and impairs healing. Most ulcers are
caused by H. pylori or NSAIDs, not stress alone.
7. A client reports a burning sensation in the chest after eating, especially when
lying down. Which additional assessment finding would support a diagnosis of
GERD?
• A) Diarrhea
• B) Regurgitation of sour liquid
• C) Constipation
• D) Fever
Answer: B) Regurgitation of sour liquid
Rationale: Regurgitation of gastric contents into the mouth is a classic symptom of
GERD, often accompanied by heartburn. Diarrhea, constipation, and fever are not
typical presenting symptoms of GERD.
8. A client with a duodenal ulcer is prescribed sucralfate (Carafate). The nurse
should instruct the client to take this medication at which time?
• A) With meals
• B) 1 hour before meals and at bedtime
• C) Immediately after meals
• D) At bedtime only
Answer: B) 1 hour before meals and at bedtime
Rationale: Sucralfate forms a protective barrier over the ulcer site. It should be taken
