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MED SURG GASTROINTESTINAL NCLEX
EXAM | ACTUAL EXAM QUESTIONS 2025
UPDATE
After undergoing Billroth I gastric surgery, the client experiences fatigue and
complains of numbness and tingling in the feet and difficulties with balance. On
the basis of these symptoms, the nurse suspects which postoperative
complication?
A. Stroke
B. Pernicious anemia
C. Bacterial meningitis
D. Peripheral arterial disease - correct-answer-B. Pernicious anemia
Rationale:
Billroth I surgery involves removing one half to two thirds of the stomach and
reanastomosing the remaining segment of the stomach to the duodenum. With
the loss of this much of the stomach, development of pernicious anemia is not
uncommon. Pernicious anemia is a macrocytic anemia that most commonly is
caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion
of the parietal cells, which are responsible for producing intrinsic factor (a
necessary component for vitamin B12 absorption), are removed. In this anemia,
the red blood cell is larger than usual and hence does not last as long in the
circulation as normal red blood cells do, causing the client to have anemia with
,2|Page
resultant fatigue. Vitamin B12 also is necessary for normal nerve function.
Because of the lack of the necessary intrinsic factor, persons with pernicious
anemia also experience paresthesias, impaired gait, and impaired balance.
Although the symptoms could possibly indicate the other options listed,
pernicious anemia is the most logical based on the surgery the client underwent.
A client experiencing chronic dumping syndrome makes the following comments
to the nurse. Which one indicates the need for further teaching?
A. "I eat at least 3 large meals each day."
B. "I eat while lying in a semirecumbent position."
C. "I have eliminated taking liquids with my meals."
D. "I eat a high-protein, low- to moderate-carbohydrate diet." - correct-answer-A.
"I eat at least 3 large meals each day."
Rationale:
Dumping syndrome describes a group of symptoms that occur after eating. It is
believed to result from rapid dumping of gastric contents into the small intestine,
which causes fluid to shift into the intestine. Signs and symptoms of dumping
syndrome include diarrhea, abdominal distention, sweating, pallor, palpitations,
and syncope. To manage this syndrome, clients are encouraged to decrease the
amount of food taken at each sitting, eat in a semirecumbent position, eliminate
ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.
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The nurse obtains an admission history for a client with suspected peptic ulcer
disease (PUD). Which client factor documented by the nurse would increase the
risk for PUD?
A. Recently retired from a job
B. Significant other has a gastric ulcer
C. Occasionally drinks 1 cup of coffee in the morning
D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis - correct-
answer-D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis
Rationale:
Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine),
chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress.
When an NSAID is taken as often as is typical for osteoarthritis, it will cause
problems with the stomach. Certain medical conditions such as Crohn's disease,
Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the
risk for PUD by changing the amount of gastric and biliary acids produced. Recent
retirement should decrease stress levels rather than increase them. Ulcer disease
in a first-degree relative also is associated with increased risk for an ulcer. A
significant other is not a first-degree relative; therefore, no genetic connection is
noted in this relationship. Although caffeinated drinks are a known risk factor for
PUD, the option states that the client drinks 1 cup of coffee occasionally.
A client who has undergone gastric surgery has a nasogastric (NG) tube connected
to low intermittent suction that is not draining properly. Which action should the
nurse take initially?
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A. Call the surgeon to report the problem.
B. Reposition the NG tube to the proper location.
C. Check the suction device to make sure it is working.
D. Irrigate the NG tube with saline to remove the obstruction. - correct-answer-C.
Check the suction device to make sure it is working.
Rationale:
After gastric surgery, the client will have an NG tube in place until bowel function
returns. It is important for the NG tube to drain properly to prevent abdominal
distention and vomiting. The nurse must ensure that the NG tube is attached to
suction at the level prescribed and that the suction device is working correctly.
The tip of the NG tube may be placed near the suture line. Because of this
possibility, the nurse should never reposition the NG tube or irrigate it. If the NG
tube needs to be repositioned, the nurse should call the surgeon, who would do
this repositioning under fluoroscopy.
The nurse is caring for a client with ulcerative colitis. Which finding does the nurse
determine is consistent with this diagnosis?
A. Hypercalcemia
B. Hypernatremia
C. Frothy, fatty stools
D. Decreased hemoglobin - correct-answer-D. Decreased hemoglobin
Rationale:
MED SURG GASTROINTESTINAL NCLEX
EXAM | ACTUAL EXAM QUESTIONS 2025
UPDATE
After undergoing Billroth I gastric surgery, the client experiences fatigue and
complains of numbness and tingling in the feet and difficulties with balance. On
the basis of these symptoms, the nurse suspects which postoperative
complication?
A. Stroke
B. Pernicious anemia
C. Bacterial meningitis
D. Peripheral arterial disease - correct-answer-B. Pernicious anemia
Rationale:
Billroth I surgery involves removing one half to two thirds of the stomach and
reanastomosing the remaining segment of the stomach to the duodenum. With
the loss of this much of the stomach, development of pernicious anemia is not
uncommon. Pernicious anemia is a macrocytic anemia that most commonly is
caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion
of the parietal cells, which are responsible for producing intrinsic factor (a
necessary component for vitamin B12 absorption), are removed. In this anemia,
the red blood cell is larger than usual and hence does not last as long in the
circulation as normal red blood cells do, causing the client to have anemia with
,2|Page
resultant fatigue. Vitamin B12 also is necessary for normal nerve function.
Because of the lack of the necessary intrinsic factor, persons with pernicious
anemia also experience paresthesias, impaired gait, and impaired balance.
Although the symptoms could possibly indicate the other options listed,
pernicious anemia is the most logical based on the surgery the client underwent.
A client experiencing chronic dumping syndrome makes the following comments
to the nurse. Which one indicates the need for further teaching?
A. "I eat at least 3 large meals each day."
B. "I eat while lying in a semirecumbent position."
C. "I have eliminated taking liquids with my meals."
D. "I eat a high-protein, low- to moderate-carbohydrate diet." - correct-answer-A.
"I eat at least 3 large meals each day."
Rationale:
Dumping syndrome describes a group of symptoms that occur after eating. It is
believed to result from rapid dumping of gastric contents into the small intestine,
which causes fluid to shift into the intestine. Signs and symptoms of dumping
syndrome include diarrhea, abdominal distention, sweating, pallor, palpitations,
and syncope. To manage this syndrome, clients are encouraged to decrease the
amount of food taken at each sitting, eat in a semirecumbent position, eliminate
ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.
,3|Page
The nurse obtains an admission history for a client with suspected peptic ulcer
disease (PUD). Which client factor documented by the nurse would increase the
risk for PUD?
A. Recently retired from a job
B. Significant other has a gastric ulcer
C. Occasionally drinks 1 cup of coffee in the morning
D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis - correct-
answer-D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis
Rationale:
Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine),
chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress.
When an NSAID is taken as often as is typical for osteoarthritis, it will cause
problems with the stomach. Certain medical conditions such as Crohn's disease,
Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the
risk for PUD by changing the amount of gastric and biliary acids produced. Recent
retirement should decrease stress levels rather than increase them. Ulcer disease
in a first-degree relative also is associated with increased risk for an ulcer. A
significant other is not a first-degree relative; therefore, no genetic connection is
noted in this relationship. Although caffeinated drinks are a known risk factor for
PUD, the option states that the client drinks 1 cup of coffee occasionally.
A client who has undergone gastric surgery has a nasogastric (NG) tube connected
to low intermittent suction that is not draining properly. Which action should the
nurse take initially?
, 4|Page
A. Call the surgeon to report the problem.
B. Reposition the NG tube to the proper location.
C. Check the suction device to make sure it is working.
D. Irrigate the NG tube with saline to remove the obstruction. - correct-answer-C.
Check the suction device to make sure it is working.
Rationale:
After gastric surgery, the client will have an NG tube in place until bowel function
returns. It is important for the NG tube to drain properly to prevent abdominal
distention and vomiting. The nurse must ensure that the NG tube is attached to
suction at the level prescribed and that the suction device is working correctly.
The tip of the NG tube may be placed near the suture line. Because of this
possibility, the nurse should never reposition the NG tube or irrigate it. If the NG
tube needs to be repositioned, the nurse should call the surgeon, who would do
this repositioning under fluoroscopy.
The nurse is caring for a client with ulcerative colitis. Which finding does the nurse
determine is consistent with this diagnosis?
A. Hypercalcemia
B. Hypernatremia
C. Frothy, fatty stools
D. Decreased hemoglobin - correct-answer-D. Decreased hemoglobin
Rationale:
