Maryville NURS 623 Exam 3, Exam 3 NURS 623 REAL
EXAM GUIDE NEWEST VERSION 2026-2027 EXPECTED
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.RATED A GRADE
What is the most common psychiatric disorder in the U.S?
CORRECT ANS: Anxiety
Expert Rationale
Anxiety disorders are the most prevalent psychiatric disorders in the United States,
affecting a significant portion of the population. This category includes generalized
anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. The
high prevalence of anxiety is attributed to a combination of genetic, environmental, and
psychological factors. Unlike other psychiatric conditions such as mood disorders or
psychotic disorders, anxiety disorders are often underdiagnosed yet have a lifetime
prevalence that surpasses all other mental health conditions. Given their high prevalence
and significant impact on quality of life, understanding and recognizing anxiety
disorders is critical for healthcare providers in primary care and psychiatric settings.
DIF: Cognitive Level: Remember (Knowledge) TOP: Psychiatric Disorders
MSC: NCLEX: Psychosocial Integrity
Describe the clinical presentation for Gastroesophageal Reflux Disease (GERD)?
CORANS: heartburn, regurgitation, water brash (reflex salivation), sour taste in
morning, belching, coughing, and hoarseness. Objective: only sign may be occult
blood in stool.
Expert Rationale
Gastroesophageal reflux disease (GERD) is a chronic condition caused by the retrograde
flow of gastric contents into the esophagus. The classic subjective symptoms include
heartburn (a burning sensation in the chest), regurgitation (the sensation of acid
,backing up into the throat or mouth), and water brash (sudden salivation due to reflex
stimulation). Patients frequently report a sour or bitter taste upon awakening, belching,
and chronic cough, which is often worse at night. Hoarseness and a feeling of a lump in
the throat are also common extraesophageal manifestations. The only objective finding
on a routine physical exam may be occult blood in the stool, which suggests mucosal
irritation or bleeding. Diagnosis is primarily clinical, but endoscopy may be warranted in
specific cases.
DIF: Cognitive Level: Understand (Comprehension) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
How is GERD diagnosed (when to refer to GI)?
CORANS: With symptoms, sometimes with upper endo; refer if failed treatment of
step 2- after 6 weeks of treatment
Expert Rationale
The diagnosis of GERD is typically based on the patient's clinical presentation and
response to empiric therapy. Patients who present with classic symptoms of heartburn
and regurgitation can be diagnosed clinically. Upper endoscopy is not required for all
patients but is indicated when there are "alarm symptoms" (dysphagia, odynophagia,
bleeding, weight loss, or anemia) or when symptoms are refractory to initial treatment. A
referral to a gastroenterologist is appropriate when a patient has failed to respond to
step 2 of treatment (usually a trial of a proton pump inhibitor, or PPI) after 6 weeks of
therapy. This ensures that patients with complex or severe disease receive appropriate
diagnostic evaluation, such as pH monitoring or endoscopy, to rule out complications
like Barrett's esophagus or erosive esophagitis.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
Discuss the patient education regarding lifestyle changes for management of GERD.
CORANS: lifestyle changes including diet weight loss, raising the head of their bed
6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours
,after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as
chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes,
wearing loose comfortable clothing, and starting a routine exercise and weight
loss program
Expert Rationale
Lifestyle modifications are the cornerstone of GERD management and should be the
first-line intervention. Patient education should emphasize several key changes.
Elevating the head of the bed by 6 to 8 inches helps to prevent nocturnal reflux by using
gravity to keep gastric contents in the stomach. Patients should avoid lying down or
sleeping for 3 to 4 hours after meals, as recumbency promotes reflux. Weight loss and a
routine exercise program are essential, as obesity increases intra-abdominal pressure
and reflux. Specific dietary triggers—including chocolate, alcohol, peppermint, caffeine,
onions, garlic, citrus, and tomatoes—should be avoided. Wearing loose, comfortable
clothing reduces pressure on the abdomen. These modifications are not only effective in
symptom reduction but also empower patients to take an active role in their disease
management.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Health Promotion and Maintenance
Describe medical management of GERD?
CORANS: step-up: LIFESTYLE changes, PRN OTC H2ra and antacid; PPI; referral;
Step-down: starts with PPI then step down until Sx under control
Expert Rationale
The medical management of GERD follows a stepped approach based on symptom
severity and response to therapy. The "step-up" approach begins with lifestyle
modifications, followed by over-the-counter (OTC) H2 receptor antagonists (H2RAs) and
antacids as needed. If symptoms persist, a proton pump inhibitor (PPI) is initiated. If
there is no response to PPI therapy, referral to a gastroenterologist is indicated. The
"step-down" approach is used for patients who initially present with more severe
symptoms. This method starts with a full-dose PPI to achieve rapid symptom control
and then gradually steps down to the lowest effective dose, often switching to an H2RA
, or using the PPI on an "as-needed" basis. This approach maintains symptom control
while minimizing long-term medication use.
DIF: Cognitive Level: Understand (Comprehension) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
46 year old male complains of dysphagia hoarseness and cough he states he wakes up
with a sour taste in his mouth. What is the most likely cause of the patient symptoms?
CORANS: GERD
Expert Rationale
The patient's constellation of symptoms—dysphagia (difficulty swallowing), hoarseness,
chronic cough, and a sour taste upon awakening—are classic atypical or
extraesophageal manifestations of GERD. The sour taste is due to the reflux of gastric
acid into the mouth overnight. While dysphagia can be a concerning "alarm symptom"
that may warrant further evaluation, in the context of other GERD symptoms, it is often a
result of acid-induced inflammation and esophageal dysmotility. The hoarseness and
cough are caused by micro-aspiration of gastric contents or direct irritation of the vocal
cords and larynx. This presentation is highly suggestive of GERD, and a therapeutic trial
of acid suppression is often indicated.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
Management of peptic/gastric ulcer.
CORANS: relieve pain, heal the ulcer, and prevent complications/reoccurrence;
PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI,
antacids, antibx w/H-pylori)
Expert Rationale
The management of peptic ulcer disease (PUD) focuses on three primary goals: relieving
pain, healing the ulcer, and preventing complications and recurrence. Pharmacological
EXAM GUIDE NEWEST VERSION 2026-2027 EXPECTED
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.RATED A GRADE
What is the most common psychiatric disorder in the U.S?
CORRECT ANS: Anxiety
Expert Rationale
Anxiety disorders are the most prevalent psychiatric disorders in the United States,
affecting a significant portion of the population. This category includes generalized
anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. The
high prevalence of anxiety is attributed to a combination of genetic, environmental, and
psychological factors. Unlike other psychiatric conditions such as mood disorders or
psychotic disorders, anxiety disorders are often underdiagnosed yet have a lifetime
prevalence that surpasses all other mental health conditions. Given their high prevalence
and significant impact on quality of life, understanding and recognizing anxiety
disorders is critical for healthcare providers in primary care and psychiatric settings.
DIF: Cognitive Level: Remember (Knowledge) TOP: Psychiatric Disorders
MSC: NCLEX: Psychosocial Integrity
Describe the clinical presentation for Gastroesophageal Reflux Disease (GERD)?
CORANS: heartburn, regurgitation, water brash (reflex salivation), sour taste in
morning, belching, coughing, and hoarseness. Objective: only sign may be occult
blood in stool.
Expert Rationale
Gastroesophageal reflux disease (GERD) is a chronic condition caused by the retrograde
flow of gastric contents into the esophagus. The classic subjective symptoms include
heartburn (a burning sensation in the chest), regurgitation (the sensation of acid
,backing up into the throat or mouth), and water brash (sudden salivation due to reflex
stimulation). Patients frequently report a sour or bitter taste upon awakening, belching,
and chronic cough, which is often worse at night. Hoarseness and a feeling of a lump in
the throat are also common extraesophageal manifestations. The only objective finding
on a routine physical exam may be occult blood in the stool, which suggests mucosal
irritation or bleeding. Diagnosis is primarily clinical, but endoscopy may be warranted in
specific cases.
DIF: Cognitive Level: Understand (Comprehension) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
How is GERD diagnosed (when to refer to GI)?
CORANS: With symptoms, sometimes with upper endo; refer if failed treatment of
step 2- after 6 weeks of treatment
Expert Rationale
The diagnosis of GERD is typically based on the patient's clinical presentation and
response to empiric therapy. Patients who present with classic symptoms of heartburn
and regurgitation can be diagnosed clinically. Upper endoscopy is not required for all
patients but is indicated when there are "alarm symptoms" (dysphagia, odynophagia,
bleeding, weight loss, or anemia) or when symptoms are refractory to initial treatment. A
referral to a gastroenterologist is appropriate when a patient has failed to respond to
step 2 of treatment (usually a trial of a proton pump inhibitor, or PPI) after 6 weeks of
therapy. This ensures that patients with complex or severe disease receive appropriate
diagnostic evaluation, such as pH monitoring or endoscopy, to rule out complications
like Barrett's esophagus or erosive esophagitis.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
Discuss the patient education regarding lifestyle changes for management of GERD.
CORANS: lifestyle changes including diet weight loss, raising the head of their bed
6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours
,after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as
chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes,
wearing loose comfortable clothing, and starting a routine exercise and weight
loss program
Expert Rationale
Lifestyle modifications are the cornerstone of GERD management and should be the
first-line intervention. Patient education should emphasize several key changes.
Elevating the head of the bed by 6 to 8 inches helps to prevent nocturnal reflux by using
gravity to keep gastric contents in the stomach. Patients should avoid lying down or
sleeping for 3 to 4 hours after meals, as recumbency promotes reflux. Weight loss and a
routine exercise program are essential, as obesity increases intra-abdominal pressure
and reflux. Specific dietary triggers—including chocolate, alcohol, peppermint, caffeine,
onions, garlic, citrus, and tomatoes—should be avoided. Wearing loose, comfortable
clothing reduces pressure on the abdomen. These modifications are not only effective in
symptom reduction but also empower patients to take an active role in their disease
management.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Health Promotion and Maintenance
Describe medical management of GERD?
CORANS: step-up: LIFESTYLE changes, PRN OTC H2ra and antacid; PPI; referral;
Step-down: starts with PPI then step down until Sx under control
Expert Rationale
The medical management of GERD follows a stepped approach based on symptom
severity and response to therapy. The "step-up" approach begins with lifestyle
modifications, followed by over-the-counter (OTC) H2 receptor antagonists (H2RAs) and
antacids as needed. If symptoms persist, a proton pump inhibitor (PPI) is initiated. If
there is no response to PPI therapy, referral to a gastroenterologist is indicated. The
"step-down" approach is used for patients who initially present with more severe
symptoms. This method starts with a full-dose PPI to achieve rapid symptom control
and then gradually steps down to the lowest effective dose, often switching to an H2RA
, or using the PPI on an "as-needed" basis. This approach maintains symptom control
while minimizing long-term medication use.
DIF: Cognitive Level: Understand (Comprehension) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
46 year old male complains of dysphagia hoarseness and cough he states he wakes up
with a sour taste in his mouth. What is the most likely cause of the patient symptoms?
CORANS: GERD
Expert Rationale
The patient's constellation of symptoms—dysphagia (difficulty swallowing), hoarseness,
chronic cough, and a sour taste upon awakening—are classic atypical or
extraesophageal manifestations of GERD. The sour taste is due to the reflux of gastric
acid into the mouth overnight. While dysphagia can be a concerning "alarm symptom"
that may warrant further evaluation, in the context of other GERD symptoms, it is often a
result of acid-induced inflammation and esophageal dysmotility. The hoarseness and
cough are caused by micro-aspiration of gastric contents or direct irritation of the vocal
cords and larynx. This presentation is highly suggestive of GERD, and a therapeutic trial
of acid suppression is often indicated.
DIF: Cognitive Level: Apply (Application) TOP: Gastrointestinal Disorders
MSC: NCLEX: Physiological Integrity
Management of peptic/gastric ulcer.
CORANS: relieve pain, heal the ulcer, and prevent complications/reoccurrence;
PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI,
antacids, antibx w/H-pylori)
Expert Rationale
The management of peptic ulcer disease (PUD) focuses on three primary goals: relieving
pain, healing the ulcer, and preventing complications and recurrence. Pharmacological
