Exam 3: NUR 209/ NUR 209 (Latest 2026/ 2027 Update) Medical Surgical Nursing II: Med-Surg Review| Comprehensive Questions| Grade A| 100% Correct (Verified Solutions) – Fortis

INSTANT PDF DOWNLOAD — This comprehensive exam preparation resource for NUR 209 Exam 3 Medical Surgical Nursing II at Fortis College covers all content for the 2026/2027 academic year third examination. It features verified questions and answers with detailed rationales in multiple-choice, select-all-that-apply (SATA), ordered response, and clinical scenario formats aligned with nursing program standards. GASTROINTESTINAL DISORDERS (EXAM 3 FOCUS) PEPTIC ULCER DISEASE (PUD) Definition – Erosions of the mucosal layer of the stomach (gastric ulcer) or duodenum (duodenal ulcer). Duodenal ulcers are more common (4x more than gastric ulcers). Causes and Risk Factors – H. pylori infection (most common cause – gram-negative bacterium, 80-90% of duodenal ulcers, 60-80% of gastric ulcers, treat with antibiotics), NSAIDs (aspirin, ibuprofen, naproxen, ketorolac – second most common cause, inhibit prostaglandin synthesis which normally protects gastric mucosa, risk increases with higher doses and longer duration), excessive alcohol, smoking, stress (physiological: burns – Curling's ulcer; increased ICP – Cushing's ulcer), Zollinger-Ellison syndrome (gastrin-secreting tumor causing multiple ulcers, high acid production, often in jejunum). Comparison of Duodenal vs. Gastric Ulcers Feature Duodenal Ulcer Gastric Ulcer Incidence More common (80%) Less common (20%) Age 30-50 years 50-60 years Pain timing 2-3 hours after meals (hunger pain), often at night (12-3 AM) 30-60 minutes after meals Pain relief Food or antacids (neutralizes acid) Food may exacerbate pain (or no change), vomiting may relieve Weight Weight gain (eat to relieve pain) Weight loss (fear of eating due to pain) Hematemesis Less common More common (bleeding) Malignancy risk Rare (not associated with cancer) Higher risk (gastric cancer) Assessment Findings – Burning or gnawing epigastric pain, bloating, belching, nausea, vomiting, gastrointestinal bleeding (hematemesis: coffee-ground emesis indicates slow bleeding; bright red blood indicates active bleeding; melena: black tarry stools from digested blood in upper GI bleed). Perforation: sudden severe abdominal pain, rigid board-like abdomen, referred shoulder pain (hemidiaphragm irritation), signs of shock (tachycardia, hypotension). Obstruction: persistent vomiting (feces-like with obstruction), abdominal distention, succussion splash (sloshing sound with abdominal shaking), early satiety. Diagnosis – Upper endoscopy (EGD) with biopsy for H. pylori (gold standard – can visualize ulcer and obtain tissue), stool antigen test for H. pylori, urea breath test (H. pylori metabolizes urea to CO2), barium swallow (upper GI series – less common now, may miss small ulcers or superficial lesions). Treatment – H. pylori eradication (triple therapy: PPI + clarithromycin + amoxicillin or metronidazole for 14 days; quadruple therapy: PPI + bismuth subsalicylate + tetracycline + metronidazole for 14 days for resistant cases or penicillin allergy). Acid suppression: PPIs (omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole – most effective, promote healing, taken 30-60 minutes before meals) or H2RAs (famotidine, ranitidine – less potent). Mucosal protectants: sucralfate (coats ulcer, requires acidic pH to activate – give 1 hour before meals and at bedtime, separate from other medications by 30-60 minutes). Antacids: symptom relief (aluminum hydroxide, magnesium hydroxide, calcium carbonate – can interfere with absorption of other medications, separate by 1-2 hours). Complications management: endoscopic therapy (injection of epinephrine, cautery, clipping) for bleeding; emergency surgery (vagotomy, antrectomy, Billroth I or II) for perforation, obstruction, uncontrolled bleeding, or failed medical therapy. Nursing Interventions – Administer medications correctly (timing matters: PPIs before meals, sucralfate 1 hour before meals and at bedtime). Monitor for GI bleeding (vital signs, H&H, stool guaiac, emesis, stool color). Monitor for perforation (sudden severe pain, rigid abdomen, increased temp, increased HR, hypotension – call provider immediately, prepare for surgery). Patient education: avoid NSAIDs (use acetaminophen acetaminophen for pain if needed), avoid alcohol, smoking cessation, stress reduction, avoid foods that trigger symptoms (spicy, acidic, caffeine, chocolate, fatty foods), take full course of antibiotics for H. pylori, return to provider if symptoms persist or worsen, follow up for repeat endoscopy to document healing (especially for gastric ulcer to rule out malignancy). GASTROESOPHAGEAL REFLUX DISEASE (GERD) Definition – Backward flow of stomach contents (acid, pepsin, bile) into esophagus due to lower esophageal sphincter (LES) dysfunction (incompetence or transient relaxation). Pathophysiology – LES normally remains contracted except during swallowing. In GERD, LES pressure decreases or relaxes inappropriately. Prolonged acid exposure leads to esophagitis, stricture, Barrett's esophagus, esophageal adenocarcinoma. Risk Factors – Hiatal hernia (most common – portion of stomach protrudes through diaphragm into chest, reduces LES pressure), obesity (increased intra-abdominal pressure), pregnancy, smoking, alcohol, certain foods (chocolate, caffeine, peppermint, spicy, fatty, fried, citrus, tomatoes, onion, garlic), medications (anticholinergics, calcium channel blockers, nitrates, beta-agonists, sedatives, theophylline).