NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
1. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is
scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins
to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are
diminished. Which is the most appropriate nursing intervention?
1. Notify the health care provider (HCP).
2. Administer the prescribed pain medication.
3. Call and ask the operating room team to perform surgery as soon as possible.
4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.
Answer:
1. Notify the health care provider (HCP).
Rationale:
On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis
and notify the HCP {Projectile
vomiting and rebound tenderness “if present”
are signs of peritonitis from rupture of the appendix and should be
reported immediately to the HCP}. Administering pain medication is not an appropriate
intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis
because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice,
although the HCP probably would perform the surgery earlier than the prescheduled time.
7. The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances
to avoid. Which items should the nurse include on this list? Select all that apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs
Answer:
1. Coffee
2. Chocolate
,NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
3. Peppermint
5. Fried chicken
Rationale:
Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase
reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances
include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4
and 6 do not promote this effect.
8. A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on
which item as part of the client's care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex
Answer:
4. Assessing for the return of the gag reflex
Rationale:
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses
the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in
temperature, which could indicate perforation of the gastrointestinal tract. This complication would be
accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also
important; however, the client's airway is the priority.
11. The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse
instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.
1. Nuts
2. Corn
3. Liver
4. Apples
5. Lentils
6. Bananas
Answer:
1. Nuts
3. Liver
5. Lentils
Rationale:
,NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of
function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb
vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin
B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans,
citrus fruits, green leafy vegetables, and yeast.
13. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would
most likely indicate perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, boardlike abdomen
Answer:
4. A rigid, boardlike abdomen
Rationale:
Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe
pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and
boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops.
Numbness in the legs is not an associated finding.
14. The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which
postoperative prescription should the nurse question and verify?
1. Leg exercises
2. Early ambulation
3. Irrigating the nasogastric tube
4. Coughing and deep-breathing exercises
Answer:
3. Irrigating the nasogastric tube
Rationale:
In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to
the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric
secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless
specifically prescribed by the health care provider. In this situation, the nurse should clarify the
prescription. Options 1, 2, and 4 are appropriate postoperative interventions.
15. The nurse is providing discharge instructions to a client following gastrectomy and should instruct
the client to take which measure to assist in preventing dumping syndrome?
1. Ambulate following a meal.
2. Eat high-carbohydrate foods.
, NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
3. Limit the fluids taken with meals.
4. Sit in a high Fowler's position during meals.
Answer:
3. Limit the fluids taken with meals.
Rationale:
Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after
eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually
occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor,
palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of
fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to
assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric
emptying; and to take antispasmodics as prescribed.
{NOTE: CORRECTION for the answer about Morphine to tx pain:
Acute Pancreatitis Pain management----> (no Morphine). Morphine
induces "spasm" of the pancreatic ducts and the sphincter of Oddi
(SO) and should not be used in acute pancreatitis.
• Meperidine (Demerol) does not SO pressures; however,
it may cause SEIZURES; so it should be avoided.
• Oral meds as narcotics such as Percocet, oxycodone, &
Methadone may be used in conjunction with non-
narcotic medicines such as muscle relaxants &
antidepressants.}
17. The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about
dietary measures to implement during exacerbation episodes. Which statement made by the client
indicates a need for further instruction?
1. "I should increase the fiber in my diet."
2. "I will need to avoid caffeinated beverages."
3. "I'm going to learn some stress reduction techniques."
4. "I can have exacerbations and remissions with Crohn's disease."
Answer:
1. "I should increase the fiber in my diet."
Rationale:
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
1. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is
scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins
to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are
diminished. Which is the most appropriate nursing intervention?
1. Notify the health care provider (HCP).
2. Administer the prescribed pain medication.
3. Call and ask the operating room team to perform surgery as soon as possible.
4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.
Answer:
1. Notify the health care provider (HCP).
Rationale:
On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis
and notify the HCP {Projectile
vomiting and rebound tenderness “if present”
are signs of peritonitis from rupture of the appendix and should be
reported immediately to the HCP}. Administering pain medication is not an appropriate
intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis
because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice,
although the HCP probably would perform the surgery earlier than the prescheduled time.
7. The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances
to avoid. Which items should the nurse include on this list? Select all that apply.
1. Coffee
2. Chocolate
3. Peppermint
4. Nonfat milk
5. Fried chicken
6. Scrambled eggs
Answer:
1. Coffee
2. Chocolate
,NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
3. Peppermint
5. Fried chicken
Rationale:
Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase
reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances
include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4
and 6 do not promote this effect.
8. A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on
which item as part of the client's care plan?
1. Monitoring the temperature
2. Monitoring complaints of heartburn
3. Giving warm gargles for a sore throat
4. Assessing for the return of the gag reflex
Answer:
4. Assessing for the return of the gag reflex
Rationale:
The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses
the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in
temperature, which could indicate perforation of the gastrointestinal tract. This complication would be
accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also
important; however, the client's airway is the priority.
11. The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse
instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.
1. Nuts
2. Corn
3. Liver
4. Apples
5. Lentils
6. Bananas
Answer:
1. Nuts
3. Liver
5. Lentils
Rationale:
,NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of
function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb
vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin
B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans,
citrus fruits, green leafy vegetables, and yeast.
13. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would
most likely indicate perforation of the ulcer?
1. Bradycardia
2. Numbness in the legs
3. Nausea and vomiting
4. A rigid, boardlike abdomen
Answer:
4. A rigid, boardlike abdomen
Rationale:
Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe
pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and
boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops.
Numbness in the legs is not an associated finding.
14. The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which
postoperative prescription should the nurse question and verify?
1. Leg exercises
2. Early ambulation
3. Irrigating the nasogastric tube
4. Coughing and deep-breathing exercises
Answer:
3. Irrigating the nasogastric tube
Rationale:
In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to
the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric
secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless
specifically prescribed by the health care provider. In this situation, the nurse should clarify the
prescription. Options 1, 2, and 4 are appropriate postoperative interventions.
15. The nurse is providing discharge instructions to a client following gastrectomy and should instruct
the client to take which measure to assist in preventing dumping syndrome?
1. Ambulate following a meal.
2. Eat high-carbohydrate foods.
, NURS Saunders Medsurg EXAM QUESTIONS AND
ANSWERS WITH RATIONALE 2023 A+ PASS
GUANTEED
3. Limit the fluids taken with meals.
4. Sit in a high Fowler's position during meals.
Answer:
3. Limit the fluids taken with meals.
Rationale:
Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after
eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually
occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor,
palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of
fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to
assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric
emptying; and to take antispasmodics as prescribed.
{NOTE: CORRECTION for the answer about Morphine to tx pain:
Acute Pancreatitis Pain management----> (no Morphine). Morphine
induces "spasm" of the pancreatic ducts and the sphincter of Oddi
(SO) and should not be used in acute pancreatitis.
• Meperidine (Demerol) does not SO pressures; however,
it may cause SEIZURES; so it should be avoided.
• Oral meds as narcotics such as Percocet, oxycodone, &
Methadone may be used in conjunction with non-
narcotic medicines such as muscle relaxants &
antidepressants.}
17. The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about
dietary measures to implement during exacerbation episodes. Which statement made by the client
indicates a need for further instruction?
1. "I should increase the fiber in my diet."
2. "I will need to avoid caffeinated beverages."
3. "I'm going to learn some stress reduction techniques."
4. "I can have exacerbations and remissions with Crohn's disease."
Answer:
1. "I should increase the fiber in my diet."
Rationale:
