NUR242 EXAM 3 ACTUAL 2026/2027 | Medical-Surgical
Nursing Exam | Questions & Verified Answers with
Rationales | 100% Correct | Grade A | Galen | Pass
Guaranteed - A+ Graded
Gastrointestinal Disorders: From Bleeding to Inflammation
Q1: A 62-year-old patient is admitted with hematemesis described as "coffee-ground" in
appearance. Which pathophysiological process explains this characteristic finding?
A. Rapid bleeding from an arterial source in the stomach
B. Oxidation of hemoglobin by gastric acid over time C. [CORRECT]
C. Mixing of bile with fresh blood in the duodenum
D. Clotting cascade activation in the esophageal lumen
Rationale: Coffee-ground emesis results from blood remaining in the stomach long
enough for gastric acid to convert hemoglobin to methemoglobin and hematin,
producing the dark, granular appearance. Bright red hematemesis indicates active, rapid
bleeding, while coffee-ground material suggests the bleeding has slowed or stopped
temporarily.
Correct Answer: B
Q2: Your patient with known cirrhosis presents with increasing confusion, asterixis, and
a serum ammonia level of 124 mcg/dL. Which medication should the nurse prepare to
administer first?
A. Rifaximin 550 mg PO twice daily
B. Lactulose 30 mL PO C. [CORRECT]
,C. Neomycin 1 g PO four times daily
D. Metronidazole 250 mg PO three times daily
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy as it acidifies
the colon, trapping ammonia and promoting its excretion. While rifaximin is an effective
adjunct, lactulose remains the initial intervention. Neomycin is rarely used today due to
nephrotoxicity and ototoxicity risks.
Correct Answer: B
Q3: A patient with acute pancreatitis has been NPO for 48 hours. Which laboratory
finding would most concern the nurse regarding the development of systemic
complications?
A. Serum amylase 450 U/L (elevated from baseline)
B. Serum calcium 7.2 mg/dL C. [CORRECT]
C. Serum lipase 380 U/L (trending down from 520)
D. Blood glucose 142 mg/dL
Rationale: Hypocalcemia in acute pancreatitis indicates saponification of calcium by
free fatty acids in necrotic fat tissue, signaling severe necrotizing pancreatitis and
increased risk for complications like ARDS, AKI, and sepsis. While elevated amylase and
lipase confirm diagnosis, trending calcium levels reflect disease severity.
Correct Answer: B
Q4: When teaching a patient newly diagnosed with Crohn's disease about their
condition, which statement by the patient indicates understanding of the disease
pathology?
A. "My entire colon is continuously inflamed, which puts me at higher risk for colon
cancer."
B. "The inflammation goes through all layers of my bowel wall and can skip healthy
sections." C. [CORRECT]
,C. "I should expect bloody diarrhea every day because my mucosa is always ulcerated."
D. "My disease only affects my large intestine, unlike ulcerative colitis."
Rationale: Crohn's disease features transmural (full-thickness) inflammation with skip
lesions—areas of diseased tissue separated by healthy bowel. This differs from
ulcerative colitis, which involves continuous mucosal inflammation limited to the colon.
Crohn's can affect any part of the GI tract from mouth to anus.
Correct Answer: B
Q5: A patient with esophageal varices begins vomiting large amounts of bright red
blood. After ensuring airway patency, what is the nurse's immediate priority?
A. Inserting a nasogastric tube for gastric lavage
B. Establishing two large-bore IV access sites C. [CORRECT]
C. Administering oral proton pump inhibitors
D. Preparing the patient for immediate endoscopy
Rationale: Massive GI bleeding requires rapid volume resuscitation through two
large-bore IV lines (14-16 gauge) to administer crystalloids and blood products. While
endoscopy is definitive therapy and PPIs are important, vascular access must precede
these interventions. NG tube insertion may worsen variceal bleeding.
Correct Answer: B
Q6: Which patient statement regarding hepatitis C treatment demonstrates accurate
understanding of current therapeutic options?
A. "I'll need to take interferon injections for 6 months to clear this infection."
B. "My doctor says new oral medications can cure hepatitis C in most people." C.
[CORRECT]
C. "Since I have hepatitis C, I should avoid all alcohol but I don't need treatment unless
my liver fails."
D. "I'll need lifelong medication to keep the virus under control, similar to HIV treatment."
, Rationale: Modern direct-acting antivirals (DAAs) such as sofosbuvir/ledipasvir achieve
sustained virologic response (cure) in over 95% of patients after 8-12 weeks of oral
therapy. Interferon-based regimens are no longer first-line due to poor tolerability and
inferior efficacy. All hepatitis C patients should be evaluated for treatment.
Correct Answer: B
Q7: A patient with ascites secondary to cirrhosis develops fever, abdominal pain, and
altered mental status. Paracentesis reveals cloudy fluid with neutrophil count of 450
cells/mm³. Which intervention is most appropriate?
A. Begin empiric antibiotic therapy immediately C. [CORRECT]
B. Repeat paracentesis in 24 hours to confirm infection
C. Increase diuretic dosage to resolve the cloudy fluid
D. Administer IV albumin only and monitor closely
Rationale: Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic fluid
neutrophil count exceeds 250 cells/mm³. Empiric antibiotic therapy (typically
ceftriaxone or cefotaxime) should begin immediately, as SBP carries high mortality.
Delaying treatment for repeat testing risks clinical deterioration.
Correct Answer: A
Q8: When monitoring a patient with acute upper GI bleed, which finding indicates the
patient is experiencing significant ongoing blood loss?
A. Blood pressure 118/76 mmHg, heart rate 88 bpm
B. Blood pressure 94/62 mmHg, heart rate 112 bpm C. [CORRECT]
C. Blood pressure 132/84 mmHg, heart rate 76 bpm
D. Blood pressure 128/78 mmHg, heart rate 92 bpm
Rationale: Orthostatic hypotension (drop in SBP >20 mmHg or DBP >10 mmHg) and
compensatory tachycardia indicate significant hypovolemia from ongoing bleeding. A
Nursing Exam | Questions & Verified Answers with
Rationales | 100% Correct | Grade A | Galen | Pass
Guaranteed - A+ Graded
Gastrointestinal Disorders: From Bleeding to Inflammation
Q1: A 62-year-old patient is admitted with hematemesis described as "coffee-ground" in
appearance. Which pathophysiological process explains this characteristic finding?
A. Rapid bleeding from an arterial source in the stomach
B. Oxidation of hemoglobin by gastric acid over time C. [CORRECT]
C. Mixing of bile with fresh blood in the duodenum
D. Clotting cascade activation in the esophageal lumen
Rationale: Coffee-ground emesis results from blood remaining in the stomach long
enough for gastric acid to convert hemoglobin to methemoglobin and hematin,
producing the dark, granular appearance. Bright red hematemesis indicates active, rapid
bleeding, while coffee-ground material suggests the bleeding has slowed or stopped
temporarily.
Correct Answer: B
Q2: Your patient with known cirrhosis presents with increasing confusion, asterixis, and
a serum ammonia level of 124 mcg/dL. Which medication should the nurse prepare to
administer first?
A. Rifaximin 550 mg PO twice daily
B. Lactulose 30 mL PO C. [CORRECT]
,C. Neomycin 1 g PO four times daily
D. Metronidazole 250 mg PO three times daily
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy as it acidifies
the colon, trapping ammonia and promoting its excretion. While rifaximin is an effective
adjunct, lactulose remains the initial intervention. Neomycin is rarely used today due to
nephrotoxicity and ototoxicity risks.
Correct Answer: B
Q3: A patient with acute pancreatitis has been NPO for 48 hours. Which laboratory
finding would most concern the nurse regarding the development of systemic
complications?
A. Serum amylase 450 U/L (elevated from baseline)
B. Serum calcium 7.2 mg/dL C. [CORRECT]
C. Serum lipase 380 U/L (trending down from 520)
D. Blood glucose 142 mg/dL
Rationale: Hypocalcemia in acute pancreatitis indicates saponification of calcium by
free fatty acids in necrotic fat tissue, signaling severe necrotizing pancreatitis and
increased risk for complications like ARDS, AKI, and sepsis. While elevated amylase and
lipase confirm diagnosis, trending calcium levels reflect disease severity.
Correct Answer: B
Q4: When teaching a patient newly diagnosed with Crohn's disease about their
condition, which statement by the patient indicates understanding of the disease
pathology?
A. "My entire colon is continuously inflamed, which puts me at higher risk for colon
cancer."
B. "The inflammation goes through all layers of my bowel wall and can skip healthy
sections." C. [CORRECT]
,C. "I should expect bloody diarrhea every day because my mucosa is always ulcerated."
D. "My disease only affects my large intestine, unlike ulcerative colitis."
Rationale: Crohn's disease features transmural (full-thickness) inflammation with skip
lesions—areas of diseased tissue separated by healthy bowel. This differs from
ulcerative colitis, which involves continuous mucosal inflammation limited to the colon.
Crohn's can affect any part of the GI tract from mouth to anus.
Correct Answer: B
Q5: A patient with esophageal varices begins vomiting large amounts of bright red
blood. After ensuring airway patency, what is the nurse's immediate priority?
A. Inserting a nasogastric tube for gastric lavage
B. Establishing two large-bore IV access sites C. [CORRECT]
C. Administering oral proton pump inhibitors
D. Preparing the patient for immediate endoscopy
Rationale: Massive GI bleeding requires rapid volume resuscitation through two
large-bore IV lines (14-16 gauge) to administer crystalloids and blood products. While
endoscopy is definitive therapy and PPIs are important, vascular access must precede
these interventions. NG tube insertion may worsen variceal bleeding.
Correct Answer: B
Q6: Which patient statement regarding hepatitis C treatment demonstrates accurate
understanding of current therapeutic options?
A. "I'll need to take interferon injections for 6 months to clear this infection."
B. "My doctor says new oral medications can cure hepatitis C in most people." C.
[CORRECT]
C. "Since I have hepatitis C, I should avoid all alcohol but I don't need treatment unless
my liver fails."
D. "I'll need lifelong medication to keep the virus under control, similar to HIV treatment."
, Rationale: Modern direct-acting antivirals (DAAs) such as sofosbuvir/ledipasvir achieve
sustained virologic response (cure) in over 95% of patients after 8-12 weeks of oral
therapy. Interferon-based regimens are no longer first-line due to poor tolerability and
inferior efficacy. All hepatitis C patients should be evaluated for treatment.
Correct Answer: B
Q7: A patient with ascites secondary to cirrhosis develops fever, abdominal pain, and
altered mental status. Paracentesis reveals cloudy fluid with neutrophil count of 450
cells/mm³. Which intervention is most appropriate?
A. Begin empiric antibiotic therapy immediately C. [CORRECT]
B. Repeat paracentesis in 24 hours to confirm infection
C. Increase diuretic dosage to resolve the cloudy fluid
D. Administer IV albumin only and monitor closely
Rationale: Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic fluid
neutrophil count exceeds 250 cells/mm³. Empiric antibiotic therapy (typically
ceftriaxone or cefotaxime) should begin immediately, as SBP carries high mortality.
Delaying treatment for repeat testing risks clinical deterioration.
Correct Answer: A
Q8: When monitoring a patient with acute upper GI bleed, which finding indicates the
patient is experiencing significant ongoing blood loss?
A. Blood pressure 118/76 mmHg, heart rate 88 bpm
B. Blood pressure 94/62 mmHg, heart rate 112 bpm C. [CORRECT]
C. Blood pressure 132/84 mmHg, heart rate 76 bpm
D. Blood pressure 128/78 mmHg, heart rate 92 bpm
Rationale: Orthostatic hypotension (drop in SBP >20 mmHg or DBP >10 mmHg) and
compensatory tachycardia indicate significant hypovolemia from ongoing bleeding. A
