NSG 123 Med Surg Exam 2: GI Disorders - PUD, GERD, IBD, Appendicitis,
Diverticulitis, Cholelithiasis, Nutrition, TPN | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: Medical-Surgical Nursing I – Gastrointestinal Disorders: Peptic Ulcer Disease (Perforation,
Bleeding, H. pylori, Sucralfate); GERD (Barrett's Esophagus, PPIs, H2 Blockers, Lifestyle); Inflammatory
Bowel Disease (Crohn's Disease vs Ulcerative Colitis, Cobblestone Appearance, Tenesmus, Colonoscopy);
Appendicitis (McBurney Point, Peritonitis, Rupture); Diverticulitis (LLQ Pain, Foods to Avoid);
Cholelithiasis/Cholecystitis (RUQ Pain Radiating to Right Shoulder, T-tube, Low Fat Diet); Bariatric
Surgery (Intragastric Balloon, Post-op Education); Obesity (BMI, Orlistat, Warfarin Interaction);
Constipation (Definition <3 BM/week, High Fiber); Diarrhea (C. diff, Pseudomembranous Colitis,
Antidiarrheals Contraindicated); Bowel Obstruction (SBO vs LBO, NG Decompression); Enteral &
Parenteral Nutrition (TPN, PPN, Central Line, Blood Sugar Q6hrs, Dextrose in Water)
Source: NSG 123 Med Surg Exam 2 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
1. Which assessment indicates to the nurse the client's gastric ulcer has perforated?
Correct Answer: A rigid, boardlike abdomen with rebound tenderness is the classic clinical
manifestation of peritonitis, which is a complication of a perforated gastric ulcer.
1. Perforation is a surgical emergency.
2. Air under diaphragm on x-ray is also indicative.
2. The nurse has been assigned to care for a client with peptic ulcer disease. Which intervention data requires
further intervention?
Correct Answer: A decrease in systolic blood pressure of 20 mmHg from lying to sitting. A decrease of
20 mmHg after changing position from lying to sitting or standing indicates orthostatic hypotension.
These findings indicate the client is bleeding.
1. Orthostatic hypotension suggests significant blood loss (hypovolemia).
2. Monitor for melena, hematemesis, tachycardia.
3. What is the biggest risk factor for peptic ulcer disease?
Correct Answer: Patient diagnosed with Helicobacter pylori (H. pylori) and NSAIDs.
1. H. pylori found in 60-80% of gastric ulcers and >90% of duodenal ulcers.
2. NSAIDs inhibit prostaglandins that protect gastric mucosa.
4. What medication forms a protective barrier to heal ulcers for peptic ulcer disease?
Correct Answer: Sucralfate. Coating protection prior to meals. Take sucralfate on empty stomach, two
hours after or one hour before meals. Effective in healing duodenal ulcers and in maintaining therapy to
prevent ulcer recurrence.
1. Sucralfate forms an adhesive barrier over the ulcer site.
2. Do not give with antacids (separate by 30 minutes).
, 5. What medications will a patient with peptic ulcer diagnosed with H. pylori take?
Correct Answer: Antibiotics, PPIs (omeprazole/Prilosec), Bismuth salts (Pepto-Bismol). These
medications suppress or eradicate H. pylori.
1. Triple or quadruple therapy for 10-14 days.
2. Common regimen: PPI + amoxicillin + clarithromycin.
6. What medication should a patient with peptic ulcer avoid?
Correct Answer: NSAIDs, aspirin, ibuprofen, naproxen, indomethacin.
1. These medications inhibit prostaglandin synthesis, reducing mucosal protection.
2. Acetaminophen is safe alternative for pain.
7. When would a patient with gastric ulcer experience pain?
Correct Answer: Gastric ulcer: pain occurs 30 minutes to 1 hour after meal. Pain increases with food,
worse at night. Weight loss. Vomiting blood (hematemesis).
1. Gastric ulcers: eating stimulates acid secretion and pain.
2. Duodenal ulcers: pain decreased with food, occurs 2-3 hours after eating, worse at night, weight gain, melena.
8. What symptoms will the nurse expect in a patient with GERD?
Correct Answer: Heartburn, regurgitation (hot, bitter, or sour liquid coming into throat or mouth),
dyspepsia (pain or discomfort centered in upper abdomen), hypersalivation, burning tight sensation felt
beneath lower sternum spreading upward to throat or jaw.
1. Heartburn is most common symptom.
2. Regurgitation is classic for GERD.
9. What are some complications of GERD?
Correct Answer: Barrett's esophagus (esophageal metaplasia) – risk of cancer. Pre-cancerous lesions
due to GERD. Diagnosis via endoscopy shows lining that is pink instead of pale white. Must be
monitored every 2 to 3 years by endoscopy.
1. Barrett's esophagus is intestinal metaplasia of lower esophagus.
2. Increases risk of esophageal adenocarcinoma.
10. What medications will a patient with GERD need and how will you educate?
Correct Answer: PPIs (omeprazole), antacids (magnesium hydroxide/aluminum hydrate), acid
protective (sucralfate), H2 blockers (ranitidine). Education: Take H2 blockers at HS (hours sleep). Prop
HOB with blocks (elevation of head of bed at least 30°). Do not lie down for 2-3 hours after eating.
Avoid late night eating. Eat small meals (6-8 per day) low fat. Avoid tobacco, milk, peppermint,
carbonated beverages, caffeine, chocolate, alcohol. Stress reduction.
1. PPIs are most effective for GERD.
2. Lifestyle modifications are essential for symptom control.
11. A patient with cardiac or renal issues is being prescribed antacids such as magnesium hydroxide or aluminum
hydrate. What should the nurse check first?
Correct Answer: The nurse should check magnesium level prior to administering.
1. Magnesium-containing antacids can cause hypermagnesemia in renal failure.
2. Aluminum-containing antacids can cause constipation and phosphate depletion.
Diverticulitis, Cholelithiasis, Nutrition, TPN | Q&A | Grade A | 100% Correct
(Verified Answers) – Nursing Program
Subject: Medical-Surgical Nursing I – Gastrointestinal Disorders: Peptic Ulcer Disease (Perforation,
Bleeding, H. pylori, Sucralfate); GERD (Barrett's Esophagus, PPIs, H2 Blockers, Lifestyle); Inflammatory
Bowel Disease (Crohn's Disease vs Ulcerative Colitis, Cobblestone Appearance, Tenesmus, Colonoscopy);
Appendicitis (McBurney Point, Peritonitis, Rupture); Diverticulitis (LLQ Pain, Foods to Avoid);
Cholelithiasis/Cholecystitis (RUQ Pain Radiating to Right Shoulder, T-tube, Low Fat Diet); Bariatric
Surgery (Intragastric Balloon, Post-op Education); Obesity (BMI, Orlistat, Warfarin Interaction);
Constipation (Definition <3 BM/week, High Fiber); Diarrhea (C. diff, Pseudomembranous Colitis,
Antidiarrheals Contraindicated); Bowel Obstruction (SBO vs LBO, NG Decompression); Enteral &
Parenteral Nutrition (TPN, PPN, Central Line, Blood Sugar Q6hrs, Dextrose in Water)
Source: NSG 123 Med Surg Exam 2 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
1. Which assessment indicates to the nurse the client's gastric ulcer has perforated?
Correct Answer: A rigid, boardlike abdomen with rebound tenderness is the classic clinical
manifestation of peritonitis, which is a complication of a perforated gastric ulcer.
1. Perforation is a surgical emergency.
2. Air under diaphragm on x-ray is also indicative.
2. The nurse has been assigned to care for a client with peptic ulcer disease. Which intervention data requires
further intervention?
Correct Answer: A decrease in systolic blood pressure of 20 mmHg from lying to sitting. A decrease of
20 mmHg after changing position from lying to sitting or standing indicates orthostatic hypotension.
These findings indicate the client is bleeding.
1. Orthostatic hypotension suggests significant blood loss (hypovolemia).
2. Monitor for melena, hematemesis, tachycardia.
3. What is the biggest risk factor for peptic ulcer disease?
Correct Answer: Patient diagnosed with Helicobacter pylori (H. pylori) and NSAIDs.
1. H. pylori found in 60-80% of gastric ulcers and >90% of duodenal ulcers.
2. NSAIDs inhibit prostaglandins that protect gastric mucosa.
4. What medication forms a protective barrier to heal ulcers for peptic ulcer disease?
Correct Answer: Sucralfate. Coating protection prior to meals. Take sucralfate on empty stomach, two
hours after or one hour before meals. Effective in healing duodenal ulcers and in maintaining therapy to
prevent ulcer recurrence.
1. Sucralfate forms an adhesive barrier over the ulcer site.
2. Do not give with antacids (separate by 30 minutes).
, 5. What medications will a patient with peptic ulcer diagnosed with H. pylori take?
Correct Answer: Antibiotics, PPIs (omeprazole/Prilosec), Bismuth salts (Pepto-Bismol). These
medications suppress or eradicate H. pylori.
1. Triple or quadruple therapy for 10-14 days.
2. Common regimen: PPI + amoxicillin + clarithromycin.
6. What medication should a patient with peptic ulcer avoid?
Correct Answer: NSAIDs, aspirin, ibuprofen, naproxen, indomethacin.
1. These medications inhibit prostaglandin synthesis, reducing mucosal protection.
2. Acetaminophen is safe alternative for pain.
7. When would a patient with gastric ulcer experience pain?
Correct Answer: Gastric ulcer: pain occurs 30 minutes to 1 hour after meal. Pain increases with food,
worse at night. Weight loss. Vomiting blood (hematemesis).
1. Gastric ulcers: eating stimulates acid secretion and pain.
2. Duodenal ulcers: pain decreased with food, occurs 2-3 hours after eating, worse at night, weight gain, melena.
8. What symptoms will the nurse expect in a patient with GERD?
Correct Answer: Heartburn, regurgitation (hot, bitter, or sour liquid coming into throat or mouth),
dyspepsia (pain or discomfort centered in upper abdomen), hypersalivation, burning tight sensation felt
beneath lower sternum spreading upward to throat or jaw.
1. Heartburn is most common symptom.
2. Regurgitation is classic for GERD.
9. What are some complications of GERD?
Correct Answer: Barrett's esophagus (esophageal metaplasia) – risk of cancer. Pre-cancerous lesions
due to GERD. Diagnosis via endoscopy shows lining that is pink instead of pale white. Must be
monitored every 2 to 3 years by endoscopy.
1. Barrett's esophagus is intestinal metaplasia of lower esophagus.
2. Increases risk of esophageal adenocarcinoma.
10. What medications will a patient with GERD need and how will you educate?
Correct Answer: PPIs (omeprazole), antacids (magnesium hydroxide/aluminum hydrate), acid
protective (sucralfate), H2 blockers (ranitidine). Education: Take H2 blockers at HS (hours sleep). Prop
HOB with blocks (elevation of head of bed at least 30°). Do not lie down for 2-3 hours after eating.
Avoid late night eating. Eat small meals (6-8 per day) low fat. Avoid tobacco, milk, peppermint,
carbonated beverages, caffeine, chocolate, alcohol. Stress reduction.
1. PPIs are most effective for GERD.
2. Lifestyle modifications are essential for symptom control.
11. A patient with cardiac or renal issues is being prescribed antacids such as magnesium hydroxide or aluminum
hydrate. What should the nurse check first?
Correct Answer: The nurse should check magnesium level prior to administering.
1. Magnesium-containing antacids can cause hypermagnesemia in renal failure.
2. Aluminum-containing antacids can cause constipation and phosphate depletion.
