ATI Med-Surg Gastrointestinal Exam Prep 2026 | 200 Practice
Questions with Answers & Rationales | Nursing Study Guide
SECTION A: UPPER GASTROINTESTINAL DISORDERS (Questions 1–50)
1. A client with gastroesophageal reflux disease (GERD) reports heartburn that awakens him at night.
Which recommendation should the nurse provide first?
A. Elevate the head of the bed on 6- to 8-inch blocks
B. Take an antacid immediately before lying down
C. Eat a large meal at bedtime to buffer acid
D. Sleep on the right side to reduce reflux
Answer: A
Explanation: Elevating the head of the bed uses gravity to reduce nocturnal reflux; antacids are short-
acting; large meals worsen reflux; left side is better.
2. A client is diagnosed with a hiatal hernia. Which statement by the client indicates understanding of
contributing factors?
A. “Obesity and increased intra-abdominal pressure can worsen my hernia.”
B. “I should lie down immediately after eating to relieve symptoms.”
C. “Drinking carbonated beverages will help reduce my symptoms.”
D. “My hernia will require immediate surgery to prevent strangulation.”
Answer: A
Explanation: Obesity, pregnancy, ascites, and heavy lifting increase intra-abdominal pressure, worsening
hiatal hernia and GERD.
3. A client with peptic ulcer disease (PUD) reports black, tarry stools. The nurse should first:
A. Assess the client’s vital signs for signs of bleeding
B. Administer a proton pump inhibitor
C. Prepare the client for an upper endoscopy
,D. Instruct the client to avoid iron supplements
Answer: A
Explanation: Black, tarry stools (melena) indicate upper GI bleeding; hemodynamic stability is priority.
Endoscopy is diagnostic but not first.
4. A client is prescribed omeprazole for GERD. The nurse should instruct the client to take this
medication:
A. 30-60 minutes before breakfast
B. With meals to reduce gastric irritation
C. At bedtime with a full glass of water
D. Only when heartburn occurs
Answer: A
Explanation: PPIs are most effective when taken on an empty stomach 30-60 min before the first meal
of the day to maximize proton pump inhibition.
5. A client with a duodenal ulcer reports that pain is relieved by eating. This is because:
A. Food buffers gastric acid, reducing duodenal acid exposure
B. The ulcer is located in the stomach, not the duodenum
C. Eating stimulates gastrin, which increases mucosal protection
D. Food physically blocks the ulcer crater
Answer: A
Explanation: Duodenal ulcer pain typically occurs 2-3 hours after meals and is relieved by food because
food buffers acid; gastric ulcer pain worsens with eating.
6. A client with a suspected perforated peptic ulcer presents with sudden, severe abdominal pain and a
rigid, board-like abdomen. The nurse should prepare for:
A. Immediate surgical consult and IV fluids
B. Administration of oral contrast for CT scan
C. Nasogastric tube irrigation with normal saline
D. Proton pump inhibitor therapy only
,Answer: A
Explanation: Perforation is a surgical emergency; resuscitation and urgent surgery are needed; NG tube
for decompression is also appropriate.
7. A client with GERD is prescribed ranitidine. The nurse explains that this medication works by:
A. Blocking histamine-2 receptors to reduce gastric acid secretion
B. Neutralizing existing stomach acid
C. Coating the esophageal mucosa
D. Inhibiting the proton pump
Answer: A
Explanation: Ranitidine is an H2 receptor antagonist; it reduces acid production but is less potent than
PPIs.
8. A client with a gastric ulcer asks why the provider prescribed both amoxicillin and clarithromycin. The
nurse explains:
A. “These antibiotics treat H. pylori infection, which is a common cause of ulcers.”
B. “The antibiotics reduce stomach acid production.”
C. “They work together to coat the ulcer and promote healing.”
D. “They prevent ulcer perforation by reducing inflammation.”
Answer: A
Explanation: H. pylori eradication requires combination antibiotic therapy (often two antibiotics plus a
PPI).
9. A client is 1 day post-esophagectomy for esophageal cancer. Which finding is most concerning?
A. Fever, crackles at lung bases, and increased white blood cell count
B. Pain rated 4 on a 0-10 scale
C. Serosanguineous drainage from chest tube
D. Nasogastric tube output of 200 mL in 4 hours
Answer: A
, Explanation: Fever and crackles suggest aspiration pneumonia or anastomotic leak; anastomotic leak is a
life-threatening complication.
10. A client with achalasia reports dysphagia to both solids and liquids, regurgitation of undigested food,
and chest pain. The nurse anticipates which diagnostic test?
A. Esophageal manometry
B. Upper GI series with barium
C. Esophagogastroduodenoscopy (EGD)
D. CT chest
Answer: A
Explanation: Esophageal manometry is the gold standard for diagnosing achalasia (failure of LES
relaxation and absent peristalsis).
11. A client with a Mallory-Weiss tear presents with hematemesis after repeated vomiting. The nurse
understands that this tear is located in the:
A. Gastroesophageal junction
B. Gastric antrum
C. Duodenal bulb
D. Esophageal body
Answer: A
Explanation: Mallory-Weiss tears are longitudinal lacerations at the gastroesophageal junction caused by
forceful retching or vomiting.
12. A client with gastroparesis secondary to diabetes is prescribed metoclopramide. The nurse should
monitor for which adverse effect?
A. Extrapyramidal symptoms (tardive dyskinesia, dystonia)
B. Hyperglycemia
C. Diarrhea
D. Hypertension
Answer: A
Questions with Answers & Rationales | Nursing Study Guide
SECTION A: UPPER GASTROINTESTINAL DISORDERS (Questions 1–50)
1. A client with gastroesophageal reflux disease (GERD) reports heartburn that awakens him at night.
Which recommendation should the nurse provide first?
A. Elevate the head of the bed on 6- to 8-inch blocks
B. Take an antacid immediately before lying down
C. Eat a large meal at bedtime to buffer acid
D. Sleep on the right side to reduce reflux
Answer: A
Explanation: Elevating the head of the bed uses gravity to reduce nocturnal reflux; antacids are short-
acting; large meals worsen reflux; left side is better.
2. A client is diagnosed with a hiatal hernia. Which statement by the client indicates understanding of
contributing factors?
A. “Obesity and increased intra-abdominal pressure can worsen my hernia.”
B. “I should lie down immediately after eating to relieve symptoms.”
C. “Drinking carbonated beverages will help reduce my symptoms.”
D. “My hernia will require immediate surgery to prevent strangulation.”
Answer: A
Explanation: Obesity, pregnancy, ascites, and heavy lifting increase intra-abdominal pressure, worsening
hiatal hernia and GERD.
3. A client with peptic ulcer disease (PUD) reports black, tarry stools. The nurse should first:
A. Assess the client’s vital signs for signs of bleeding
B. Administer a proton pump inhibitor
C. Prepare the client for an upper endoscopy
,D. Instruct the client to avoid iron supplements
Answer: A
Explanation: Black, tarry stools (melena) indicate upper GI bleeding; hemodynamic stability is priority.
Endoscopy is diagnostic but not first.
4. A client is prescribed omeprazole for GERD. The nurse should instruct the client to take this
medication:
A. 30-60 minutes before breakfast
B. With meals to reduce gastric irritation
C. At bedtime with a full glass of water
D. Only when heartburn occurs
Answer: A
Explanation: PPIs are most effective when taken on an empty stomach 30-60 min before the first meal
of the day to maximize proton pump inhibition.
5. A client with a duodenal ulcer reports that pain is relieved by eating. This is because:
A. Food buffers gastric acid, reducing duodenal acid exposure
B. The ulcer is located in the stomach, not the duodenum
C. Eating stimulates gastrin, which increases mucosal protection
D. Food physically blocks the ulcer crater
Answer: A
Explanation: Duodenal ulcer pain typically occurs 2-3 hours after meals and is relieved by food because
food buffers acid; gastric ulcer pain worsens with eating.
6. A client with a suspected perforated peptic ulcer presents with sudden, severe abdominal pain and a
rigid, board-like abdomen. The nurse should prepare for:
A. Immediate surgical consult and IV fluids
B. Administration of oral contrast for CT scan
C. Nasogastric tube irrigation with normal saline
D. Proton pump inhibitor therapy only
,Answer: A
Explanation: Perforation is a surgical emergency; resuscitation and urgent surgery are needed; NG tube
for decompression is also appropriate.
7. A client with GERD is prescribed ranitidine. The nurse explains that this medication works by:
A. Blocking histamine-2 receptors to reduce gastric acid secretion
B. Neutralizing existing stomach acid
C. Coating the esophageal mucosa
D. Inhibiting the proton pump
Answer: A
Explanation: Ranitidine is an H2 receptor antagonist; it reduces acid production but is less potent than
PPIs.
8. A client with a gastric ulcer asks why the provider prescribed both amoxicillin and clarithromycin. The
nurse explains:
A. “These antibiotics treat H. pylori infection, which is a common cause of ulcers.”
B. “The antibiotics reduce stomach acid production.”
C. “They work together to coat the ulcer and promote healing.”
D. “They prevent ulcer perforation by reducing inflammation.”
Answer: A
Explanation: H. pylori eradication requires combination antibiotic therapy (often two antibiotics plus a
PPI).
9. A client is 1 day post-esophagectomy for esophageal cancer. Which finding is most concerning?
A. Fever, crackles at lung bases, and increased white blood cell count
B. Pain rated 4 on a 0-10 scale
C. Serosanguineous drainage from chest tube
D. Nasogastric tube output of 200 mL in 4 hours
Answer: A
, Explanation: Fever and crackles suggest aspiration pneumonia or anastomotic leak; anastomotic leak is a
life-threatening complication.
10. A client with achalasia reports dysphagia to both solids and liquids, regurgitation of undigested food,
and chest pain. The nurse anticipates which diagnostic test?
A. Esophageal manometry
B. Upper GI series with barium
C. Esophagogastroduodenoscopy (EGD)
D. CT chest
Answer: A
Explanation: Esophageal manometry is the gold standard for diagnosing achalasia (failure of LES
relaxation and absent peristalsis).
11. A client with a Mallory-Weiss tear presents with hematemesis after repeated vomiting. The nurse
understands that this tear is located in the:
A. Gastroesophageal junction
B. Gastric antrum
C. Duodenal bulb
D. Esophageal body
Answer: A
Explanation: Mallory-Weiss tears are longitudinal lacerations at the gastroesophageal junction caused by
forceful retching or vomiting.
12. A client with gastroparesis secondary to diabetes is prescribed metoclopramide. The nurse should
monitor for which adverse effect?
A. Extrapyramidal symptoms (tardive dyskinesia, dystonia)
B. Hyperglycemia
C. Diarrhea
D. Hypertension
Answer: A
