NUR 170 Exam 4: Medical-Surgical Nursing Study Guide 2026 Galen
College
1. A patient with Gastroesophageal Reflux Disease (GERD) is being discharged.
Which dietary instruction should the nurse include?
A. Avoid eating within 3 hours of going to sleep.
B. Drink a glass of milk before bedtime to coat the stomach.
C. Increase intake of peppermint tea to soothe the esophagus.
D. Consume three large meals a day instead of small frequent ones.
Answer: A
Rationale: Eating within 3 hours of bedtime increases the risk of reflux while lying down.
Peppermint, caffeine, and large meals decrease lower esophageal sphincter pressure and
should be avoided.
2. Which clinical manifestation is a hallmark sign of a suspected bowel
perforation in a patient with a peptic ulcer?
A. A decrease in heart rate and increased blood pressure.
B. Hyperactive bowel sounds in all four quadrants.
C. Increased hunger and craving for spicy foods.
D. Sudden, severe abdominal pain and a rigid, board-like abdomen.
Answer: D
Rationale: A rigid, board-like abdomen and sudden severe pain are classic signs of
peritonitis caused by a perforated ulcer. This is a medical emergency.
,3. A nurse is caring for a patient following a Billroth II procedure. The patient
reports dizziness, sweating, and palpitations after eating. What is the priority
intervention?
A. Encourage the patient to walk for 15 minutes after meals.
B. Administer a bolus of intravenous fluids.
C. Increase the amount of fluids consumed during the meal.
D. Instruct the patient to lie down for 30 minutes after eating.
Answer: D
Rationale: These symptoms suggest Dumping Syndrome. Lying down after meals slows
the transit of food into the small intestine. Fluids should be avoided during meals to
prevent rapid emptying.
4. A patient with Ulcerative Colitis is admitted with severe diarrhea. Which
electrolyte imbalance is this patient at the highest risk for?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
Answer: B
Rationale: Severe diarrhea leads to significant loss of potassium and fluids from the GI
tract, making hypokalemia a primary concern.
5. Which physical assessment finding is most characteristic of Crohn’s disease
compared to Ulcerative Colitis?
A. The presence of ‘skip lesions’ throughout the GI tract.
B. Bloody diarrhea occurring 10-20 times per day.
C. Continuous inflammation starting in the rectum.
D. Inflammation limited only to the mucosal layer.
Answer: A
, Rationale: Crohn’s disease is characterized by ‘skip lesions’ (discontinuous areas of
inflammation) and can affect any part of the GI tract, whereas Ulcerative Colitis is
continuous and starts in the rectum.
6. A patient is admitted with Acute Pancreatitis. Which laboratory result would
the nurse expect to be elevated?
A. Serum Calcium
B. Serum Albumin
C. Serum Amylase
D. Hemoglobin
Answer: C
Rationale: Serum amylase and lipase are significantly elevated in acute pancreatitis due to
the autodigestion of the pancreas. Calcium levels often drop (hypocalcemia) in severe
cases.
7. Which medication is typically administered to a patient with Hepatic
Encephalopathy to reduce ammonia levels?
A. Spironolactone
B. Furosemide
C. Propranolol
D. Lactulose
Answer: D
Rationale: Lactulose promotes the excretion of ammonia through the stool by creating an
acidic environment in the bowel and acting as an osmotic laxative.
College
1. A patient with Gastroesophageal Reflux Disease (GERD) is being discharged.
Which dietary instruction should the nurse include?
A. Avoid eating within 3 hours of going to sleep.
B. Drink a glass of milk before bedtime to coat the stomach.
C. Increase intake of peppermint tea to soothe the esophagus.
D. Consume three large meals a day instead of small frequent ones.
Answer: A
Rationale: Eating within 3 hours of bedtime increases the risk of reflux while lying down.
Peppermint, caffeine, and large meals decrease lower esophageal sphincter pressure and
should be avoided.
2. Which clinical manifestation is a hallmark sign of a suspected bowel
perforation in a patient with a peptic ulcer?
A. A decrease in heart rate and increased blood pressure.
B. Hyperactive bowel sounds in all four quadrants.
C. Increased hunger and craving for spicy foods.
D. Sudden, severe abdominal pain and a rigid, board-like abdomen.
Answer: D
Rationale: A rigid, board-like abdomen and sudden severe pain are classic signs of
peritonitis caused by a perforated ulcer. This is a medical emergency.
,3. A nurse is caring for a patient following a Billroth II procedure. The patient
reports dizziness, sweating, and palpitations after eating. What is the priority
intervention?
A. Encourage the patient to walk for 15 minutes after meals.
B. Administer a bolus of intravenous fluids.
C. Increase the amount of fluids consumed during the meal.
D. Instruct the patient to lie down for 30 minutes after eating.
Answer: D
Rationale: These symptoms suggest Dumping Syndrome. Lying down after meals slows
the transit of food into the small intestine. Fluids should be avoided during meals to
prevent rapid emptying.
4. A patient with Ulcerative Colitis is admitted with severe diarrhea. Which
electrolyte imbalance is this patient at the highest risk for?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
Answer: B
Rationale: Severe diarrhea leads to significant loss of potassium and fluids from the GI
tract, making hypokalemia a primary concern.
5. Which physical assessment finding is most characteristic of Crohn’s disease
compared to Ulcerative Colitis?
A. The presence of ‘skip lesions’ throughout the GI tract.
B. Bloody diarrhea occurring 10-20 times per day.
C. Continuous inflammation starting in the rectum.
D. Inflammation limited only to the mucosal layer.
Answer: A
, Rationale: Crohn’s disease is characterized by ‘skip lesions’ (discontinuous areas of
inflammation) and can affect any part of the GI tract, whereas Ulcerative Colitis is
continuous and starts in the rectum.
6. A patient is admitted with Acute Pancreatitis. Which laboratory result would
the nurse expect to be elevated?
A. Serum Calcium
B. Serum Albumin
C. Serum Amylase
D. Hemoglobin
Answer: C
Rationale: Serum amylase and lipase are significantly elevated in acute pancreatitis due to
the autodigestion of the pancreas. Calcium levels often drop (hypocalcemia) in severe
cases.
7. Which medication is typically administered to a patient with Hepatic
Encephalopathy to reduce ammonia levels?
A. Spironolactone
B. Furosemide
C. Propranolol
D. Lactulose
Answer: D
Rationale: Lactulose promotes the excretion of ammonia through the stool by creating an
acidic environment in the bowel and acting as an osmotic laxative.
