Med-Surg Week 8 Comprehensive Exam
GI & Hepatobiliary Disorders: Most Frequently Tested
Questions (2020–2025)
100 Questions with Answers & Rationales
Section 1: Upper GI Disorders (GERD, PUD, Gastritis)
Questions 1–15
1. A nurse is teaching a client with gastroesophageal reflux disease (GERD).
Which statement by the client indicates correct understanding of lifestyle
modifications?
• A) "I should lie down for 30 minutes after eating to help digestion."
• B) "I can drink orange juice in the morning as long as I take my medication."
• C) "I will elevate the head of my bed on 6-inch blocks."
• D) "I should wear tight-fitting clothes to support my abdomen."
Answer: C) "I will elevate the head of my bed on 6-inch blocks."
Rationale: Elevating the head of the bed (HOB) by 6–8 inches uses gravity to prevent
gastric contents from refluxing into the esophagus during sleep. This is a key
evidence-based recommendation. Lying down after eating, citrus juices, and tight
clothing all worsen GERD.
2. A client with peptic ulcer disease (PUD) reports epigastric pain that worsens
with eating. The nurse suspects which type of ulcer?
,• A) Duodenal ulcer
• B) Gastric ulcer
• C) Esophageal ulcer
• D) Stress ulcer
Answer: B) Gastric ulcer
Rationale: Gastric ulcers typically cause pain that worsens with eating because food
increases gastric acid secretion and irritates the ulcerated area. Duodenal ulcers are
classically relieved by eating.
3. A client is prescribed omeprazole (Prilosec) for GERD. Which instruction
should the nurse provide?
• A) "Take this medication at bedtime."
• B) "Take this medication 30–60 minutes before breakfast."
• C) "Take this medication with a full glass of milk."
• D) "Take this medication when you have heartburn symptoms."
Answer: B) "Take this medication 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, as they inhibit the proton
pump that is activated by food intake.
4. A client with peptic ulcer disease is diagnosed with Helicobacter
pylori infection. Which medication regimen is first-line treatment?
• A) Antacids and H2 blockers
• B) Triple therapy (PPI + two antibiotics)
• C) Corticosteroids and sucralfate
• D) Bismuth subsalicylate alone
Answer: B) Triple therapy (PPI + two antibiotics)
Rationale: First-line treatment for H. pylori is triple or quadruple therapy, typically a
proton pump inhibitor (PPI) combined with two antibiotics (e.g., amoxicillin and
clarithromycin) to eradicate the bacteria and promote ulcer healing.
, 5. A client with a history of PUD reports 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. Peritonitis develops rapidly,
and surgery is required to repair the perforation.
6. 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 autoimmune gastritis destroys parietal cells, which produce
intrinsic factor. Without intrinsic factor, vitamin B12 cannot be absorbed, leading to
pernicious anemia.
7. A client is prescribed sucralfate (Carafate) for a gastric ulcer. Which
instruction should the nurse include?
• A) "Take this medication with meals."
• B) "Take this medication 1 hour before meals and at bedtime."
• C) "Take this medication with antacids."
• D) "Take this medication only when pain occurs."
Answer: B) "Take this medication 1 hour before meals and at bedtime."
Rationale: Sucralfate forms a protective barrier over the ulcer and must be taken on
an empty stomach (1 hour before meals and at bedtime) to adhere properly without
interference from food or other medications.
, 8. A nurse is assessing a client with suspected upper GI bleeding. Which finding
indicates significant blood loss?
• A) Blood pressure 120/80 mmHg
• B) Heart rate 112 bpm
• C) Hemoglobin 14 g/dL
• D) Warm, dry skin
Answer: B) Heart rate 112 bpm
Rationale: Tachycardia is an early sign of hypovolemia from blood loss. Blood
pressure may remain normal initially. Hemoglobin may not immediately reflect acute
blood loss due to hemodilution.
9. A client with GERD asks about lifestyle modifications. Which
recommendation should the nurse prioritize?
• A) Wear tight-fitting clothing
• B) Lie down immediately after meals
• C) Elevate the head of the bed
• D) Increase intake of carbonated beverages
Answer: C) Elevate the head of the bed
Rationale: Elevating the HOB (6–8 inches) reduces nocturnal reflux. Tight clothing
increases intra-abdominal pressure, lying down after eating worsens reflux, and
carbonated beverages increase gastric distention.
10. A client with a gastric ulcer is prescribed famotidine (Pepcid). How does this
medication work?
• A) Neutralizes gastric acid
• B) Blocks histamine H2 receptors to reduce acid secretion
• C) Inhibits the proton pump
• D) Coats the ulcer surface
Answer: B) Blocks histamine H2 receptors to reduce acid secretion
Rationale: Famotidine is an H2 receptor antagonist that blocks histamine-induced
GI & Hepatobiliary Disorders: Most Frequently Tested
Questions (2020–2025)
100 Questions with Answers & Rationales
Section 1: Upper GI Disorders (GERD, PUD, Gastritis)
Questions 1–15
1. A nurse is teaching a client with gastroesophageal reflux disease (GERD).
Which statement by the client indicates correct understanding of lifestyle
modifications?
• A) "I should lie down for 30 minutes after eating to help digestion."
• B) "I can drink orange juice in the morning as long as I take my medication."
• C) "I will elevate the head of my bed on 6-inch blocks."
• D) "I should wear tight-fitting clothes to support my abdomen."
Answer: C) "I will elevate the head of my bed on 6-inch blocks."
Rationale: Elevating the head of the bed (HOB) by 6–8 inches uses gravity to prevent
gastric contents from refluxing into the esophagus during sleep. This is a key
evidence-based recommendation. Lying down after eating, citrus juices, and tight
clothing all worsen GERD.
2. A client with peptic ulcer disease (PUD) reports epigastric pain that worsens
with eating. The nurse suspects which type of ulcer?
,• A) Duodenal ulcer
• B) Gastric ulcer
• C) Esophageal ulcer
• D) Stress ulcer
Answer: B) Gastric ulcer
Rationale: Gastric ulcers typically cause pain that worsens with eating because food
increases gastric acid secretion and irritates the ulcerated area. Duodenal ulcers are
classically relieved by eating.
3. A client is prescribed omeprazole (Prilosec) for GERD. Which instruction
should the nurse provide?
• A) "Take this medication at bedtime."
• B) "Take this medication 30–60 minutes before breakfast."
• C) "Take this medication with a full glass of milk."
• D) "Take this medication when you have heartburn symptoms."
Answer: B) "Take this medication 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, as they inhibit the proton
pump that is activated by food intake.
4. A client with peptic ulcer disease is diagnosed with Helicobacter
pylori infection. Which medication regimen is first-line treatment?
• A) Antacids and H2 blockers
• B) Triple therapy (PPI + two antibiotics)
• C) Corticosteroids and sucralfate
• D) Bismuth subsalicylate alone
Answer: B) Triple therapy (PPI + two antibiotics)
Rationale: First-line treatment for H. pylori is triple or quadruple therapy, typically a
proton pump inhibitor (PPI) combined with two antibiotics (e.g., amoxicillin and
clarithromycin) to eradicate the bacteria and promote ulcer healing.
, 5. A client with a history of PUD reports 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. Peritonitis develops rapidly,
and surgery is required to repair the perforation.
6. 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 autoimmune gastritis destroys parietal cells, which produce
intrinsic factor. Without intrinsic factor, vitamin B12 cannot be absorbed, leading to
pernicious anemia.
7. A client is prescribed sucralfate (Carafate) for a gastric ulcer. Which
instruction should the nurse include?
• A) "Take this medication with meals."
• B) "Take this medication 1 hour before meals and at bedtime."
• C) "Take this medication with antacids."
• D) "Take this medication only when pain occurs."
Answer: B) "Take this medication 1 hour before meals and at bedtime."
Rationale: Sucralfate forms a protective barrier over the ulcer and must be taken on
an empty stomach (1 hour before meals and at bedtime) to adhere properly without
interference from food or other medications.
, 8. A nurse is assessing a client with suspected upper GI bleeding. Which finding
indicates significant blood loss?
• A) Blood pressure 120/80 mmHg
• B) Heart rate 112 bpm
• C) Hemoglobin 14 g/dL
• D) Warm, dry skin
Answer: B) Heart rate 112 bpm
Rationale: Tachycardia is an early sign of hypovolemia from blood loss. Blood
pressure may remain normal initially. Hemoglobin may not immediately reflect acute
blood loss due to hemodilution.
9. A client with GERD asks about lifestyle modifications. Which
recommendation should the nurse prioritize?
• A) Wear tight-fitting clothing
• B) Lie down immediately after meals
• C) Elevate the head of the bed
• D) Increase intake of carbonated beverages
Answer: C) Elevate the head of the bed
Rationale: Elevating the HOB (6–8 inches) reduces nocturnal reflux. Tight clothing
increases intra-abdominal pressure, lying down after eating worsens reflux, and
carbonated beverages increase gastric distention.
10. A client with a gastric ulcer is prescribed famotidine (Pepcid). How does this
medication work?
• A) Neutralizes gastric acid
• B) Blocks histamine H2 receptors to reduce acid secretion
• C) Inhibits the proton pump
• D) Coats the ulcer surface
Answer: B) Blocks histamine H2 receptors to reduce acid secretion
Rationale: Famotidine is an H2 receptor antagonist that blocks histamine-induced
