NUR2502: Multidimensional Care III (MDC 3) - Exam 2
(2026/2027) – Rasmussen University
SECTION 1: Gastrointestinal Disorders (Q1-Q20)
Q1: A 58-year-old male with a history of GERD reports heartburn that occurs after eating
spicy foods and when lying down at night. Which lifestyle modification should the nurse
prioritize in patient education?
A. Eat large meals three times daily to reduce stomach acid production
B. Elevate the head of the bed 30 degrees and avoid eating 3 hours before lying down
[CORRECT]
C. Drink a glass of milk before bedtime to neutralize stomach acid
D. Take antacids immediately before each meal as a preventive measure
Correct Answer: B
Rationale: Elevating the head of the bed and avoiding meals within 3 hours of lying
down reduces nocturnal gastric reflux by using gravity to keep stomach contents in
place; large meals increase gastric pressure and reflux, milk may worsen symptoms,
and antacids should be taken after meals or when symptoms occur, not before. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q2: A patient with GERD is prescribed omeprazole 20 mg daily. The nurse instructs the
patient to take the medication:
A. With breakfast to improve absorption
B. 30-60 minutes before meals on an empty stomach [CORRECT]
C. At bedtime with a snack for sustained effect
D. As needed when heartburn occurs
Correct Answer: B
Rationale: PPIs such as omeprazole must be taken 30-60 minutes before meals on an
empty stomach to allow time for proton pump inhibition before food stimulates acid
secretion; taking with food or as needed significantly reduces efficacy. [100% VERIFIED
– Rasmussen NUR2502 MDC3]
,Q3: A patient with long-standing GERD undergoes endoscopy, which reveals
salmon-colored mucosa in the distal esophagus. Biopsy confirms intestinal metaplasia.
The nurse understands this finding represents:
A. Normal esophageal anatomy
B. Barrett's esophagus with increased risk of esophageal adenocarcinoma [CORRECT]
C. Esophageal candidiasis
D. Mallory-Weiss tear
Correct Answer: B
Rationale: Barrett's esophagus is characterized by intestinal metaplasia of the distal
esophageal mucosa due to chronic acid exposure, appearing as salmon-colored
patches; it is a premalignant condition that increases the risk of esophageal
adenocarcinoma and requires surveillance endoscopy every 1-3 years. [100% VERIFIED
– Rasmussen NUR2502 MDC3]
Q4: A patient with peptic ulcer disease reports epigastric pain that occurs 2-3 hours
after eating and is relieved by food or antacids. The nurse recognizes this pattern as
most consistent with:
A. Gastric ulcer
B. Duodenal ulcer [CORRECT]
C. GERD
D. Gastritis
Correct Answer: B
Rationale: Duodenal ulcers classically present with pain 2-3 hours after eating (when
acid enters the duodenum), nocturnal pain, and relief with food or antacids; gastric
ulcers typically cause pain soon after eating that worsens with food, distinguishing the
two types of PUD. [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q5: A patient with peptic ulcer disease tests positive for H. pylori. The nurse anticipates
which treatment regimen?
A. PPI monotherapy for 4 weeks
B. Triple therapy with PPI + clarithromycin + amoxicillin for 10-14 days [CORRECT]
C. Antacid therapy only
D. Surgical vagotomy and antrectomy
Correct Answer: B
,Rationale: H. pylori eradication requires combination therapy; standard first-line
treatment is triple therapy (PPI + clarithromycin + amoxicillin or metronidazole) for
10-14 days, with quadruple therapy (bismuth-based) for resistant infections or penicillin
allergy; monotherapy or antacids alone will not eradicate the bacteria. [100% VERIFIED –
Rasmussen NUR2502 MDC3]
Q6: A patient with PUD suddenly develops severe, sharp abdominal pain, a rigid
board-like abdomen, rebound tenderness, and hypotension. The nurse recognizes these
findings as indicative of:
A. Gastric outlet obstruction
B. Perforation with peritonitis [CORRECT]
C. Hemorrhage from the ulcer
D. Pancreatitis
Correct Answer: B
Rationale: Sudden severe abdominal pain with a rigid abdomen, rebound tenderness,
guarding, and hypotension is classic for ulcer perforation with chemical peritonitis and
subsequent bacterial peritonitis; this is a surgical emergency requiring immediate
intervention, distinguishing it from obstruction (vomiting, distention) or hemorrhage
(hematemesis, melena). [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q7: A patient with a bleeding peptic ulcer presents with coffee-ground emesis and black
tarry stools. The nurse understands these findings represent:
A. Upper GI bleeding with hematemesis and melena [CORRECT]
B. Lower GI bleeding with hematochezia
C. Biliary obstruction with clay-colored stools
D. Pancreatic insufficiency with steatorrhea
Correct Answer: A
Rationale: Coffee-ground emesis results from partial digestion of blood by gastric acid,
and melena (black, tarry, foul-smelling stools) results from digestion of blood in the
upper GI tract; these findings indicate upper GI bleeding, in contrast to bright red
hematochezia from lower GI sources. [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q8: A patient with PUD is prescribed sucralfate. The nurse instructs the patient to take
this medication:
, A. With meals to improve absorption
B. On an empty stomach 1 hour before meals and at bedtime [CORRECT]
C. With antacids for enhanced effect
D. Only when pain is severe
Correct Answer: B
Rationale: Sucralfate forms a protective barrier over ulcers by adhering to damaged
mucosa in an acidic environment; it must be taken on an empty stomach (1 hour before
meals and at bedtime) to allow proper adherence, and antacids should be taken
separately (2 hours apart) as they raise gastric pH and reduce sucralfate efficacy. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q9: A patient with chronic NSAID use develops gastric ulcer symptoms. The nurse
practitioner considers prescribing misoprostol. Which patient education is most
important?
A. Misoprostol can cause diarrhea and is contraindicated in pregnancy [CORRECT]
B. Misoprostol should be taken with high-fat meals
C. Misoprostol is safe for use during pregnancy
D. Misoprostol has no significant adverse effects
Correct Answer: A
Rationale: Misoprostol is a prostaglandin E1 analog that protects against
NSAID-induced ulcers but causes diarrhea (common adverse effect) and is absolutely
contraindicated in pregnancy due to its abortifacient properties (uterine contractions,
cervical ripening); women of childbearing age must use effective contraception. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q10: A patient with GERD is considering Nissen fundoplication. The nurse explains that
this surgical procedure:
A. Removes the lower esophageal sphincter
B. Wraps the gastric fundus around the LES to increase sphincter pressure [CORRECT]
C. Creates a permanent opening in the diaphragm
D. Removes the distal esophagus
Correct Answer: B
Rationale: Nissen fundoplication is a laparoscopic surgical procedure that wraps the
gastric fundus 360 degrees around the lower esophageal sphincter, augmenting LES
(2026/2027) – Rasmussen University
SECTION 1: Gastrointestinal Disorders (Q1-Q20)
Q1: A 58-year-old male with a history of GERD reports heartburn that occurs after eating
spicy foods and when lying down at night. Which lifestyle modification should the nurse
prioritize in patient education?
A. Eat large meals three times daily to reduce stomach acid production
B. Elevate the head of the bed 30 degrees and avoid eating 3 hours before lying down
[CORRECT]
C. Drink a glass of milk before bedtime to neutralize stomach acid
D. Take antacids immediately before each meal as a preventive measure
Correct Answer: B
Rationale: Elevating the head of the bed and avoiding meals within 3 hours of lying
down reduces nocturnal gastric reflux by using gravity to keep stomach contents in
place; large meals increase gastric pressure and reflux, milk may worsen symptoms,
and antacids should be taken after meals or when symptoms occur, not before. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q2: A patient with GERD is prescribed omeprazole 20 mg daily. The nurse instructs the
patient to take the medication:
A. With breakfast to improve absorption
B. 30-60 minutes before meals on an empty stomach [CORRECT]
C. At bedtime with a snack for sustained effect
D. As needed when heartburn occurs
Correct Answer: B
Rationale: PPIs such as omeprazole must be taken 30-60 minutes before meals on an
empty stomach to allow time for proton pump inhibition before food stimulates acid
secretion; taking with food or as needed significantly reduces efficacy. [100% VERIFIED
– Rasmussen NUR2502 MDC3]
,Q3: A patient with long-standing GERD undergoes endoscopy, which reveals
salmon-colored mucosa in the distal esophagus. Biopsy confirms intestinal metaplasia.
The nurse understands this finding represents:
A. Normal esophageal anatomy
B. Barrett's esophagus with increased risk of esophageal adenocarcinoma [CORRECT]
C. Esophageal candidiasis
D. Mallory-Weiss tear
Correct Answer: B
Rationale: Barrett's esophagus is characterized by intestinal metaplasia of the distal
esophageal mucosa due to chronic acid exposure, appearing as salmon-colored
patches; it is a premalignant condition that increases the risk of esophageal
adenocarcinoma and requires surveillance endoscopy every 1-3 years. [100% VERIFIED
– Rasmussen NUR2502 MDC3]
Q4: A patient with peptic ulcer disease reports epigastric pain that occurs 2-3 hours
after eating and is relieved by food or antacids. The nurse recognizes this pattern as
most consistent with:
A. Gastric ulcer
B. Duodenal ulcer [CORRECT]
C. GERD
D. Gastritis
Correct Answer: B
Rationale: Duodenal ulcers classically present with pain 2-3 hours after eating (when
acid enters the duodenum), nocturnal pain, and relief with food or antacids; gastric
ulcers typically cause pain soon after eating that worsens with food, distinguishing the
two types of PUD. [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q5: A patient with peptic ulcer disease tests positive for H. pylori. The nurse anticipates
which treatment regimen?
A. PPI monotherapy for 4 weeks
B. Triple therapy with PPI + clarithromycin + amoxicillin for 10-14 days [CORRECT]
C. Antacid therapy only
D. Surgical vagotomy and antrectomy
Correct Answer: B
,Rationale: H. pylori eradication requires combination therapy; standard first-line
treatment is triple therapy (PPI + clarithromycin + amoxicillin or metronidazole) for
10-14 days, with quadruple therapy (bismuth-based) for resistant infections or penicillin
allergy; monotherapy or antacids alone will not eradicate the bacteria. [100% VERIFIED –
Rasmussen NUR2502 MDC3]
Q6: A patient with PUD suddenly develops severe, sharp abdominal pain, a rigid
board-like abdomen, rebound tenderness, and hypotension. The nurse recognizes these
findings as indicative of:
A. Gastric outlet obstruction
B. Perforation with peritonitis [CORRECT]
C. Hemorrhage from the ulcer
D. Pancreatitis
Correct Answer: B
Rationale: Sudden severe abdominal pain with a rigid abdomen, rebound tenderness,
guarding, and hypotension is classic for ulcer perforation with chemical peritonitis and
subsequent bacterial peritonitis; this is a surgical emergency requiring immediate
intervention, distinguishing it from obstruction (vomiting, distention) or hemorrhage
(hematemesis, melena). [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q7: A patient with a bleeding peptic ulcer presents with coffee-ground emesis and black
tarry stools. The nurse understands these findings represent:
A. Upper GI bleeding with hematemesis and melena [CORRECT]
B. Lower GI bleeding with hematochezia
C. Biliary obstruction with clay-colored stools
D. Pancreatic insufficiency with steatorrhea
Correct Answer: A
Rationale: Coffee-ground emesis results from partial digestion of blood by gastric acid,
and melena (black, tarry, foul-smelling stools) results from digestion of blood in the
upper GI tract; these findings indicate upper GI bleeding, in contrast to bright red
hematochezia from lower GI sources. [100% VERIFIED – Rasmussen NUR2502 MDC3]
Q8: A patient with PUD is prescribed sucralfate. The nurse instructs the patient to take
this medication:
, A. With meals to improve absorption
B. On an empty stomach 1 hour before meals and at bedtime [CORRECT]
C. With antacids for enhanced effect
D. Only when pain is severe
Correct Answer: B
Rationale: Sucralfate forms a protective barrier over ulcers by adhering to damaged
mucosa in an acidic environment; it must be taken on an empty stomach (1 hour before
meals and at bedtime) to allow proper adherence, and antacids should be taken
separately (2 hours apart) as they raise gastric pH and reduce sucralfate efficacy. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q9: A patient with chronic NSAID use develops gastric ulcer symptoms. The nurse
practitioner considers prescribing misoprostol. Which patient education is most
important?
A. Misoprostol can cause diarrhea and is contraindicated in pregnancy [CORRECT]
B. Misoprostol should be taken with high-fat meals
C. Misoprostol is safe for use during pregnancy
D. Misoprostol has no significant adverse effects
Correct Answer: A
Rationale: Misoprostol is a prostaglandin E1 analog that protects against
NSAID-induced ulcers but causes diarrhea (common adverse effect) and is absolutely
contraindicated in pregnancy due to its abortifacient properties (uterine contractions,
cervical ripening); women of childbearing age must use effective contraception. [100%
VERIFIED – Rasmussen NUR2502 MDC3]
Q10: A patient with GERD is considering Nissen fundoplication. The nurse explains that
this surgical procedure:
A. Removes the lower esophageal sphincter
B. Wraps the gastric fundus around the LES to increase sphincter pressure [CORRECT]
C. Creates a permanent opening in the diaphragm
D. Removes the distal esophagus
Correct Answer: B
Rationale: Nissen fundoplication is a laparoscopic surgical procedure that wraps the
gastric fundus 360 degrees around the lower esophageal sphincter, augmenting LES
