ATI Med Surg Gastrointestinal Comprehensive
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
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SECTION 1: UPPER GI DISORDERS Q1 – Q10
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Question 1 of 50
A 58-year-old patient with a BMI of 32 reports heartburn three to four times per week,
regurgitation, and a chronic cough that worsens at night. The nurse is developing a plan of
care to reduce symptoms. Which intervention should the nurse prioritize?
A. Encourage the patient to lie down for 30 minutes after meals to aid digestion
B. Teach the patient to avoid eating within 3 hours of bedtime ✓ CORRECT
C. Recommend increasing citrus fruit intake to improve gastric emptying
D. Advise the patient to wear a tight abdominal binder for lumbar support
Correct Answer: B
Rationale: Avoiding eating within 3 hours of bedtime reduces nocturnal acid reflux by allowing
gastric emptying before the patient reclines. Lying down after meals worsens reflux by
allowing gastric contents to flow backward into the esophagus. Elevating the head of the bed
and weight reduction are also key components of GERD management.
Question 2 of 50
A 44-year-old patient with a history of duodenal ulcer has tested positive for H. pylori and is
prescribed clarithromycin, amoxicillin, and omeprazole. On day 5 of therapy, the patient calls
the clinic reporting four episodes of watery diarrhea. What should the nurse instruct the
patient to do?
A. Stop all antibiotics immediately and contact the provider in the morning
B. The diarrhea indicates the infection is worsening and requires a higher dose
C. Take an over-the-counter antidiarrheal with each dose of antibiotics
D. Contact the provider if diarrhea is severe, bloody, or accompanied by fever ✓ CORRECT
,Correct Answer: D
Rationale: Antibiotic-associated diarrhea is common with H. pylori eradication therapy, but
severe or bloody diarrhea may indicate Clostridioides difficile infection requiring immediate
evaluation. Stopping antibiotics prematurely can lead to treatment failure and antibiotic
resistance. Mild diarrhea can be managed with fluids and probiotics if approved by the
provider.
Question 3 of 50
A 67-year-old patient with esophageal cancer has undergone esophagectomy with cervical
anastomosis and jejunostomy tube placement. On postoperative day 3, the nurse prepares to
initiate enteral feeding. Which assessment is the priority before starting the feeding?
A. Auscultate for bowel sounds and confirm tube patency and placement ✓ CORRECT
B. Begin oral clear liquids to maintain hydration and prevent mucosal atrophy
C. Flush the jejunostomy tube with 100 mL water every 4 hours per protocol
D. Administer crushed medications via the jejunostomy tube for pain control
Correct Answer: A
Rationale: Assessing bowel sounds and jejunostomy tube patency ensures safe enteral
feeding delivery and identifies ileus or tube obstruction before complications develop. Oral
intake is contraindicated until a swallow study confirms anastomotic integrity. Jejunostomy
tubes require small flush volumes of 15 to 30 mL; large volumes cause cramping and
dumping.
Question 4 of 50
A 38-year-old patient presents to the emergency department with epigastric pain and reports
two episodes of coffee-ground emesis after taking ibuprofen 800 mg three times daily for
knee pain. The patient is diaphoretic and tachycardic. What is the nurse's priority
intervention?
A. Insert an orogastric tube for gastric lavage and specimen collection
B. Prepare the patient for immediate endoscopy in the GI lab
C. Assess vital signs and initiate IV access for fluid resuscitation ✓ CORRECT
D. Administer a proton pump inhibitor orally to suppress acid production
Correct Answer: C
Rationale: Coffee-ground emesis indicates upper GI bleeding, and the priority is to assess
hemodynamic stability and establish IV access for fluid resuscitation to prevent hypovolemic
shock. Endoscopy is important but follows stabilization of the patient's airway, breathing, and
circulation. Oral medications are contraindicated in active vomiting and suspected bleeding.
Question 5 of 50
, A 55-year-old patient with a large hiatal hernia has undergone Nissen fundoplication. On
postoperative day 2, the patient asks when they can resume their usual diet of three large
meals with carbonated beverages. What is the nurse's best response?
A. A regular diet is safe to start on the first postoperative day
B. Eat small, frequent meals and avoid carbonated beverages ✓ CORRECT
C. Consume a high-fiber diet immediately to prevent postoperative constipation
D. Drink plenty of liquids with each meal to aid digestion
Correct Answer: B
Rationale: After Nissen fundoplication, small frequent meals prevent gastric distention that
could disrupt the wrap, and carbonated beverages increase gas and bloating that cause
discomfort. A regular diet is advanced slowly over several weeks from clear liquids to soft
foods. Drinking with meals increases gastric volume and pressure against the new
fundoplication.
Question 6 of 50
A 62-year-old patient with long-standing Barrett's esophagus undergoes surveillance
endoscopy. Biopsy results reveal low-grade dysplasia. The patient asks if they can stop
having endoscopies. What is the nurse's best response?
A. Immediate esophagectomy is recommended for all dysplasia
B. Discontinue surveillance as the condition is benign and stable
C. Repeat endoscopy in 10 years since the finding is low risk
D. Repeat endoscopy in 6 to 12 months with advanced imaging ✓ CORRECT
Correct Answer: D
Rationale: Low-grade dysplasia in Barrett's esophagus requires closer surveillance with
high-definition endoscopy and advanced imaging every 6 to 12 months to detect progression
to high-grade dysplasia or adenocarcinoma. Immediate esophagectomy is reserved for
high-grade dysplasia or invasive cancer. Discontinuing surveillance places the patient at risk
for missed malignant transformation.
Question 7 of 50
A 48-year-old patient with peptic ulcer disease reports sudden, severe abdominal pain that
radiates to the shoulder. Assessment reveals a rigid, board-like abdomen, absent bowel
sounds, and hypotension. What is the nurse's priority action?
A. Prepare for emergency surgery and aggressive fluid resuscitation ✓ CORRECT
B. Administer oral antacids for pain relief and acid suppression
C. Place the patient in high Fowler's position for comfort
D. Insert a nasogastric tube for decompression and begin enteral feedings
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
══════════════════════════════════════
SECTION 1: UPPER GI DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old patient with a BMI of 32 reports heartburn three to four times per week,
regurgitation, and a chronic cough that worsens at night. The nurse is developing a plan of
care to reduce symptoms. Which intervention should the nurse prioritize?
A. Encourage the patient to lie down for 30 minutes after meals to aid digestion
B. Teach the patient to avoid eating within 3 hours of bedtime ✓ CORRECT
C. Recommend increasing citrus fruit intake to improve gastric emptying
D. Advise the patient to wear a tight abdominal binder for lumbar support
Correct Answer: B
Rationale: Avoiding eating within 3 hours of bedtime reduces nocturnal acid reflux by allowing
gastric emptying before the patient reclines. Lying down after meals worsens reflux by
allowing gastric contents to flow backward into the esophagus. Elevating the head of the bed
and weight reduction are also key components of GERD management.
Question 2 of 50
A 44-year-old patient with a history of duodenal ulcer has tested positive for H. pylori and is
prescribed clarithromycin, amoxicillin, and omeprazole. On day 5 of therapy, the patient calls
the clinic reporting four episodes of watery diarrhea. What should the nurse instruct the
patient to do?
A. Stop all antibiotics immediately and contact the provider in the morning
B. The diarrhea indicates the infection is worsening and requires a higher dose
C. Take an over-the-counter antidiarrheal with each dose of antibiotics
D. Contact the provider if diarrhea is severe, bloody, or accompanied by fever ✓ CORRECT
,Correct Answer: D
Rationale: Antibiotic-associated diarrhea is common with H. pylori eradication therapy, but
severe or bloody diarrhea may indicate Clostridioides difficile infection requiring immediate
evaluation. Stopping antibiotics prematurely can lead to treatment failure and antibiotic
resistance. Mild diarrhea can be managed with fluids and probiotics if approved by the
provider.
Question 3 of 50
A 67-year-old patient with esophageal cancer has undergone esophagectomy with cervical
anastomosis and jejunostomy tube placement. On postoperative day 3, the nurse prepares to
initiate enteral feeding. Which assessment is the priority before starting the feeding?
A. Auscultate for bowel sounds and confirm tube patency and placement ✓ CORRECT
B. Begin oral clear liquids to maintain hydration and prevent mucosal atrophy
C. Flush the jejunostomy tube with 100 mL water every 4 hours per protocol
D. Administer crushed medications via the jejunostomy tube for pain control
Correct Answer: A
Rationale: Assessing bowel sounds and jejunostomy tube patency ensures safe enteral
feeding delivery and identifies ileus or tube obstruction before complications develop. Oral
intake is contraindicated until a swallow study confirms anastomotic integrity. Jejunostomy
tubes require small flush volumes of 15 to 30 mL; large volumes cause cramping and
dumping.
Question 4 of 50
A 38-year-old patient presents to the emergency department with epigastric pain and reports
two episodes of coffee-ground emesis after taking ibuprofen 800 mg three times daily for
knee pain. The patient is diaphoretic and tachycardic. What is the nurse's priority
intervention?
A. Insert an orogastric tube for gastric lavage and specimen collection
B. Prepare the patient for immediate endoscopy in the GI lab
C. Assess vital signs and initiate IV access for fluid resuscitation ✓ CORRECT
D. Administer a proton pump inhibitor orally to suppress acid production
Correct Answer: C
Rationale: Coffee-ground emesis indicates upper GI bleeding, and the priority is to assess
hemodynamic stability and establish IV access for fluid resuscitation to prevent hypovolemic
shock. Endoscopy is important but follows stabilization of the patient's airway, breathing, and
circulation. Oral medications are contraindicated in active vomiting and suspected bleeding.
Question 5 of 50
, A 55-year-old patient with a large hiatal hernia has undergone Nissen fundoplication. On
postoperative day 2, the patient asks when they can resume their usual diet of three large
meals with carbonated beverages. What is the nurse's best response?
A. A regular diet is safe to start on the first postoperative day
B. Eat small, frequent meals and avoid carbonated beverages ✓ CORRECT
C. Consume a high-fiber diet immediately to prevent postoperative constipation
D. Drink plenty of liquids with each meal to aid digestion
Correct Answer: B
Rationale: After Nissen fundoplication, small frequent meals prevent gastric distention that
could disrupt the wrap, and carbonated beverages increase gas and bloating that cause
discomfort. A regular diet is advanced slowly over several weeks from clear liquids to soft
foods. Drinking with meals increases gastric volume and pressure against the new
fundoplication.
Question 6 of 50
A 62-year-old patient with long-standing Barrett's esophagus undergoes surveillance
endoscopy. Biopsy results reveal low-grade dysplasia. The patient asks if they can stop
having endoscopies. What is the nurse's best response?
A. Immediate esophagectomy is recommended for all dysplasia
B. Discontinue surveillance as the condition is benign and stable
C. Repeat endoscopy in 10 years since the finding is low risk
D. Repeat endoscopy in 6 to 12 months with advanced imaging ✓ CORRECT
Correct Answer: D
Rationale: Low-grade dysplasia in Barrett's esophagus requires closer surveillance with
high-definition endoscopy and advanced imaging every 6 to 12 months to detect progression
to high-grade dysplasia or adenocarcinoma. Immediate esophagectomy is reserved for
high-grade dysplasia or invasive cancer. Discontinuing surveillance places the patient at risk
for missed malignant transformation.
Question 7 of 50
A 48-year-old patient with peptic ulcer disease reports sudden, severe abdominal pain that
radiates to the shoulder. Assessment reveals a rigid, board-like abdomen, absent bowel
sounds, and hypotension. What is the nurse's priority action?
A. Prepare for emergency surgery and aggressive fluid resuscitation ✓ CORRECT
B. Administer oral antacids for pain relief and acid suppression
C. Place the patient in high Fowler's position for comfort
D. Insert a nasogastric tube for decompression and begin enteral feedings
