,QUESTION 1
A client with GERD is prescribed omeprazole. Which instruction should the nurse include in the
teaching plan?
A) Take the medication immediately after the largest meal of the day.
B) Take the medication 30 to 60 minutes before breakfast.
C) Chew the capsule thoroughly before swallowing.
D) Limit fluid intake while taking this medication.
CORRECT ANSWER: B) Take the medication 30 to 60 minutes before breakfast.
Rationale: Proton pump inhibitors (PPIs) such as omeprazole inhibit the H+/K+ ATPase enzyme system. They
are most effective when taken on an empty stomach 30 to 60 minutes prior to the first meal of the day, as
meal ingestion stimulates the proton pumps.
QUESTION 2
Which clinical manifestation should the nurse expect in a client diagnosed with a severe hiatal hernia?
A) Right lower quadrant abdominal pain
B) Retrosternal burning, regurgitation, and dysphagia
C) Clay-colored stools and jaundice
D) Projectile vomiting and constipation
CORRECT ANSWER: B) Retrosternal burning, regurgitation, and dysphagia
Rationale: Hiatal hernia occurs when a portion of the stomach herniates through the esophageal hiatus into
the thorax. Common findings include heartburn (pyrosis), regurgitation, dysphagia, and chest pain mimicking
angina.
QUESTION 3
The nurse provides care for a client following an Esophagogastroduodenoscopy (EGD). What is the
priority nursing action?
A) Administer prescribed oral analgesics for throat soreness.
B) Assess for the return of the gag reflex prior to offering fluids.
C) Encourage immediate ambulation to prevent deep vein thrombosis.
D) Position the client in a left lateral Sims position for 4 hours.
CORRECT ANSWER: B) Assess for the return of the gag reflex prior to offering fluids.
Rationale: Local topical anesthesia applied to the pharynx during EGD depresses the gag reflex. To prevent
aspiration, fluids and food must be withheld until the gag reflex fully returns.
, QUESTION 4
A client with esophageal varices experiences acute hematemesis. Which intervention takes absolute
priority?
A) Insert a nasogastric tube for decompression.
B) Ensure patent airway and evaluate hemodynamic stability.
C) Administer an oral antacid immediately.
D) Prepare the client for an urgent barium swallow test.
CORRECT ANSWER: B) Ensure patent airway and evaluate hemodynamic stability.
Rationale: Massive bleeding from esophageal varices poses a life-threatening risk of airway compromise and
hypovolemic shock. Airway protection, oxygenation, and fluid/blood resuscitation are the immediate
priorities.
QUESTION 5
A client admitted with suspected peptic ulcer disease (PUD) reports burning epigastric pain that
improves immediately after eating. The nurse recognizes this as indicative of:
A) Gastric ulcer
B) Duodenal ulcer
C) Esophageal stricture
D) Acute pancreatitis
CORRECT ANSWER: B) Duodenal ulcer
Rationale: Pain from duodenal ulcers classically occurs 2 to 3 hours after meals or at night and is relieved by
food or antacids because food buffers stomach acid. In contrast, gastric ulcer pain worsens shortly after
eating.
QUESTION 6
The nurse reviews laboratory results for a client diagnosed with chronic gastritis. Which finding
suggests a deficiency in intrinsic factor?
A) Microcytic hypochromic anemia
B) Macrocytic normochromic anemia (Pernicious anemia)
C) Elevated white blood cell count
D) Thrombocytopenia
CORRECT ANSWER: B) Macrocytic normochromic anemia (Pernicious anemia)
Rationale: Chronic gastritis (especially Type A autoimmune) leads to atrophy of gastric parietal cells,
resulting in loss of intrinsic factor essential for vitamin B12 absorption, leading to pernicious anemia.
A client with GERD is prescribed omeprazole. Which instruction should the nurse include in the
teaching plan?
A) Take the medication immediately after the largest meal of the day.
B) Take the medication 30 to 60 minutes before breakfast.
C) Chew the capsule thoroughly before swallowing.
D) Limit fluid intake while taking this medication.
CORRECT ANSWER: B) Take the medication 30 to 60 minutes before breakfast.
Rationale: Proton pump inhibitors (PPIs) such as omeprazole inhibit the H+/K+ ATPase enzyme system. They
are most effective when taken on an empty stomach 30 to 60 minutes prior to the first meal of the day, as
meal ingestion stimulates the proton pumps.
QUESTION 2
Which clinical manifestation should the nurse expect in a client diagnosed with a severe hiatal hernia?
A) Right lower quadrant abdominal pain
B) Retrosternal burning, regurgitation, and dysphagia
C) Clay-colored stools and jaundice
D) Projectile vomiting and constipation
CORRECT ANSWER: B) Retrosternal burning, regurgitation, and dysphagia
Rationale: Hiatal hernia occurs when a portion of the stomach herniates through the esophageal hiatus into
the thorax. Common findings include heartburn (pyrosis), regurgitation, dysphagia, and chest pain mimicking
angina.
QUESTION 3
The nurse provides care for a client following an Esophagogastroduodenoscopy (EGD). What is the
priority nursing action?
A) Administer prescribed oral analgesics for throat soreness.
B) Assess for the return of the gag reflex prior to offering fluids.
C) Encourage immediate ambulation to prevent deep vein thrombosis.
D) Position the client in a left lateral Sims position for 4 hours.
CORRECT ANSWER: B) Assess for the return of the gag reflex prior to offering fluids.
Rationale: Local topical anesthesia applied to the pharynx during EGD depresses the gag reflex. To prevent
aspiration, fluids and food must be withheld until the gag reflex fully returns.
, QUESTION 4
A client with esophageal varices experiences acute hematemesis. Which intervention takes absolute
priority?
A) Insert a nasogastric tube for decompression.
B) Ensure patent airway and evaluate hemodynamic stability.
C) Administer an oral antacid immediately.
D) Prepare the client for an urgent barium swallow test.
CORRECT ANSWER: B) Ensure patent airway and evaluate hemodynamic stability.
Rationale: Massive bleeding from esophageal varices poses a life-threatening risk of airway compromise and
hypovolemic shock. Airway protection, oxygenation, and fluid/blood resuscitation are the immediate
priorities.
QUESTION 5
A client admitted with suspected peptic ulcer disease (PUD) reports burning epigastric pain that
improves immediately after eating. The nurse recognizes this as indicative of:
A) Gastric ulcer
B) Duodenal ulcer
C) Esophageal stricture
D) Acute pancreatitis
CORRECT ANSWER: B) Duodenal ulcer
Rationale: Pain from duodenal ulcers classically occurs 2 to 3 hours after meals or at night and is relieved by
food or antacids because food buffers stomach acid. In contrast, gastric ulcer pain worsens shortly after
eating.
QUESTION 6
The nurse reviews laboratory results for a client diagnosed with chronic gastritis. Which finding
suggests a deficiency in intrinsic factor?
A) Microcytic hypochromic anemia
B) Macrocytic normochromic anemia (Pernicious anemia)
C) Elevated white blood cell count
D) Thrombocytopenia
CORRECT ANSWER: B) Macrocytic normochromic anemia (Pernicious anemia)
Rationale: Chronic gastritis (especially Type A autoimmune) leads to atrophy of gastric parietal cells,
resulting in loss of intrinsic factor essential for vitamin B12 absorption, leading to pernicious anemia.
