NSG 320 Exam 3: (Latest 2026/2027 Update) Gastrointestinal, Renal, Urologic,
Oncology, & Pharmacology | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / GI & Renal Systems
Source: NSG 320 Exam 3 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: What are the causes of GERD?
Correct Answer: Incompetent lower esophageal sphincter (obesity, pregnancy, tobacco use,
medications).
1. Lower esophageal sphincter incompetence allows gastric contents to reflux into esophagus.
2. Risk factors include obesity, pregnancy, smoking, and certain medications.
3. Lifestyle modifications include weight loss and smoking cessation.
2: What pain can GERD mimic?
Correct Answer: Cardiac pain! Rule this out first.
1. GERD symptoms can mimic angina or myocardial infarction.
2. Always rule out cardiac causes first before treating as GERD.
3. Obtain ECG and cardiac biomarkers if cardiac etiology suspected.
3: How should we position a client with GERD?
Correct Answer: Elevate HOB 30+ degrees, use pillows for support, 4-6 inch blocks, do not lay down
for 2-3 hours after ingestion.
1. Elevation uses gravity to prevent reflux.
2. Avoiding recumbent position for 2-3 hours after meals reduces reflux episodes.
3. Wedge pillows are more effective than stacking regular pillows.
4: What is omeprazole and what does it treat?
Correct Answer: Proton pump inhibitor. Treats GERD and PUD.
1. PPIs reduce gastric acid production by inhibiting H+/K+ ATPase in parietal cells.
2. Most effective medication for GERD and healing peptic ulcers.
3. Should be taken 30-60 minutes before breakfast.
5: What is pantoprazole and what does it treat?
Correct Answer: Proton pump inhibitor. Treats GERD and PUD.
1. Similar to omeprazole, available IV and PO.
2. Often used in hospitalized patients.
3. Long-term use associated with osteoporosis and B12 deficiency.
,6: What is ranitidine and what does it treat?
Correct Answer: H2 receptor blocker (decreases acid production). Treats GERD and PUD. Less potent
than PPI. Can cause confusion in older adults.
1. Note: Ranitidine (Zantac) was recalled; famotidine (Pepcid) is now the preferred H2 blocker.
2. H2 blockers are less effective than PPIs but work faster for acute relief.
3. Monitor elderly patients for confusion, dizziness, and falls.
7: When should PPIs be administered?
Correct Answer: Once daily before breakfast.
1. PPIs are most effective when taken 30-60 minutes before the first meal of the day.
2. Food activates the proton pumps that PPIs inhibit.
3. Consistent timing improves efficacy.
8: What nutrition education should be provided for clients with GERD?
Correct Answer: Create a food diary, no eating prior to bedtime, avoid full fat dairy.
1. Food diary helps identify individual trigger foods.
2. Fatty foods delay gastric emptying and relax the LES.
3. Avoid meals 2-3 hours before bedtime.
9: Which symptoms require immediate attention and may indicate complications in clients with
GERD?
Correct Answer: Difficulty swallowing (esophageal injury or strictures), black tarry stools (bleeding or
ulceration), unintentional weight loss (Barrett's esophagus).
1. Dysphagia may indicate stricture or esophageal cancer.
2. Melena indicates upper GI bleeding.
3. Unintentional weight loss is a red flag for malignancy.
10: What are the causes of peptic ulcer disease (PUD)?
Correct Answer: Breakdown of barrier that protects stomach lining. H. pylori, NSAIDs, decreased pH
of GI secretions.
1. H. pylori is the most common cause (60-80% of gastric ulcers).
2. NSAIDs inhibit prostaglandins that protect gastric mucosa.
3. Eradication of H. pylori cures the ulcer.
11: How do gastric PUD and duodenal PUD differ in symptoms?
Correct Answer: Gastric: pain 1-2 hours after eating, burning gaseous, food worsens pain. Duodenal:
pain 2-5 hours after eating, burning/cramp, food helps pain.
1. Duodenal ulcer pain is relieved by food because food buffers acid.
2. Gastric ulcer pain is worsened by food due to increased gastric distention.
3. Duodenal ulcers often cause nighttime pain (2-3 AM).
,12: What labs should we look at when diagnosing PUD?
Correct Answer: Liver and CBC (liver and pancreas have similar signs and symptoms when something
is wrong).
1. CBC may show anemia from chronic GI bleeding.
2. Liver function tests help rule out hepatobiliary causes.
3. H. pylori testing (stool antigen, breath test, or biopsy).
13: How is an H. pylori infection treated in a client with PUD?
Correct Answer: In addition to a PPI, H2 inhibitor, and/or antacids, antibiotics: amoxicillin or
clarithromycin.
1. Triple therapy: PPI + amoxicillin + clarithromycin for 14 days.
2. Quadruple therapy if resistant or penicillin allergy.
3. Confirm eradication with repeat testing 4 weeks after treatment.
14: What is a GI perforation?
Correct Answer: An opening in the GI tract leads to leakage in the peritoneal cavity. Complication of
PUD. S/S: severe abdominal pain, rigid abdomen, signs of shock.
1. Perforation is a surgical emergency requiring immediate intervention.
2. Signs include sudden, severe abdominal pain and board-like rigidity.
3. Free air under the diaphragm on X-ray is diagnostic.
15: What are nursing considerations for acute exacerbations of PUD?
Correct Answer: NPO with NG suction, IV fluids, rest, pain management.
1. NPO and NG suction rest the GI tract.
2. IV fluids correct dehydration and electrolyte imbalances.
3. IV pain medications (avoid oral meds).
16: What RN education should be provided for clients with PUD?
Correct Answer: No NSAIDs or ASA, do not change prescription brands, report excessive pain, fever,
etc.
1. NSAIDs and ASA can cause or exacerbate ulcers.
2. Different brands of PPIs/H2 blockers may have different bioequivalence.
3. Report signs of bleeding (melena, hematemesis) or perforation (sudden severe pain).
17: What symptom is most apparent in an elderly client with PUD?
Correct Answer: First sign is frank blood, then pain. Treatment is same as younger client.
1. Elderly patients may have atypical presentation with bleeding as first sign.
2. May present with confusion, weakness, or syncope from anemia.
3. NSAID use is common risk factor in elderly.
, 18: What is dumping syndrome?
Correct Answer: Complication after gastric surgery (ex: portion of stomach removed). When food
moves too quickly from the stomach into the small intestine, causing symptoms like nausea, cramping,
diarrhea, dizziness, and sweating after eating.
1. Rapid gastric emptying causes fluid shift into bowel lumen.
2. Early dumping: 15-30 minutes after meals (GI and vasomotor symptoms).
3. Late dumping: 1-3 hours after meals (hypoglycemia symptoms).
19: What are RN considerations for a client with dumping syndrome?
Correct Answer: 1. Small frequent meals, 2. avoid fluids with meals (drink between meals), 3. high-
protein, low-simple sugar diet, 4. lie down after eating, 5. monitor for hypoglycemia, 6. reinforce diet
teaching to prevent episodes.
1. Smaller meals reduce gastric volume and rapid emptying.
2. Fluids with meals increase osmolar load and worsen symptoms.
3. Sugars worsen dumping; complex carbs and protein are better.
20: What are nursing considerations for clients post op gastric surgery?
Correct Answer: Assess NG tube, respiratory assessment, IV fluids, assess for anastomosis leaks, I/O,
daily weights.
1. Monitor NG output for bleeding (bright red) or coffee-ground material.
2. Assess for signs of anastomotic leak: fever, tachycardia, abdominal pain.
3. Daily weights monitor fluid status.
21: How often should we check an NG hooked up to suction for patency?
Correct Answer: Every four hours. Flush to ensure patency.
1. NG tubes can become clogged with thick secretions or clots.
2. Flush with prescribed irrigation solution (usually normal saline).
3. Document output color, consistency, and volume.
22: What are nutrition components post gastric surgery?
Correct Answer: Potassium and vitamin supplements, EN or TPN, soft, bland, high fiber diet (high
CHO and protein), cobalamin replacement for pernicious anemia.
1. Gastric surgery can cause malabsorption of iron, B12, calcium, and fat-soluble vitamins.
2. B12 injections may be needed monthly.
3. Small, frequent meals (>6 per day).
23: What vitamin should we monitor for a client who just had gastric surgery?
Correct Answer: B12. Surgery can cause pernicious anemia, requiring cobalamin replacement.
1. Gastric resection removes cells that produce intrinsic factor.
2. Without intrinsic factor, B12 cannot be absorbed.
3. Monitor for signs of B12 deficiency: fatigue, paresthesias, neurological changes.
Oncology, & Pharmacology | Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Medical-Surgical Nursing / GI & Renal Systems
Source: NSG 320 Exam 3 – Comprehensive Review
Format: Q&A Guide with Clinical Rationale
1: What are the causes of GERD?
Correct Answer: Incompetent lower esophageal sphincter (obesity, pregnancy, tobacco use,
medications).
1. Lower esophageal sphincter incompetence allows gastric contents to reflux into esophagus.
2. Risk factors include obesity, pregnancy, smoking, and certain medications.
3. Lifestyle modifications include weight loss and smoking cessation.
2: What pain can GERD mimic?
Correct Answer: Cardiac pain! Rule this out first.
1. GERD symptoms can mimic angina or myocardial infarction.
2. Always rule out cardiac causes first before treating as GERD.
3. Obtain ECG and cardiac biomarkers if cardiac etiology suspected.
3: How should we position a client with GERD?
Correct Answer: Elevate HOB 30+ degrees, use pillows for support, 4-6 inch blocks, do not lay down
for 2-3 hours after ingestion.
1. Elevation uses gravity to prevent reflux.
2. Avoiding recumbent position for 2-3 hours after meals reduces reflux episodes.
3. Wedge pillows are more effective than stacking regular pillows.
4: What is omeprazole and what does it treat?
Correct Answer: Proton pump inhibitor. Treats GERD and PUD.
1. PPIs reduce gastric acid production by inhibiting H+/K+ ATPase in parietal cells.
2. Most effective medication for GERD and healing peptic ulcers.
3. Should be taken 30-60 minutes before breakfast.
5: What is pantoprazole and what does it treat?
Correct Answer: Proton pump inhibitor. Treats GERD and PUD.
1. Similar to omeprazole, available IV and PO.
2. Often used in hospitalized patients.
3. Long-term use associated with osteoporosis and B12 deficiency.
,6: What is ranitidine and what does it treat?
Correct Answer: H2 receptor blocker (decreases acid production). Treats GERD and PUD. Less potent
than PPI. Can cause confusion in older adults.
1. Note: Ranitidine (Zantac) was recalled; famotidine (Pepcid) is now the preferred H2 blocker.
2. H2 blockers are less effective than PPIs but work faster for acute relief.
3. Monitor elderly patients for confusion, dizziness, and falls.
7: When should PPIs be administered?
Correct Answer: Once daily before breakfast.
1. PPIs are most effective when taken 30-60 minutes before the first meal of the day.
2. Food activates the proton pumps that PPIs inhibit.
3. Consistent timing improves efficacy.
8: What nutrition education should be provided for clients with GERD?
Correct Answer: Create a food diary, no eating prior to bedtime, avoid full fat dairy.
1. Food diary helps identify individual trigger foods.
2. Fatty foods delay gastric emptying and relax the LES.
3. Avoid meals 2-3 hours before bedtime.
9: Which symptoms require immediate attention and may indicate complications in clients with
GERD?
Correct Answer: Difficulty swallowing (esophageal injury or strictures), black tarry stools (bleeding or
ulceration), unintentional weight loss (Barrett's esophagus).
1. Dysphagia may indicate stricture or esophageal cancer.
2. Melena indicates upper GI bleeding.
3. Unintentional weight loss is a red flag for malignancy.
10: What are the causes of peptic ulcer disease (PUD)?
Correct Answer: Breakdown of barrier that protects stomach lining. H. pylori, NSAIDs, decreased pH
of GI secretions.
1. H. pylori is the most common cause (60-80% of gastric ulcers).
2. NSAIDs inhibit prostaglandins that protect gastric mucosa.
3. Eradication of H. pylori cures the ulcer.
11: How do gastric PUD and duodenal PUD differ in symptoms?
Correct Answer: Gastric: pain 1-2 hours after eating, burning gaseous, food worsens pain. Duodenal:
pain 2-5 hours after eating, burning/cramp, food helps pain.
1. Duodenal ulcer pain is relieved by food because food buffers acid.
2. Gastric ulcer pain is worsened by food due to increased gastric distention.
3. Duodenal ulcers often cause nighttime pain (2-3 AM).
,12: What labs should we look at when diagnosing PUD?
Correct Answer: Liver and CBC (liver and pancreas have similar signs and symptoms when something
is wrong).
1. CBC may show anemia from chronic GI bleeding.
2. Liver function tests help rule out hepatobiliary causes.
3. H. pylori testing (stool antigen, breath test, or biopsy).
13: How is an H. pylori infection treated in a client with PUD?
Correct Answer: In addition to a PPI, H2 inhibitor, and/or antacids, antibiotics: amoxicillin or
clarithromycin.
1. Triple therapy: PPI + amoxicillin + clarithromycin for 14 days.
2. Quadruple therapy if resistant or penicillin allergy.
3. Confirm eradication with repeat testing 4 weeks after treatment.
14: What is a GI perforation?
Correct Answer: An opening in the GI tract leads to leakage in the peritoneal cavity. Complication of
PUD. S/S: severe abdominal pain, rigid abdomen, signs of shock.
1. Perforation is a surgical emergency requiring immediate intervention.
2. Signs include sudden, severe abdominal pain and board-like rigidity.
3. Free air under the diaphragm on X-ray is diagnostic.
15: What are nursing considerations for acute exacerbations of PUD?
Correct Answer: NPO with NG suction, IV fluids, rest, pain management.
1. NPO and NG suction rest the GI tract.
2. IV fluids correct dehydration and electrolyte imbalances.
3. IV pain medications (avoid oral meds).
16: What RN education should be provided for clients with PUD?
Correct Answer: No NSAIDs or ASA, do not change prescription brands, report excessive pain, fever,
etc.
1. NSAIDs and ASA can cause or exacerbate ulcers.
2. Different brands of PPIs/H2 blockers may have different bioequivalence.
3. Report signs of bleeding (melena, hematemesis) or perforation (sudden severe pain).
17: What symptom is most apparent in an elderly client with PUD?
Correct Answer: First sign is frank blood, then pain. Treatment is same as younger client.
1. Elderly patients may have atypical presentation with bleeding as first sign.
2. May present with confusion, weakness, or syncope from anemia.
3. NSAID use is common risk factor in elderly.
, 18: What is dumping syndrome?
Correct Answer: Complication after gastric surgery (ex: portion of stomach removed). When food
moves too quickly from the stomach into the small intestine, causing symptoms like nausea, cramping,
diarrhea, dizziness, and sweating after eating.
1. Rapid gastric emptying causes fluid shift into bowel lumen.
2. Early dumping: 15-30 minutes after meals (GI and vasomotor symptoms).
3. Late dumping: 1-3 hours after meals (hypoglycemia symptoms).
19: What are RN considerations for a client with dumping syndrome?
Correct Answer: 1. Small frequent meals, 2. avoid fluids with meals (drink between meals), 3. high-
protein, low-simple sugar diet, 4. lie down after eating, 5. monitor for hypoglycemia, 6. reinforce diet
teaching to prevent episodes.
1. Smaller meals reduce gastric volume and rapid emptying.
2. Fluids with meals increase osmolar load and worsen symptoms.
3. Sugars worsen dumping; complex carbs and protein are better.
20: What are nursing considerations for clients post op gastric surgery?
Correct Answer: Assess NG tube, respiratory assessment, IV fluids, assess for anastomosis leaks, I/O,
daily weights.
1. Monitor NG output for bleeding (bright red) or coffee-ground material.
2. Assess for signs of anastomotic leak: fever, tachycardia, abdominal pain.
3. Daily weights monitor fluid status.
21: How often should we check an NG hooked up to suction for patency?
Correct Answer: Every four hours. Flush to ensure patency.
1. NG tubes can become clogged with thick secretions or clots.
2. Flush with prescribed irrigation solution (usually normal saline).
3. Document output color, consistency, and volume.
22: What are nutrition components post gastric surgery?
Correct Answer: Potassium and vitamin supplements, EN or TPN, soft, bland, high fiber diet (high
CHO and protein), cobalamin replacement for pernicious anemia.
1. Gastric surgery can cause malabsorption of iron, B12, calcium, and fat-soluble vitamins.
2. B12 injections may be needed monthly.
3. Small, frequent meals (>6 per day).
23: What vitamin should we monitor for a client who just had gastric surgery?
Correct Answer: B12. Surgery can cause pernicious anemia, requiring cobalamin replacement.
1. Gastric resection removes cells that produce intrinsic factor.
2. Without intrinsic factor, B12 cannot be absorbed.
3. Monitor for signs of B12 deficiency: fatigue, paresthesias, neurological changes.
