NURSING 326 FINAL EXAM
COMPREHENSIVE REVIEW 2026 SOLVED
QUESTIONS WITH Verified ACCURATE
RESPONSES AND RATIONALES
1. The nurse on a medical unit has received the morning report. Which
medication should the nurse administer first?
A) The proton-pump inhibitor pantoprazole (Protonix) to a client on call to
surgery
B) The antacid calcium carbonate (TUMS) to a client complaining of indigestion
C) The antimicrobial bismuth (Pepto-Bismol) to a client diagnosed with an ulcer
D) The H2 blocker famotidine (Pepcid) to a client diagnosed with GERD
Rationale: A medication for a client on call to surgery is a priority; surgery could
be delayed if the medication has not been administered when the call to surgery
comes.
2. Which statement is the scientific rationale for administering a proton-pump
inhibitor (PPI)?
A) PPI medications block H2 receptors on the parietal cell
B) PPI medications inhibit the enzyme that generates gastrin
C) PPI medications inhibit the enzyme that generates gastric acid
D) PPI medications form a protective barrier against acid pepsin
Rationale: Proton-pump inhibitors inhibit the enzyme (H+/K+ ATPase) that
generates gastric acid, providing potent acid suppression.
3. Which statement is an advantage to administering a histamine H2 blocker
rather than an antacid to a client diagnosed with gastroesophageal reflux
disease (GERD)?
A) Antacids are more potent than H2 blockers in relieving symptoms of GERD
B) Histamine2 blockers have more side effects than antacids
,C) Histamine2 blockers are less expensive than antacids
D) Histamine2 blockers require less frequent dosing than antacids
Rationale: H2 blockers provide longer-lasting acid suppression and require less
frequent dosing compared to antacids, improving patient compliance.
4. Which side effects would the nurse explain to a male client prescribed
cimetidine (Tagamet), a histamine2 blocker?
A) The medication can cause indigestion and heartburn
B) The medication can cause impotence and gynecomastia
C) The medication can cause insomnia and hypervigilance
D) The medication can cause Zollinger-Ellison syndrome
Rationale: Over time, Tagamet can cause males to become impotent, have
decreased libido, and develop breast tissue (gynecomastia).
5. Which data indicates the client is experiencing a hiatal hernia?
A) The client complains of heartburn after eating a large meal
B) The client complains of indigestion after eating a large meal
C) The client states that he did not wake up with heartburn during the night
D) The client has lost 3 pounds in the past 2 weeks
Rationale: Hiatal hernia allows stomach acid to reflux into the esophagus, causing
heartburn, especially after large meals when intra-abdominal pressure increases.
6. The nurse is preparing to administer the proton-pump inhibitor
esomeprazole (Nexium). Which interventions should the nurse implement?
Select all that apply.
A) Order an infusion pump for the client
B) Elevate the client's head of the bed
C) Check the client's ID band with MAR
D) Check for allergies to cephalosporin
E) Ask the client his or her date of birth
,Rationale: Elevating the head of the bed helps prevent reflux; checking ID band
and asking date of birth are essential for patient identification prior to medication
administration. Cephalosporin allergy is not relevant to PPIs.
7. Which information should the nurse include when discharging a client
diagnosed with gastroesophageal reflux disease (GERD)?
A) There are no complications of GERD as long as the client is compliant
B) The client is taking a proton-pump inhibitor and a histamine blocker
C) The client is taking a proton-pump inhibitor
D) The client is taking a histamine blocker
Rationale: GERD may require combination therapy with both a PPI and H2
blocker for adequate symptom control and healing of esophageal mucosa.
8. A client is prescribed omeprazole (Prilosec) for GERD. The nurse should
instruct the client to take this medication:
A) With meals
B) On an empty stomach, 30-60 minutes before meals
C) At bedtime
D) With antacids
Rationale: PPIs should be taken on an empty stomach 30-60 minutes before the
first meal of the day for optimal absorption and effectiveness.
9. The client asks the nurse how long it will take for omeprazole (Prilosec) to
relieve heartburn symptoms. The nurse's best response is:
A) Immediately
B) 1-4 days
C) 1-2 weeks
D) 4-6 weeks
Rationale: PPIs may take 1-4 days to provide symptomatic relief and up to 4-6
weeks for complete healing of erosive esophagitis.
, 10. A client is prescribed both a PPI and an H2 blocker. The nurse should
administer these medications:
A) At different times of the day (H2 blocker at bedtime, PPI before breakfast)
B) Together in the morning
C) Together at bedtime
D) Only when symptoms occur
Rationale: H2 blockers should be given at bedtime to suppress nocturnal acid,
while PPIs are given in the morning for daytime acid suppression. Giving them
together can reduce PPI effectiveness.
11. The nurse is caring for a client with Zollinger-Ellison syndrome. Which
medication is most likely to be prescribed?
A) Calcium carbonate (TUMS)
B) Pantoprazole (Protonix)
C) Famotidine (Pepcid)
D) Bismuth subsalicylate (Pepto-Bismol)
Rationale: Zollinger-Ellison syndrome causes extreme gastric acid hypersecretion
requiring high-dose PPI therapy for management.
12. Which of the following is a complication of untreated GERD?
A) Diabetes mellitus
B) Barrett's esophagus
C) Hypertension
D) Osteoporosis
Rationale: Chronic GERD can lead to Barrett's esophagus, a precancerous
condition where the esophageal lining changes to intestinal-type cells.
13. The nurse is teaching a client about lifestyle modifications for GERD.
Which statement indicates the client needs further teaching?
A) "I should avoid eating within 3 hours of bedtime"
B) "I should elevate the head of my bed 6-8 inches"
COMPREHENSIVE REVIEW 2026 SOLVED
QUESTIONS WITH Verified ACCURATE
RESPONSES AND RATIONALES
1. The nurse on a medical unit has received the morning report. Which
medication should the nurse administer first?
A) The proton-pump inhibitor pantoprazole (Protonix) to a client on call to
surgery
B) The antacid calcium carbonate (TUMS) to a client complaining of indigestion
C) The antimicrobial bismuth (Pepto-Bismol) to a client diagnosed with an ulcer
D) The H2 blocker famotidine (Pepcid) to a client diagnosed with GERD
Rationale: A medication for a client on call to surgery is a priority; surgery could
be delayed if the medication has not been administered when the call to surgery
comes.
2. Which statement is the scientific rationale for administering a proton-pump
inhibitor (PPI)?
A) PPI medications block H2 receptors on the parietal cell
B) PPI medications inhibit the enzyme that generates gastrin
C) PPI medications inhibit the enzyme that generates gastric acid
D) PPI medications form a protective barrier against acid pepsin
Rationale: Proton-pump inhibitors inhibit the enzyme (H+/K+ ATPase) that
generates gastric acid, providing potent acid suppression.
3. Which statement is an advantage to administering a histamine H2 blocker
rather than an antacid to a client diagnosed with gastroesophageal reflux
disease (GERD)?
A) Antacids are more potent than H2 blockers in relieving symptoms of GERD
B) Histamine2 blockers have more side effects than antacids
,C) Histamine2 blockers are less expensive than antacids
D) Histamine2 blockers require less frequent dosing than antacids
Rationale: H2 blockers provide longer-lasting acid suppression and require less
frequent dosing compared to antacids, improving patient compliance.
4. Which side effects would the nurse explain to a male client prescribed
cimetidine (Tagamet), a histamine2 blocker?
A) The medication can cause indigestion and heartburn
B) The medication can cause impotence and gynecomastia
C) The medication can cause insomnia and hypervigilance
D) The medication can cause Zollinger-Ellison syndrome
Rationale: Over time, Tagamet can cause males to become impotent, have
decreased libido, and develop breast tissue (gynecomastia).
5. Which data indicates the client is experiencing a hiatal hernia?
A) The client complains of heartburn after eating a large meal
B) The client complains of indigestion after eating a large meal
C) The client states that he did not wake up with heartburn during the night
D) The client has lost 3 pounds in the past 2 weeks
Rationale: Hiatal hernia allows stomach acid to reflux into the esophagus, causing
heartburn, especially after large meals when intra-abdominal pressure increases.
6. The nurse is preparing to administer the proton-pump inhibitor
esomeprazole (Nexium). Which interventions should the nurse implement?
Select all that apply.
A) Order an infusion pump for the client
B) Elevate the client's head of the bed
C) Check the client's ID band with MAR
D) Check for allergies to cephalosporin
E) Ask the client his or her date of birth
,Rationale: Elevating the head of the bed helps prevent reflux; checking ID band
and asking date of birth are essential for patient identification prior to medication
administration. Cephalosporin allergy is not relevant to PPIs.
7. Which information should the nurse include when discharging a client
diagnosed with gastroesophageal reflux disease (GERD)?
A) There are no complications of GERD as long as the client is compliant
B) The client is taking a proton-pump inhibitor and a histamine blocker
C) The client is taking a proton-pump inhibitor
D) The client is taking a histamine blocker
Rationale: GERD may require combination therapy with both a PPI and H2
blocker for adequate symptom control and healing of esophageal mucosa.
8. A client is prescribed omeprazole (Prilosec) for GERD. The nurse should
instruct the client to take this medication:
A) With meals
B) On an empty stomach, 30-60 minutes before meals
C) At bedtime
D) With antacids
Rationale: PPIs should be taken on an empty stomach 30-60 minutes before the
first meal of the day for optimal absorption and effectiveness.
9. The client asks the nurse how long it will take for omeprazole (Prilosec) to
relieve heartburn symptoms. The nurse's best response is:
A) Immediately
B) 1-4 days
C) 1-2 weeks
D) 4-6 weeks
Rationale: PPIs may take 1-4 days to provide symptomatic relief and up to 4-6
weeks for complete healing of erosive esophagitis.
, 10. A client is prescribed both a PPI and an H2 blocker. The nurse should
administer these medications:
A) At different times of the day (H2 blocker at bedtime, PPI before breakfast)
B) Together in the morning
C) Together at bedtime
D) Only when symptoms occur
Rationale: H2 blockers should be given at bedtime to suppress nocturnal acid,
while PPIs are given in the morning for daytime acid suppression. Giving them
together can reduce PPI effectiveness.
11. The nurse is caring for a client with Zollinger-Ellison syndrome. Which
medication is most likely to be prescribed?
A) Calcium carbonate (TUMS)
B) Pantoprazole (Protonix)
C) Famotidine (Pepcid)
D) Bismuth subsalicylate (Pepto-Bismol)
Rationale: Zollinger-Ellison syndrome causes extreme gastric acid hypersecretion
requiring high-dose PPI therapy for management.
12. Which of the following is a complication of untreated GERD?
A) Diabetes mellitus
B) Barrett's esophagus
C) Hypertension
D) Osteoporosis
Rationale: Chronic GERD can lead to Barrett's esophagus, a precancerous
condition where the esophageal lining changes to intestinal-type cells.
13. The nurse is teaching a client about lifestyle modifications for GERD.
Which statement indicates the client needs further teaching?
A) "I should avoid eating within 3 hours of bedtime"
B) "I should elevate the head of my bed 6-8 inches"
