NUR 242 MED SURG EXAM 2 GALEN COLLEGE OF NURSING |
LATEST ACTUAL EXAM COMPLETE QUESTIONS
WITH CORRECT ANSWERS AND RATIONALES ALREADY
GRADED A+
SECTION A: GASTROINTESTINAL DISORDERS (Questions 1–50)
1. A client with a history of peptic ulcer disease (PUD) reports a sudden onset of
severe, sharp abdominal pain that is generalized and accompanied by a rigid,
board-like abdomen. The nurse suspects:
A. Gastroesophageal reflux disease (GERD)
B. Perforation of the ulcer ✔
C. Gastritis
D. Esophageal varices
Rationale: A sudden, severe sharp pain with a board-like (rigid) abdomen is a
classic sign of a perforated peptic ulcer, which is a surgical emergency. The pain is
due to gastric contents spilling into the peritoneal cavity causing peritonitis.
2. The nurse is providing teaching to a client with newly diagnosed GERD. Which
instruction should the nurse include?
A. Lie down immediately after meals to promote digestion
B. Elevate the head of the bed and avoid eating 2-3 hours before bedtime ✔
C. Increase consumption of spicy foods to stimulate gastric emptying
D. Drink orange juice with breakfast to reduce acid
Rationale: GERD is managed by elevating the head of the bed, avoiding meals 2-3
hours before lying down, avoiding trigger foods (spicy, acidic, fatty), and weight
loss. Lying down after meals worsens reflux.
3. A client is admitted with acute pancreatitis. The nurse should prioritize which
intervention?
A. Encourage oral intake to maintain nutrition
B. Maintain NPO status and administer IV fluids ✔
C. Administer oral pancreatic enzymes
1
,D. Place the client in a prone position
Rationale: Acute pancreatitis is managed with NPO to rest the pancreas, IV fluids
to correct dehydration and electrolyte imbalances, and pain management. Oral
enzymes are used for chronic pancreatitis.
4. The nurse is assessing a client with cirrhosis. Which finding indicates the client
is developing hepatic encephalopathy?
A. Asterixis (liver flap) and confusion ✔
B. Spider angiomas
C. Palmar erythema
D. Ascites
Rationale: Hepatic encephalopathy is a complication of liver failure characterized
by confusion, altered LOC, and asterixis (flapping tremor). Spider angiomas,
palmar erythema, and ascites are signs of chronic liver disease but not specifically
encephalopathy.
5. A client with ulcerative colitis is at risk for which complication?
A. Toxic megacolon ✔
B. Malabsorption of fats
C. Fistulas
D. Strictures
Rationale: Toxic megacolon is a life-threatening complication of ulcerative colitis
(and Crohn's). Fistulas and strictures are more common in Crohn's disease.
Malabsorption is also more typical of Crohn's.
6. The nurse is caring for a client with a nasogastric (NG) tube for gastric
decompression. Which assessment finding indicates proper tube placement?
A. The client is able to speak clearly
B. Aspirated gastric contents have a pH of 3.5 ✔
C. The tube is taped to the client's gown
D. The client reports no nausea
2
,Rationale: Gastric aspirate pH should be ≤ 5.5 (acidic). A pH of 3.5 confirms gastric
placement. X-ray is the gold standard. Ability to speak and tube taping do not
confirm placement.
7. A client is diagnosed with diverticulitis. The nurse should instruct the client to
avoid which food?
A. Clear broth
B. White bread
C. Nuts and seeds ✔
D. Applesauce
Rationale: Clients with diverticulitis should avoid foods that can lodge in
diverticula (nuts, seeds, popcorn, corn) to prevent inflammation. A low-fiber diet
is recommended during acute episodes.
8. The nurse is assessing a client with a small bowel obstruction. Which finding is
most consistent with this condition?
A. Abdominal distention and high-pitched, hyperactive bowel sounds above the
obstruction ✔
B. Constant, non-colicky pain
C. Large, frequent bowel movements
D. Absent bowel sounds in all quadrants
Rationale: Small bowel obstruction presents with colicky, intermittent pain,
abdominal distention, and high-pitched, hyperactive bowel sounds (borborygmi)
above the obstruction. Bowel sounds may be absent later if strangulation occurs.
9. A client with hepatitis A is admitted. The nurse should implement which type of
precautions?
A. Contact precautions
B. Droplet precautions
C. Standard precautions ✔
D. Airborne precautions
3
, Rationale: Hepatitis A is transmitted via the fecal-oral route. Standard precautions
(hand hygiene, gloves) are sufficient. Contact precautions are not typically
required unless the client is incontinent.
10. The nurse is preparing a client for a colonoscopy. Which instruction should the
nurse provide?
A. "You will need to drink a clear liquid diet the day before the procedure." ✔
B. "You can eat a full meal up to 4 hours before the procedure."
C. "You will need to take a laxative after the procedure."
D. "You will be awake and able to drive home."
Rationale: Colonoscopy requires a clear liquid diet and bowel preparation
(laxative/enema) the day before. The client will receive sedation and should not
drive.
11. A client with a history of chronic liver disease presents with ascites and pedal
edema. The nurse understands that these findings are primarily due to:
A. Decreased albumin production causing fluid shifts ✔
B. Increased portal blood flow
C. Renal failure
D. Heart failure
Rationale: Liver disease leads to decreased albumin synthesis, reducing oncotic
pressure and causing fluid to shift into interstitial spaces (ascites, edema). Portal
hypertension also contributes.
12. The nurse is administering lactulose to a client with hepatic encephalopathy.
The expected therapeutic effect is:
A. Decreased serum ammonia levels ✔
B. Increased serum potassium levels
C. Decreased urinary output
D. Increased serum bilirubin
4
LATEST ACTUAL EXAM COMPLETE QUESTIONS
WITH CORRECT ANSWERS AND RATIONALES ALREADY
GRADED A+
SECTION A: GASTROINTESTINAL DISORDERS (Questions 1–50)
1. A client with a history of peptic ulcer disease (PUD) reports a sudden onset of
severe, sharp abdominal pain that is generalized and accompanied by a rigid,
board-like abdomen. The nurse suspects:
A. Gastroesophageal reflux disease (GERD)
B. Perforation of the ulcer ✔
C. Gastritis
D. Esophageal varices
Rationale: A sudden, severe sharp pain with a board-like (rigid) abdomen is a
classic sign of a perforated peptic ulcer, which is a surgical emergency. The pain is
due to gastric contents spilling into the peritoneal cavity causing peritonitis.
2. The nurse is providing teaching to a client with newly diagnosed GERD. Which
instruction should the nurse include?
A. Lie down immediately after meals to promote digestion
B. Elevate the head of the bed and avoid eating 2-3 hours before bedtime ✔
C. Increase consumption of spicy foods to stimulate gastric emptying
D. Drink orange juice with breakfast to reduce acid
Rationale: GERD is managed by elevating the head of the bed, avoiding meals 2-3
hours before lying down, avoiding trigger foods (spicy, acidic, fatty), and weight
loss. Lying down after meals worsens reflux.
3. A client is admitted with acute pancreatitis. The nurse should prioritize which
intervention?
A. Encourage oral intake to maintain nutrition
B. Maintain NPO status and administer IV fluids ✔
C. Administer oral pancreatic enzymes
1
,D. Place the client in a prone position
Rationale: Acute pancreatitis is managed with NPO to rest the pancreas, IV fluids
to correct dehydration and electrolyte imbalances, and pain management. Oral
enzymes are used for chronic pancreatitis.
4. The nurse is assessing a client with cirrhosis. Which finding indicates the client
is developing hepatic encephalopathy?
A. Asterixis (liver flap) and confusion ✔
B. Spider angiomas
C. Palmar erythema
D. Ascites
Rationale: Hepatic encephalopathy is a complication of liver failure characterized
by confusion, altered LOC, and asterixis (flapping tremor). Spider angiomas,
palmar erythema, and ascites are signs of chronic liver disease but not specifically
encephalopathy.
5. A client with ulcerative colitis is at risk for which complication?
A. Toxic megacolon ✔
B. Malabsorption of fats
C. Fistulas
D. Strictures
Rationale: Toxic megacolon is a life-threatening complication of ulcerative colitis
(and Crohn's). Fistulas and strictures are more common in Crohn's disease.
Malabsorption is also more typical of Crohn's.
6. The nurse is caring for a client with a nasogastric (NG) tube for gastric
decompression. Which assessment finding indicates proper tube placement?
A. The client is able to speak clearly
B. Aspirated gastric contents have a pH of 3.5 ✔
C. The tube is taped to the client's gown
D. The client reports no nausea
2
,Rationale: Gastric aspirate pH should be ≤ 5.5 (acidic). A pH of 3.5 confirms gastric
placement. X-ray is the gold standard. Ability to speak and tube taping do not
confirm placement.
7. A client is diagnosed with diverticulitis. The nurse should instruct the client to
avoid which food?
A. Clear broth
B. White bread
C. Nuts and seeds ✔
D. Applesauce
Rationale: Clients with diverticulitis should avoid foods that can lodge in
diverticula (nuts, seeds, popcorn, corn) to prevent inflammation. A low-fiber diet
is recommended during acute episodes.
8. The nurse is assessing a client with a small bowel obstruction. Which finding is
most consistent with this condition?
A. Abdominal distention and high-pitched, hyperactive bowel sounds above the
obstruction ✔
B. Constant, non-colicky pain
C. Large, frequent bowel movements
D. Absent bowel sounds in all quadrants
Rationale: Small bowel obstruction presents with colicky, intermittent pain,
abdominal distention, and high-pitched, hyperactive bowel sounds (borborygmi)
above the obstruction. Bowel sounds may be absent later if strangulation occurs.
9. A client with hepatitis A is admitted. The nurse should implement which type of
precautions?
A. Contact precautions
B. Droplet precautions
C. Standard precautions ✔
D. Airborne precautions
3
, Rationale: Hepatitis A is transmitted via the fecal-oral route. Standard precautions
(hand hygiene, gloves) are sufficient. Contact precautions are not typically
required unless the client is incontinent.
10. The nurse is preparing a client for a colonoscopy. Which instruction should the
nurse provide?
A. "You will need to drink a clear liquid diet the day before the procedure." ✔
B. "You can eat a full meal up to 4 hours before the procedure."
C. "You will need to take a laxative after the procedure."
D. "You will be awake and able to drive home."
Rationale: Colonoscopy requires a clear liquid diet and bowel preparation
(laxative/enema) the day before. The client will receive sedation and should not
drive.
11. A client with a history of chronic liver disease presents with ascites and pedal
edema. The nurse understands that these findings are primarily due to:
A. Decreased albumin production causing fluid shifts ✔
B. Increased portal blood flow
C. Renal failure
D. Heart failure
Rationale: Liver disease leads to decreased albumin synthesis, reducing oncotic
pressure and causing fluid to shift into interstitial spaces (ascites, edema). Portal
hypertension also contributes.
12. The nurse is administering lactulose to a client with hepatic encephalopathy.
The expected therapeutic effect is:
A. Decreased serum ammonia levels ✔
B. Increased serum potassium levels
C. Decreased urinary output
D. Increased serum bilirubin
4
