NSG-320 Exam 3: (Latest 2026/2027 Update) GI, Hepatic, Renal, &
Reproductive Disorders | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: NSG-320 – Medical-Surgical Nursing / GI, Hepatic, Renal & Reproductive
Source: NSG-320 Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is enteral nutrition and what are its indications?
Correct Answer: Administration of nutritionally balanced liquefied food through a tube inserted into
the stomach, duodenum, or jejunum for patients with a functioning GI tract who cannot take oral
nourishment. Indications include conditions affecting safe swallowing, anorexia, facial fractures,
head/neck cancer, neurologic/psychiatric conditions, burns, critical illness, chemotherapy, radiation
therapy, and stroke.
1. Feedings can start when bowel sounds are present, typically 24 hours after placement.
2. Delivery options: continuous infusion by pump, cyclic feedings, intermittent by gravity or
bolus.
3. Aspiration risk requires proper tube position, HOB elevation 30-45°, and checking gastric
residual volume.
2. What are the key considerations for enteral tube position and patient positioning?
Correct Answer: Patient should be sitting or lying with HOB at 30-45°, remains elevated for 30-60
minutes after intermittent feeding. X-ray confirmation for new nasal/orogastric tubes. Mark exit site at
initial X-ray and monitor for changes in external tube length. Check placement before each
feeding/drug administration or every 8 hours for continuous feeds.
1. Proper positioning decreases aspiration risk.
2. Polyurethane or silicone tubes are soft, flexible, radiopaque, and decrease mucosal damage
risk.
3. Nasogastric/nasointestinal tubes can clog easily; flush after drug administration and residual
checks.
3. What is parenteral nutrition and when is it indicated?
Correct Answer: Administration of nutrients directly into bloodstream when GI tract cannot be used
for ingestion, digestion, and absorption. Indications: chronic severe diarrhea/vomiting, complicated
surgery/trauma, GI obstruction, intractable diarrhea, severe anorexia nervosa, severe malabsorption,
short bowel syndrome, GI anomalies/fistulae.
1. Normal adult requires minimum 1200-1500 calories/day; severely injured or malnourished
patients have increased needs.
2. Central PN uses catheter tip in superior vena cava for long-term support; peripheral PN for
short-term.
3. Solutions are hypertonic (central PN ≥1600 mOsm/L) and must be infused with pump to
control rate.
,4. What are the common side effects and precautions for IV fat emulsion (Intralipids)?
Correct Answer: Side effects: vomiting, shivering, fever, chills. Use with caution in patients with
disturbance in fat metabolism, danger of fat embolism, or allergies to eggs. Do not infuse lipids too
quickly.
1. Fat emulsion provides essential fatty acids and calories (9 kcal/g).
2. Rapid infusion may cause fat overload syndrome (hyperlipidemia, hepatomegaly,
coagulopathy).
3. Monitor triglyceride levels during TPN therapy.
5. What is GERD and what are its predisposing factors and symptoms?
Correct Answer: GERD occurs when HCl acid and pepsin in refluxate cause esophageal irritation.
Predisposing factors: incompetent lower esophageal sphincter (LES), decreased LES pressure, increased
intraabdominal pressure, hiatal hernia. Symptoms: heartburn (pyrosis), chest pain (burning/squeezing,
radiating to back/neck/jaw/arms, can mimic angina), respiratory symptoms (wheezing, cough, dyspnea,
nocturnal discomfort).
1. Heartburn is most common: burning sensation beneath sternum spreading upward to throat/jaw,
felt intermittently.
2. GERD-related chest pain more common in older adults; relieved with antacids.
3. Complications: Barrett's esophagus (precancerous), esophageal varices, ulcers, respiratory
issues.
6. What medications are used for GERD and what are their mechanisms?
Correct Answer: Proton pump inhibitors (PPIs): omeprazole (Prilosec) – promote esophageal healing
in 80-90%; side effect headache. Histamine-2 receptor blockers (H2R): cimetidine, ranitidine (Zantac),
famotidine (Pepcid) – decrease HCl secretion. Acid protective agents for cytoprotection.
1. PPIs reduce gastric acid by irreversibly blocking gastric H+/K+ ATPase; most potent acid
suppression.
2. H2 blockers block histamine at parietal cells; less potent but effective for mild-moderate
GERD.
3. Acid protectives (sucralfate, misoprostol) coat mucosa and enhance defense mechanisms.
7. What is a hiatal hernia and what are its types?
Correct Answer: Herniation of portion of stomach into esophagus through an opening (hiatus) in
diaphragm. Two types: Sliding (most common) – stomach slides through hiatal opening when supine,
returns when upright. Paraesophageal/rolling – fundus and greater curvature roll up through diaphragm
forming pocket alongside esophagus; junction remains normal position; acute paraesophageal hernia is
medical emergency.
1. More common in older adults and women.
2. Factors: structural changes with aging (weakened diaphragm muscles); increased
intraabdominal pressure (obesity, pregnancy, heavy lifting).
3. Complications: GERD, esophagitis, hemorrhage, stenosis, ulcerations.
, 8. What are the medical and surgical interventions for hiatal hernia?
Correct Answer: Conservative: medication, lifestyle modifications (eliminate alcohol, elevate HOB 3-
4'' blocks, stop smoking, avoid lifting/straining, weight reduction, antisecretory agents, antacids).
Surgical: gastropexy (attachment of stomach sub-diaphragmatically), herniotomy (reduction of
herniated stomach, excision of hernia sac), anti-reflux procedures.
1. Lifestyle changes are first-line therapy for symptomatic hiatal hernia.
2. Surgery indicated for complications: strangulation, bleeding, obstruction, or refractory
symptoms.
3. Fundoplication (wrapping gastric fundus around esophagus) is common anti-reflux procedure.
9. What are invasive imaging procedures of the GI system and what are their complications?
Correct Answer: Procedures: sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy (EGD).
Allow direct visualization of GI mucosa; can take biopsies, irrigate, and move/angle the scope. Potential
complications: bleeding, perforation. Recovery focuses on LOC, swallowing/gag reflex, stable vitals.
1. Pre-procedural: NPO status, bowel prep 1-2 days, IV access for sedation, cardiac monitor.
2. Clients receive moderate sedation (medication to forget the procedure).
3. Discharge teaching: call MD for bleeding in vomit/stool, inability to have BM,
nausea/vomiting; do not make major decisions or sign legal paperwork.
10. What is peptic ulcer disease (PUD) and what are its causes?
Correct Answer: Erosion of GI mucosa from hydrochloric acid (HCl) and pepsin, affecting lower
esophagus, stomach, and duodenum. Ulcers can be acute (superficial erosion, resolves when cause
treated) or chronic (erodes through muscular wall, most common). Causes: Helicobacter pylori,
medications (aspirin, NSAIDs, corticosteroids, anticoagulants, SSRIs), lifestyle (excessive ETOH,
coffee, smoking, stress).
1. H. pylori causes 60-90% of duodenal ulcers and 40-70% of gastric ulcers.
2. NSAIDs inhibit prostaglandin synthesis, reducing mucosal protection and blood flow.
3. Endoscopy with biopsy most common diagnostic test; allows direct viewing and H. pylori
testing.
11. What are the drug therapies for peptic ulcer disease (PUD)?
Correct Answer: PPIs, H2R blockers, antibiotics (for H. pylori – triple therapy: PPI + amoxicillin +
clarithromycin), antacids, anticholinergics, cytoprotective therapy (sucralfate, misoprostol).
1. Eradication of H. pylori requires combination antibiotic therapy (no single agent effective).
2. Triple therapy duration 10-14 days; quadruple therapy if macrolide resistance.
3. Test-of-cure is recommended (urea breath test 4-6 weeks after treatment).
12. What is gastritis and what are its causes?
Correct Answer: Inflammation of the stomach lining due to breakdown of normal mucosal barrier.
Causes: drugs, diet, microorganisms, environment, diseases. Symptoms: nausea, vomiting, anorexia,
epigastric tenderness, feeling of fullness, GI bleed. Chronic management: remove causes, manage
symptoms, treat pernicious anemia if stomach tissue atrophies.
1. Acute gastritis: short-term inflammation, often due to NSAIDs, alcohol, or stress.
2. Chronic gastritis: may lead to atrophic gastritis and pernicious anemia (B12 deficiency).
3. H. pylori is common infectious cause of chronic gastritis.
Reproductive Disorders | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: NSG-320 – Medical-Surgical Nursing / GI, Hepatic, Renal & Reproductive
Source: NSG-320 Exam 3 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is enteral nutrition and what are its indications?
Correct Answer: Administration of nutritionally balanced liquefied food through a tube inserted into
the stomach, duodenum, or jejunum for patients with a functioning GI tract who cannot take oral
nourishment. Indications include conditions affecting safe swallowing, anorexia, facial fractures,
head/neck cancer, neurologic/psychiatric conditions, burns, critical illness, chemotherapy, radiation
therapy, and stroke.
1. Feedings can start when bowel sounds are present, typically 24 hours after placement.
2. Delivery options: continuous infusion by pump, cyclic feedings, intermittent by gravity or
bolus.
3. Aspiration risk requires proper tube position, HOB elevation 30-45°, and checking gastric
residual volume.
2. What are the key considerations for enteral tube position and patient positioning?
Correct Answer: Patient should be sitting or lying with HOB at 30-45°, remains elevated for 30-60
minutes after intermittent feeding. X-ray confirmation for new nasal/orogastric tubes. Mark exit site at
initial X-ray and monitor for changes in external tube length. Check placement before each
feeding/drug administration or every 8 hours for continuous feeds.
1. Proper positioning decreases aspiration risk.
2. Polyurethane or silicone tubes are soft, flexible, radiopaque, and decrease mucosal damage
risk.
3. Nasogastric/nasointestinal tubes can clog easily; flush after drug administration and residual
checks.
3. What is parenteral nutrition and when is it indicated?
Correct Answer: Administration of nutrients directly into bloodstream when GI tract cannot be used
for ingestion, digestion, and absorption. Indications: chronic severe diarrhea/vomiting, complicated
surgery/trauma, GI obstruction, intractable diarrhea, severe anorexia nervosa, severe malabsorption,
short bowel syndrome, GI anomalies/fistulae.
1. Normal adult requires minimum 1200-1500 calories/day; severely injured or malnourished
patients have increased needs.
2. Central PN uses catheter tip in superior vena cava for long-term support; peripheral PN for
short-term.
3. Solutions are hypertonic (central PN ≥1600 mOsm/L) and must be infused with pump to
control rate.
,4. What are the common side effects and precautions for IV fat emulsion (Intralipids)?
Correct Answer: Side effects: vomiting, shivering, fever, chills. Use with caution in patients with
disturbance in fat metabolism, danger of fat embolism, or allergies to eggs. Do not infuse lipids too
quickly.
1. Fat emulsion provides essential fatty acids and calories (9 kcal/g).
2. Rapid infusion may cause fat overload syndrome (hyperlipidemia, hepatomegaly,
coagulopathy).
3. Monitor triglyceride levels during TPN therapy.
5. What is GERD and what are its predisposing factors and symptoms?
Correct Answer: GERD occurs when HCl acid and pepsin in refluxate cause esophageal irritation.
Predisposing factors: incompetent lower esophageal sphincter (LES), decreased LES pressure, increased
intraabdominal pressure, hiatal hernia. Symptoms: heartburn (pyrosis), chest pain (burning/squeezing,
radiating to back/neck/jaw/arms, can mimic angina), respiratory symptoms (wheezing, cough, dyspnea,
nocturnal discomfort).
1. Heartburn is most common: burning sensation beneath sternum spreading upward to throat/jaw,
felt intermittently.
2. GERD-related chest pain more common in older adults; relieved with antacids.
3. Complications: Barrett's esophagus (precancerous), esophageal varices, ulcers, respiratory
issues.
6. What medications are used for GERD and what are their mechanisms?
Correct Answer: Proton pump inhibitors (PPIs): omeprazole (Prilosec) – promote esophageal healing
in 80-90%; side effect headache. Histamine-2 receptor blockers (H2R): cimetidine, ranitidine (Zantac),
famotidine (Pepcid) – decrease HCl secretion. Acid protective agents for cytoprotection.
1. PPIs reduce gastric acid by irreversibly blocking gastric H+/K+ ATPase; most potent acid
suppression.
2. H2 blockers block histamine at parietal cells; less potent but effective for mild-moderate
GERD.
3. Acid protectives (sucralfate, misoprostol) coat mucosa and enhance defense mechanisms.
7. What is a hiatal hernia and what are its types?
Correct Answer: Herniation of portion of stomach into esophagus through an opening (hiatus) in
diaphragm. Two types: Sliding (most common) – stomach slides through hiatal opening when supine,
returns when upright. Paraesophageal/rolling – fundus and greater curvature roll up through diaphragm
forming pocket alongside esophagus; junction remains normal position; acute paraesophageal hernia is
medical emergency.
1. More common in older adults and women.
2. Factors: structural changes with aging (weakened diaphragm muscles); increased
intraabdominal pressure (obesity, pregnancy, heavy lifting).
3. Complications: GERD, esophagitis, hemorrhage, stenosis, ulcerations.
, 8. What are the medical and surgical interventions for hiatal hernia?
Correct Answer: Conservative: medication, lifestyle modifications (eliminate alcohol, elevate HOB 3-
4'' blocks, stop smoking, avoid lifting/straining, weight reduction, antisecretory agents, antacids).
Surgical: gastropexy (attachment of stomach sub-diaphragmatically), herniotomy (reduction of
herniated stomach, excision of hernia sac), anti-reflux procedures.
1. Lifestyle changes are first-line therapy for symptomatic hiatal hernia.
2. Surgery indicated for complications: strangulation, bleeding, obstruction, or refractory
symptoms.
3. Fundoplication (wrapping gastric fundus around esophagus) is common anti-reflux procedure.
9. What are invasive imaging procedures of the GI system and what are their complications?
Correct Answer: Procedures: sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy (EGD).
Allow direct visualization of GI mucosa; can take biopsies, irrigate, and move/angle the scope. Potential
complications: bleeding, perforation. Recovery focuses on LOC, swallowing/gag reflex, stable vitals.
1. Pre-procedural: NPO status, bowel prep 1-2 days, IV access for sedation, cardiac monitor.
2. Clients receive moderate sedation (medication to forget the procedure).
3. Discharge teaching: call MD for bleeding in vomit/stool, inability to have BM,
nausea/vomiting; do not make major decisions or sign legal paperwork.
10. What is peptic ulcer disease (PUD) and what are its causes?
Correct Answer: Erosion of GI mucosa from hydrochloric acid (HCl) and pepsin, affecting lower
esophagus, stomach, and duodenum. Ulcers can be acute (superficial erosion, resolves when cause
treated) or chronic (erodes through muscular wall, most common). Causes: Helicobacter pylori,
medications (aspirin, NSAIDs, corticosteroids, anticoagulants, SSRIs), lifestyle (excessive ETOH,
coffee, smoking, stress).
1. H. pylori causes 60-90% of duodenal ulcers and 40-70% of gastric ulcers.
2. NSAIDs inhibit prostaglandin synthesis, reducing mucosal protection and blood flow.
3. Endoscopy with biopsy most common diagnostic test; allows direct viewing and H. pylori
testing.
11. What are the drug therapies for peptic ulcer disease (PUD)?
Correct Answer: PPIs, H2R blockers, antibiotics (for H. pylori – triple therapy: PPI + amoxicillin +
clarithromycin), antacids, anticholinergics, cytoprotective therapy (sucralfate, misoprostol).
1. Eradication of H. pylori requires combination antibiotic therapy (no single agent effective).
2. Triple therapy duration 10-14 days; quadruple therapy if macrolide resistance.
3. Test-of-cure is recommended (urea breath test 4-6 weeks after treatment).
12. What is gastritis and what are its causes?
Correct Answer: Inflammation of the stomach lining due to breakdown of normal mucosal barrier.
Causes: drugs, diet, microorganisms, environment, diseases. Symptoms: nausea, vomiting, anorexia,
epigastric tenderness, feeling of fullness, GI bleed. Chronic management: remove causes, manage
symptoms, treat pernicious anemia if stomach tissue atrophies.
1. Acute gastritis: short-term inflammation, often due to NSAIDs, alcohol, or stress.
2. Chronic gastritis: may lead to atrophic gastritis and pernicious anemia (B12 deficiency).
3. H. pylori is common infectious cause of chronic gastritis.
