ATI Medical-Surgical Nursing (GI)
Gastrointestinal Disorders Practice Exam
2026–2027 | GI Bleeding, Cirrhosis,
Pancreatitis, IBD & Peptic Ulcer Disease |
100 Practice Questions with Detailed
Rationales
Section Questions Topic
1 1–12 Gastrointestinal Bleeding
2 13–24 Peptic Ulcer Disease and GERD
3 25–36 Liver Disorders
4 37–46 Pancreatitis
5 47–54 Inflammatory Bowel Disease
6 55–62 Intestinal Obstruction
7 63–70 Gallbladder Disorders
8 71–77 Ostomy Care
9 78–84 Nutrition Support
10 85–100 GI Diagnostic Procedures
SECTION 1: GASTROINTESTINAL BLEEDING
(Questions 1–12)
1. A nurse is caring for a patient who vomits bright red blood and has a blood pressure of 88/56
mmHg and heart rate of 122 bpm. Which nursing intervention takes PRIORITY?
A. Prepare the patient for emergent endoscopy
B. Administer IV proton pump inhibitor as ordered
,C. Insert a nasogastric tube for gastric lavage
D. Establish two large-bore IV lines and initiate fluid resuscitation
Rationale: Hemodynamic instability requires immediate vascular access and aggressive fluid
resuscitation to restore perfusion before any diagnostic or therapeutic procedure.
2. A nurse assesses a patient with upper GI bleeding. Which finding requires IMMEDIATE
intervention?
A. Orthostatic hypotension with dizziness upon sitting
B. Blood pressure 110/70 mmHg
C. Heart rate 88 bpm
D. Hemoglobin 10.2 g/dL
Rationale: Orthostatic hypotension indicates significant volume depletion of at least 15–20%
blood volume loss, requiring immediate nursing intervention.
3. A patient is admitted with melena and coffee-ground emesis. The nurse correctly identifies
these findings as consistent with:
A. Lower gastrointestinal bleeding
B. Colonic diverticular bleeding
C. Upper gastrointestinal bleeding
D. Hemorrhoidal bleeding
Rationale: Melena and coffee-ground emesis both indicate upper GI bleeding proximal to the
ligament of Treitz where blood is digested by gastric acid and intestinal bacteria.
4. Which of the following BEST describes hematochezia?
A. Black tarry foul-smelling stool
B. Bright red or maroon blood passed per rectum
C. Coffee-ground appearance of vomitus
D. Blood-tinged mucus in stool only
Rationale: Hematochezia refers to bright red or maroon rectal bleeding typically indicating a
lower GI source; massive upper GI hemorrhage with rapid transit can also cause it.
,5. A nurse is preparing a patient for an upper endoscopy (EGD) for GI bleeding evaluation.
Which pre-procedure action is most important?
A. Administer a bowel prep the night before
B. Insert a urinary catheter before the procedure
C. Apply a topical anesthetic to the abdomen
D. Ensure the patient has been NPO for at least 6–8 hours
Rationale: NPO status for 6–8 hours is essential before EGD to reduce aspiration risk and
ensure adequate visualization of the upper GI mucosa.
6. After an upper endoscopy, which nursing assessment is the PRIORITY?
A. Assess the return of the gag reflex before allowing oral intake
B. Monitor for abdominal distension
C. Check the surgical incision site
D. Monitor urine output hourly
Rationale: Throat anesthesia used during EGD suppresses the gag reflex; oral intake must be
withheld until the gag reflex returns fully to prevent aspiration.
7. A patient with GI bleeding requires a blood transfusion. Which action must the nurse take
before initiating the transfusion?
A. Warm the blood to room temperature in a microwave
B. Prime the IV tubing with dextrose 5% in water
C. Administer diphenhydramine routinely before all transfusions
D. Verify the blood product with another nurse at the bedside using two patient identifiers
Rationale: Two-nurse verification of blood product compatibility using two patient identifiers is
mandatory before transfusion to prevent fatal hemolytic transfusion reactions.
8. A nurse is monitoring a patient receiving a blood transfusion who develops sudden chills,
fever of 102°F, back pain, and dark urine 15 minutes after the transfusion started. The priority
action is:
A. Slow the transfusion rate and monitor closely
B. Stop the transfusion immediately and notify the provider
C. Administer acetaminophen and continue the transfusion
D. Obtain a repeat type and crossmatch
, Rationale: These symptoms indicate an acute hemolytic transfusion reaction; the transfusion
must be stopped immediately, IV access maintained with normal saline, and the provider
notified.
9. Which of the following lab values would the nurse MOST closely monitor in a patient with
active GI bleeding?
A. Serum potassium and sodium
B. Blood glucose and HbA1c
C. Hemoglobin, hematocrit, and coagulation studies (PT/INR)
D. BUN and creatinine only
Rationale: Serial hemoglobin/hematocrit values track blood loss severity; PT/INR assesses
coagulation status, which guides transfusion and treatment decisions in GI hemorrhage.
10. A patient with liver cirrhosis develops massive hematemesis from esophageal varices. Which
medication does the nurse anticipate administering?
A. Pantoprazole IV bolus only
B. Vasopressin alone
C. Octreotide IV infusion
D. Propranolol oral tablet
Rationale: Octreotide (somatostatin analog) reduces splanchnic blood flow and portal pressure
and is the vasoactive drug of choice in acute variceal hemorrhage alongside endoscopic therapy.
11. A nurse is caring for a patient with a nasogastric tube following GI hemorrhage. The nurse
aspirates 300 mL of bright red blood. What is the priority action?
A. Notify the provider immediately and prepare for emergent intervention
B. Document the finding and continue monitoring
C. Irrigate the NG tube with 60 mL of normal saline
D. Reposition the patient to the left lateral position
Rationale: Aspiration of bright red blood from the NG tube indicates active hemorrhage
requiring immediate provider notification and preparation for urgent endoscopic or surgical
intervention.
Gastrointestinal Disorders Practice Exam
2026–2027 | GI Bleeding, Cirrhosis,
Pancreatitis, IBD & Peptic Ulcer Disease |
100 Practice Questions with Detailed
Rationales
Section Questions Topic
1 1–12 Gastrointestinal Bleeding
2 13–24 Peptic Ulcer Disease and GERD
3 25–36 Liver Disorders
4 37–46 Pancreatitis
5 47–54 Inflammatory Bowel Disease
6 55–62 Intestinal Obstruction
7 63–70 Gallbladder Disorders
8 71–77 Ostomy Care
9 78–84 Nutrition Support
10 85–100 GI Diagnostic Procedures
SECTION 1: GASTROINTESTINAL BLEEDING
(Questions 1–12)
1. A nurse is caring for a patient who vomits bright red blood and has a blood pressure of 88/56
mmHg and heart rate of 122 bpm. Which nursing intervention takes PRIORITY?
A. Prepare the patient for emergent endoscopy
B. Administer IV proton pump inhibitor as ordered
,C. Insert a nasogastric tube for gastric lavage
D. Establish two large-bore IV lines and initiate fluid resuscitation
Rationale: Hemodynamic instability requires immediate vascular access and aggressive fluid
resuscitation to restore perfusion before any diagnostic or therapeutic procedure.
2. A nurse assesses a patient with upper GI bleeding. Which finding requires IMMEDIATE
intervention?
A. Orthostatic hypotension with dizziness upon sitting
B. Blood pressure 110/70 mmHg
C. Heart rate 88 bpm
D. Hemoglobin 10.2 g/dL
Rationale: Orthostatic hypotension indicates significant volume depletion of at least 15–20%
blood volume loss, requiring immediate nursing intervention.
3. A patient is admitted with melena and coffee-ground emesis. The nurse correctly identifies
these findings as consistent with:
A. Lower gastrointestinal bleeding
B. Colonic diverticular bleeding
C. Upper gastrointestinal bleeding
D. Hemorrhoidal bleeding
Rationale: Melena and coffee-ground emesis both indicate upper GI bleeding proximal to the
ligament of Treitz where blood is digested by gastric acid and intestinal bacteria.
4. Which of the following BEST describes hematochezia?
A. Black tarry foul-smelling stool
B. Bright red or maroon blood passed per rectum
C. Coffee-ground appearance of vomitus
D. Blood-tinged mucus in stool only
Rationale: Hematochezia refers to bright red or maroon rectal bleeding typically indicating a
lower GI source; massive upper GI hemorrhage with rapid transit can also cause it.
,5. A nurse is preparing a patient for an upper endoscopy (EGD) for GI bleeding evaluation.
Which pre-procedure action is most important?
A. Administer a bowel prep the night before
B. Insert a urinary catheter before the procedure
C. Apply a topical anesthetic to the abdomen
D. Ensure the patient has been NPO for at least 6–8 hours
Rationale: NPO status for 6–8 hours is essential before EGD to reduce aspiration risk and
ensure adequate visualization of the upper GI mucosa.
6. After an upper endoscopy, which nursing assessment is the PRIORITY?
A. Assess the return of the gag reflex before allowing oral intake
B. Monitor for abdominal distension
C. Check the surgical incision site
D. Monitor urine output hourly
Rationale: Throat anesthesia used during EGD suppresses the gag reflex; oral intake must be
withheld until the gag reflex returns fully to prevent aspiration.
7. A patient with GI bleeding requires a blood transfusion. Which action must the nurse take
before initiating the transfusion?
A. Warm the blood to room temperature in a microwave
B. Prime the IV tubing with dextrose 5% in water
C. Administer diphenhydramine routinely before all transfusions
D. Verify the blood product with another nurse at the bedside using two patient identifiers
Rationale: Two-nurse verification of blood product compatibility using two patient identifiers is
mandatory before transfusion to prevent fatal hemolytic transfusion reactions.
8. A nurse is monitoring a patient receiving a blood transfusion who develops sudden chills,
fever of 102°F, back pain, and dark urine 15 minutes after the transfusion started. The priority
action is:
A. Slow the transfusion rate and monitor closely
B. Stop the transfusion immediately and notify the provider
C. Administer acetaminophen and continue the transfusion
D. Obtain a repeat type and crossmatch
, Rationale: These symptoms indicate an acute hemolytic transfusion reaction; the transfusion
must be stopped immediately, IV access maintained with normal saline, and the provider
notified.
9. Which of the following lab values would the nurse MOST closely monitor in a patient with
active GI bleeding?
A. Serum potassium and sodium
B. Blood glucose and HbA1c
C. Hemoglobin, hematocrit, and coagulation studies (PT/INR)
D. BUN and creatinine only
Rationale: Serial hemoglobin/hematocrit values track blood loss severity; PT/INR assesses
coagulation status, which guides transfusion and treatment decisions in GI hemorrhage.
10. A patient with liver cirrhosis develops massive hematemesis from esophageal varices. Which
medication does the nurse anticipate administering?
A. Pantoprazole IV bolus only
B. Vasopressin alone
C. Octreotide IV infusion
D. Propranolol oral tablet
Rationale: Octreotide (somatostatin analog) reduces splanchnic blood flow and portal pressure
and is the vasoactive drug of choice in acute variceal hemorrhage alongside endoscopic therapy.
11. A nurse is caring for a patient with a nasogastric tube following GI hemorrhage. The nurse
aspirates 300 mL of bright red blood. What is the priority action?
A. Notify the provider immediately and prepare for emergent intervention
B. Document the finding and continue monitoring
C. Irrigate the NG tube with 60 mL of normal saline
D. Reposition the patient to the left lateral position
Rationale: Aspiration of bright red blood from the NG tube indicates active hemorrhage
requiring immediate provider notification and preparation for urgent endoscopic or surgical
intervention.
