NUR 170 Exam 4 Med Surg | Actual study Questions and
Answers + Expert Rationales | 2026 Updated | 100%
correct | Galen
1. A client with GERD asks the nurse about lifestyle changes to manage symptoms. Which
recommendation should the nurse prioritize?
A. Lie flat after meals to promote digestion
B. Eat three large meals daily
C. Elevate the head of the bed and avoid lying down for 2-3 hours after eating
D. Increase consumption of citrus fruits and tomato products
Correct Answer: C
Expert Rationale: Elevating the head of the bed and avoiding lying down for 2-3 hours after
meals reduces nocturnal acid reflux by using gravity to keep stomach contents in the stomach.
This is a cornerstone of GERD management. Large meals (B) increase gastric pressure and reflux.
Citrus and tomato products (D) are acidic and worsen symptoms. The 2026 Leeds Teaching
Hospitals NHS Trust guidelines emphasize small, frequent meals and upright positioning after
eating.
2. Which patient population is at highest risk for developing GERD?
A. Young, athletic males
B. Obese individuals, pregnant women, and older adults
C. Vegans and vegetarians
D. Individuals with low-fat diets
Correct Answer: B
Expert Rationale: Obesity increases intra-abdominal pressure promoting reflux. Pregnancy
causes hormonal relaxation of the lower esophageal sphincter and increased pressure. Older
adults have decreased esophageal motility and increased incidence of hiatal hernia. These are
well-documented risk factors. The 2026 literature confirms that tight clothing and obesity are
key risk factors for GERD. Options A, C, and D do not represent high-risk populations.
3. A client with a hiatal hernia asks if it is possible to have GERD without a hernia. Which
response is correct?
,A. No, GERD always requires a hiatal hernia
B. Yes, GERD can occur without a hiatal hernia
C. No, they are the same condition
D. Only if the patient is over 65
Correct Answer: B
Expert Rationale: GERD and hiatal hernia are distinct but related conditions. GERD results from
lower esophageal sphincter dysfunction causing acid reflux. Hiatal hernia involves stomach
protrusion through the diaphragm. A hiatal hernia can cause or worsen GERD, but GERD can
occur independently. The 2026 N-ECCO consensus statements distinguish these as separate
conditions requiring individualized assessment .
4. A client with GERD reports heartburn and indigestion. Which medication class is most
commonly prescribed for initial management?
A. Antibiotics
B. Proton pump inhibitors (PPIs)
C. Anticoagulants
D. Beta-blockers
Correct Answer: B
Expert Rationale: Proton pump inhibitors (omeprazole, pantoprazole) are first-line therapy for
GERD, reducing gastric acid production and promoting healing of esophageal mucosa. The 2026
post-anti-reflux surgery dietary guidelines reinforce that medications that decrease or block
stomach acid are essential for symptom control . Options A, C, and D are not indicated for GERD.
5. A client with GERD is at risk for which serious complication?
A. Aspiration pneumonia
B. Urinary tract infection
C. Deep vein thrombosis
D. Hyperglycemia
Correct Answer: A
Expert Rationale: GERD patients are at risk for aspiration of gastric contents, which can lead to
aspiration pneumonia. This is a potentially life-threatening complication, particularly in older
,adults or those with impaired swallowing. The 2026 guidelines emphasize the importance of
managing reflux to prevent this serious complication .
6. The nurse is teaching a client with GERD about proper positioning for sleep. Which position
is recommended?
A. Supine position with head flat
B. Right side-lying with head of bed elevated 30 degrees
C. Prone position
D. Left side-lying with head flat
Correct Answer: B
Expert Rationale: Right side-lying with head of bed elevation (30 degrees) reduces acid reflux by
using gravity and positioning the stomach below the esophagus. Flat positions (A, D) increase
reflux. Prone (C) is not recommended. The 2026 dietary advice after anti-reflux surgery
reinforces that remaining upright for 30 minutes after eating and sleeping with head elevated
are critical measures .
7. Which statement about the relationship between hiatal hernia and GERD is correct?
A. All patients with hiatal hernia have GERD
B. Most patients with GERD have a hiatal hernia
C. Hiatal hernia and GERD are unrelated
D. Hiatal hernia prevents GERD
Correct Answer: B
Expert Rationale: Most patients with GERD have a hiatal hernia, but not all patients with hiatal
hernia have GERD. A hiatal hernia can disrupt the lower esophageal sphincter function,
contributing to reflux. The 2026 Leeds Teaching Hospitals NHS Trust information on anti-reflux
surgery explains that a hiatus hernia, where parts of the stomach slide upwards through the
diaphragm, often occurs alongside acid reflux . Option A is incorrect; hiatal hernia can be
asymptomatic. Option C is incorrect; they are related. Option D is incorrect.
8. A client is diagnosed with peptic ulcer disease. Which is the most common cause?
A. H. pylori infection
B. Excessive caffeine intake
, C. Stress
D. High-fat diet
Correct Answer: A
Expert Rationale: Helicobacter pylori infection is the leading cause of peptic ulcer disease,
responsible for the majority of duodenal and gastric ulcers. The 2026 Chinese guidelines on
peptic ulcer nursing confirm that H. pylori-positive patients must complete eradication therapy .
NSAIDs are the second most common cause. While stress and diet can exacerbate ulcers, they
are not the primary cause.
9. A client with a peptic ulcer is prescribed a proton pump inhibitor (PPI). When should the
nurse instruct the client to take this medication?
A. With meals
B. 30 minutes before meals
C. At bedtime
D. Immediately after meals
Correct Answer: B
Expert Rationale: Proton pump inhibitors are most effective when taken 30 minutes before
meals, as they need to inhibit the proton pumps that are activated by food intake. The 2026
Chinese nursing guidelines specify that PPIs should be taken before meals for optimal acid
suppression . Options A, C, and D are incorrect based on pharmacokinetics.
10. A patient with peptic ulcer disease develops sudden, severe abdominal pain with a
boardlike abdomen. The nurse suspects:
A. Gastroesophageal reflux
B. Perforation with peritonitis
C. Gastritis
D. Constipation
Correct Answer: B
Expert Rationale: A boardlike (rigid) abdomen with sudden severe pain is a classic sign of
peritonitis, often resulting from perforation of a peptic ulcer. This is a surgical emergency
requiring immediate intervention. The 2026 N-ECCO consensus on IBD care also emphasizes
Answers + Expert Rationales | 2026 Updated | 100%
correct | Galen
1. A client with GERD asks the nurse about lifestyle changes to manage symptoms. Which
recommendation should the nurse prioritize?
A. Lie flat after meals to promote digestion
B. Eat three large meals daily
C. Elevate the head of the bed and avoid lying down for 2-3 hours after eating
D. Increase consumption of citrus fruits and tomato products
Correct Answer: C
Expert Rationale: Elevating the head of the bed and avoiding lying down for 2-3 hours after
meals reduces nocturnal acid reflux by using gravity to keep stomach contents in the stomach.
This is a cornerstone of GERD management. Large meals (B) increase gastric pressure and reflux.
Citrus and tomato products (D) are acidic and worsen symptoms. The 2026 Leeds Teaching
Hospitals NHS Trust guidelines emphasize small, frequent meals and upright positioning after
eating.
2. Which patient population is at highest risk for developing GERD?
A. Young, athletic males
B. Obese individuals, pregnant women, and older adults
C. Vegans and vegetarians
D. Individuals with low-fat diets
Correct Answer: B
Expert Rationale: Obesity increases intra-abdominal pressure promoting reflux. Pregnancy
causes hormonal relaxation of the lower esophageal sphincter and increased pressure. Older
adults have decreased esophageal motility and increased incidence of hiatal hernia. These are
well-documented risk factors. The 2026 literature confirms that tight clothing and obesity are
key risk factors for GERD. Options A, C, and D do not represent high-risk populations.
3. A client with a hiatal hernia asks if it is possible to have GERD without a hernia. Which
response is correct?
,A. No, GERD always requires a hiatal hernia
B. Yes, GERD can occur without a hiatal hernia
C. No, they are the same condition
D. Only if the patient is over 65
Correct Answer: B
Expert Rationale: GERD and hiatal hernia are distinct but related conditions. GERD results from
lower esophageal sphincter dysfunction causing acid reflux. Hiatal hernia involves stomach
protrusion through the diaphragm. A hiatal hernia can cause or worsen GERD, but GERD can
occur independently. The 2026 N-ECCO consensus statements distinguish these as separate
conditions requiring individualized assessment .
4. A client with GERD reports heartburn and indigestion. Which medication class is most
commonly prescribed for initial management?
A. Antibiotics
B. Proton pump inhibitors (PPIs)
C. Anticoagulants
D. Beta-blockers
Correct Answer: B
Expert Rationale: Proton pump inhibitors (omeprazole, pantoprazole) are first-line therapy for
GERD, reducing gastric acid production and promoting healing of esophageal mucosa. The 2026
post-anti-reflux surgery dietary guidelines reinforce that medications that decrease or block
stomach acid are essential for symptom control . Options A, C, and D are not indicated for GERD.
5. A client with GERD is at risk for which serious complication?
A. Aspiration pneumonia
B. Urinary tract infection
C. Deep vein thrombosis
D. Hyperglycemia
Correct Answer: A
Expert Rationale: GERD patients are at risk for aspiration of gastric contents, which can lead to
aspiration pneumonia. This is a potentially life-threatening complication, particularly in older
,adults or those with impaired swallowing. The 2026 guidelines emphasize the importance of
managing reflux to prevent this serious complication .
6. The nurse is teaching a client with GERD about proper positioning for sleep. Which position
is recommended?
A. Supine position with head flat
B. Right side-lying with head of bed elevated 30 degrees
C. Prone position
D. Left side-lying with head flat
Correct Answer: B
Expert Rationale: Right side-lying with head of bed elevation (30 degrees) reduces acid reflux by
using gravity and positioning the stomach below the esophagus. Flat positions (A, D) increase
reflux. Prone (C) is not recommended. The 2026 dietary advice after anti-reflux surgery
reinforces that remaining upright for 30 minutes after eating and sleeping with head elevated
are critical measures .
7. Which statement about the relationship between hiatal hernia and GERD is correct?
A. All patients with hiatal hernia have GERD
B. Most patients with GERD have a hiatal hernia
C. Hiatal hernia and GERD are unrelated
D. Hiatal hernia prevents GERD
Correct Answer: B
Expert Rationale: Most patients with GERD have a hiatal hernia, but not all patients with hiatal
hernia have GERD. A hiatal hernia can disrupt the lower esophageal sphincter function,
contributing to reflux. The 2026 Leeds Teaching Hospitals NHS Trust information on anti-reflux
surgery explains that a hiatus hernia, where parts of the stomach slide upwards through the
diaphragm, often occurs alongside acid reflux . Option A is incorrect; hiatal hernia can be
asymptomatic. Option C is incorrect; they are related. Option D is incorrect.
8. A client is diagnosed with peptic ulcer disease. Which is the most common cause?
A. H. pylori infection
B. Excessive caffeine intake
, C. Stress
D. High-fat diet
Correct Answer: A
Expert Rationale: Helicobacter pylori infection is the leading cause of peptic ulcer disease,
responsible for the majority of duodenal and gastric ulcers. The 2026 Chinese guidelines on
peptic ulcer nursing confirm that H. pylori-positive patients must complete eradication therapy .
NSAIDs are the second most common cause. While stress and diet can exacerbate ulcers, they
are not the primary cause.
9. A client with a peptic ulcer is prescribed a proton pump inhibitor (PPI). When should the
nurse instruct the client to take this medication?
A. With meals
B. 30 minutes before meals
C. At bedtime
D. Immediately after meals
Correct Answer: B
Expert Rationale: Proton pump inhibitors are most effective when taken 30 minutes before
meals, as they need to inhibit the proton pumps that are activated by food intake. The 2026
Chinese nursing guidelines specify that PPIs should be taken before meals for optimal acid
suppression . Options A, C, and D are incorrect based on pharmacokinetics.
10. A patient with peptic ulcer disease develops sudden, severe abdominal pain with a
boardlike abdomen. The nurse suspects:
A. Gastroesophageal reflux
B. Perforation with peritonitis
C. Gastritis
D. Constipation
Correct Answer: B
Expert Rationale: A boardlike (rigid) abdomen with sudden severe pain is a classic sign of
peritonitis, often resulting from perforation of a peptic ulcer. This is a surgical emergency
requiring immediate intervention. The 2026 N-ECCO consensus on IBD care also emphasizes
