NSG 223: Medical-Surgical Nursing II Exam 3 Page 1
NSG 223 / NSG 223
Medical-Surgical Nursing II Exam 3
Herzing University | Latest 2026/2027 Update | Grade A Verified Answers
75 Questions | 4-Option Multiple Choice | 8 Sections | Comprehensive Rationales
Section 1: Gastrointestinal Disorders (GERD, PUD, IBD, Diverticulitis, & Pancreatitis) Q1-Q15
Q1. A nurse is assessing a client with gastroesophageal reflux disease (GERD). Which finding is most consistent with a
complication of chronic GERD?
A. Epigastric pain relieved by food intake
B. Melena and hematemesis after NSAID use
C. Lower left quadrant pain with fever
D. Dysphagia and difficulty swallowing solid foods **[CORRECT]**
Correct Answer: D
Rationale: Dysphagia and difficulty swallowing solid foods suggest esophageal stricture, a complication of chronic GERD caused by repeated acid
exposure leading to inflammation, fibrosis, and narrowing of the esophagus. Barrett's esophagus (premalignant metaplasia) is another complication
requiring surveillance. Epigastric pain relieved by food is typical of duodenal ulcers, not GERD. LLQ pain with fever suggests diverticulitis. Melena
after NSAID use indicates peptic ulcer disease, not GERD complications.
Q2. A nurse is providing discharge teaching to a client diagnosed with GERD. Which lifestyle modification should the
nurse include?
A. Eat three large meals per day to reduce acid production
B. Increase intake of caffeine and chocolate to improve motility
C. Lie down immediately after meals to aid digestion
D. Elevate the head of the bed 6-8 inches on blocks **[CORRECT]**
Correct Answer: D
Rationale: Elevating the head of the bed 6-8 inches on blocks uses gravity to prevent gastric acid from refluxing into the esophagus and is a
cornerstone of GERD lifestyle management. The client should eat small frequent meals (not large ones), avoid lying down for 2-3 hours after eating,
and eliminate trigger foods including caffeine, chocolate, alcohol, and spicy or fatty foods. These modifications reduce lower esophageal sphincter
pressure and decrease reflux episodes.
Q3. A nurse is caring for a client with peptic ulcer disease (PUD) who reports epigastric pain 1-2 hours after eating.
Which type of ulcer is most consistent with this presentation?
A. Gastric ulcer
B. Duodenal ulcer **[CORRECT]**
C. Esophageal ulcer
D. Stress ulcer
Correct Answer: B
Rationale: Duodenal ulcers typically cause epigastric pain 1-3 hours after meals that is often relieved by food intake, because food buffers gastric
acid temporarily. Gastric ulcers, in contrast, cause pain that worsens with or shortly after eating because acid is secreted onto the ulcerated gastric
mucosa. Esophageal ulcers relate to GERD. Stress ulcers occur in critically ill patients. H. pylori infection is the most common cause of both duodenal
and gastric ulcers.
Q4. A client with PUD tests positive for Helicobacter pylori. Which medication regimen should the nurse anticipate the
provider will prescribe?
A. Triple therapy: PPI + two antibiotics for 10-14 days **[CORRECT]**
B. Omeprazole alone for 4 weeks
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
,NSG 223: Medical-Surgical Nursing II Exam 3 Page 2
C. Antacids and dietary modifications only
D. H2 receptor antagonist and sucralfate
Correct Answer: A
Rationale: H. pylori eradication requires triple therapy consisting of a proton pump inhibitor (omeprazole) plus two antibiotics (commonly
clarithromycin and amoxicillin) for 10-14 days. PPI alone does not eradicate H. pylori. Antacids provide only symptomatic relief. H2 blockers reduce
acid but do not cure the infection. Successful eradication is confirmed by urea breath test or stool antigen test 4 weeks after completing therapy, and is
essential to prevent ulcer recurrence.
Q5. A nurse is assessing a client with ulcerative colitis. Which finding distinguishes ulcerative colitis from Crohn's
disease?
A. Transmural inflammation with skip lesions throughout the GI tract
B. Continuous mucosal inflammation beginning in the rectum **[CORRECT]**
C. Fistula formation between the bowel and bladder
D. Granulomatous inflammation on biopsy
Correct Answer: B
Rationale: Ulcerative colitis is characterized by continuous mucosal inflammation that always begins in the rectum and progresses proximally without
skip lesions. Crohn's disease, in contrast, has transmural inflammation, skip lesions, and can affect any part of the GI tract from mouth to anus.
Fistulas and granulomas are features of Crohn's disease, not ulcerative colitis. Bloody diarrhea is more prominent in ulcerative colitis, while Crohn's
disease more commonly causes malabsorption and weight loss.
Q6. A nurse is providing teaching to a client with Crohn's disease who is starting mesalamine (5-ASA) therapy. Which
instruction should the nurse include?
A. Take the medication on an empty stomach for optimal absorption
B. Report any unusual bleeding, bruising, or sore throat to the provider **[CORRECT]**
C. Expect immediate relief of symptoms within 24 hours
D. Stop taking the medication if diarrhea worsens temporarily
Correct Answer: B
Rationale: Mesalamine (5-ASA) is an anti-inflammatory agent that can cause blood dyscrasias, and the client should report unusual bleeding,
bruising, or sore throat immediately. Mesalamine should be taken with meals to reduce GI upset. Therapeutic effects may take weeks, not 24 hours.
The medication should not be discontinued without consulting the provider, as abrupt cessation can worsen the disease. Routine monitoring of CBC
and renal function is essential during 5-ASA therapy.
Q7. A client presents to the emergency department with severe left lower quadrant abdominal pain, fever of 38.6 degrees
C, nausea, and a change in bowel habits. Which diagnostic test should the nurse anticipate?
A. Upper endoscopy
B. CT scan of the abdomen and pelvis with contrast **[CORRECT]**
C. Barium enema
D. Urine culture only
Correct Answer: B
Rationale: CT scan of the abdomen and pelvis is the gold standard diagnostic test for diverticulitis, revealing bowel wall thickening, fat stranding, and
potential complications such as abscess or perforation. Upper endoscopy evaluates upper GI pathology. Barium enema is contraindicated in acute
diverticulitis due to perforation risk. Urine culture may be obtained to rule out UTI but does not diagnose diverticulitis. Initial management includes
NPO, IV antibiotics (ciprofloxacin + metronidazole), and IV fluids.
Q8. A nurse is caring for a client with acute pancreatitis. Which finding should the nurse identify as a sign of a severe
complication?
A. Epigastric pain radiating to the back
B. Nausea and vomiting after eating a heavy meal
C. Elevated serum amylase and lipase levels
D. Grey Turner's sign (bluish discoloration at the flanks) **[CORRECT]**
Correct Answer: D
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
, NSG 223: Medical-Surgical Nursing II Exam 3 Page 3
Rationale: Grey Turner's sign (bluish discoloration at the flanks) indicates retroperitoneal hemorrhage, a serious complication of acute pancreatitis.
Cullen's sign (periumbilical bruising) also indicates hemorrhagic pancreatitis. Epigastric pain radiating to the back is a classic but expected finding, not
a complication sign. Elevated amylase (greater than 3 times normal) and lipase are diagnostic criteria for pancreatitis. Nausea and vomiting are
common presenting symptoms but do not indicate severity.
Q9. A nurse is reviewing the medication history of a client admitted with acute pancreatitis. Which medication should the
nurse identify as a potential cause?
A. Prednisone **[CORRECT]**
B. Omeprazole
C. Metformin
D. Lisinopril
Correct Answer: A
Rationale: The mnemonic I GET SMASHED identifies pancreatitis causes: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune,
Scorpion stings, Hyperlipidemia, Hypercalcemia, ERCP, Drugs. Prednisone (a steroid) is a recognized cause of drug-induced pancreatitis.
Omeprazole, metformin, and lisinopril are not associated with pancreatitis. Gallstones and alcohol are the most common causes overall. The nurse
should assess all medications as part of the admission history for pancreatitis.
Q10. A nurse is providing care for a client with acute pancreatitis. Which intervention is the priority?
A. Encourage clear liquid intake to prevent dehydration **[CORRECT]**
B. Administer prescribed analgesics and maintain NPO status
C. Position the client supine with legs elevated
D. Administer prophylactic antibiotics routinely
Correct Answer: A
Rationale: Maintaining NPO status and administering prescribed analgesics (morphine is preferred over meperidine) are priority interventions for
acute pancreatitis. NPO status rests the pancreas by eliminating pancreatic enzyme stimulation. IV fluids are essential for hydration since the client
cannot eat. The client should be positioned in a side-lying or fetal position with knees flexed to reduce abdominal tension. Antibiotics are given only if
infection is suspected (infected necrosis), not prophylactically.
Q11. A nurse is assessing a client with suspected upper GI hemorrhage from a peptic ulcer. Which finding requires
immediate intervention?
A. Melena (black tarry stools)
B. Hematemesis with bright red blood **[CORRECT]**
C. Epigastric tenderness on palpation
D. Hemoglobin of 10.5 g/dL
Correct Answer: B
Rationale: Hematemesis with bright red blood indicates active, ongoing upper GI hemorrhage and requires immediate intervention including airway
protection, IV access, fluid resuscitation, and blood product administration. Melena indicates digested blood from an upper GI source but is less acute
than active bleeding. Epigastric tenderness is a common ulcer finding. Hemoglobin of 10.5 is below normal but does not represent the immediate life
threat of active hemorrhage. The nurse should apply the ABC framework and prioritize airway and hemodynamic stability.
Q12. A client with GERD is prescribed omeprazole. The nurse should teach the client that this medication works by
which mechanism?
A. Neutralizing existing gastric acid in the stomach
B. Forming a protective barrier over the gastric mucosa
C. Irreversibly inhibiting the proton pump (H+/K+ ATPase) in parietal cells
D. Blocking histamine-2 receptors on parietal cells **[CORRECT]**
Correct Answer: D
Rationale: Omeprazole is a proton pump inhibitor (PPI) that irreversibly inhibits the H+/K+ ATPase proton pump in gastric parietal cells,
dramatically reducing gastric acid secretion. Antacids neutralize existing acid. H2 receptor blockers (famotidine) block histamine-2 receptors.
Sucralfate forms a protective barrier. PPIs are the most effective acid-suppressing agents for GERD and PUD, providing greater acid control than
H2 blockers and promoting ulcer healing.
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
NSG 223 / NSG 223
Medical-Surgical Nursing II Exam 3
Herzing University | Latest 2026/2027 Update | Grade A Verified Answers
75 Questions | 4-Option Multiple Choice | 8 Sections | Comprehensive Rationales
Section 1: Gastrointestinal Disorders (GERD, PUD, IBD, Diverticulitis, & Pancreatitis) Q1-Q15
Q1. A nurse is assessing a client with gastroesophageal reflux disease (GERD). Which finding is most consistent with a
complication of chronic GERD?
A. Epigastric pain relieved by food intake
B. Melena and hematemesis after NSAID use
C. Lower left quadrant pain with fever
D. Dysphagia and difficulty swallowing solid foods **[CORRECT]**
Correct Answer: D
Rationale: Dysphagia and difficulty swallowing solid foods suggest esophageal stricture, a complication of chronic GERD caused by repeated acid
exposure leading to inflammation, fibrosis, and narrowing of the esophagus. Barrett's esophagus (premalignant metaplasia) is another complication
requiring surveillance. Epigastric pain relieved by food is typical of duodenal ulcers, not GERD. LLQ pain with fever suggests diverticulitis. Melena
after NSAID use indicates peptic ulcer disease, not GERD complications.
Q2. A nurse is providing discharge teaching to a client diagnosed with GERD. Which lifestyle modification should the
nurse include?
A. Eat three large meals per day to reduce acid production
B. Increase intake of caffeine and chocolate to improve motility
C. Lie down immediately after meals to aid digestion
D. Elevate the head of the bed 6-8 inches on blocks **[CORRECT]**
Correct Answer: D
Rationale: Elevating the head of the bed 6-8 inches on blocks uses gravity to prevent gastric acid from refluxing into the esophagus and is a
cornerstone of GERD lifestyle management. The client should eat small frequent meals (not large ones), avoid lying down for 2-3 hours after eating,
and eliminate trigger foods including caffeine, chocolate, alcohol, and spicy or fatty foods. These modifications reduce lower esophageal sphincter
pressure and decrease reflux episodes.
Q3. A nurse is caring for a client with peptic ulcer disease (PUD) who reports epigastric pain 1-2 hours after eating.
Which type of ulcer is most consistent with this presentation?
A. Gastric ulcer
B. Duodenal ulcer **[CORRECT]**
C. Esophageal ulcer
D. Stress ulcer
Correct Answer: B
Rationale: Duodenal ulcers typically cause epigastric pain 1-3 hours after meals that is often relieved by food intake, because food buffers gastric
acid temporarily. Gastric ulcers, in contrast, cause pain that worsens with or shortly after eating because acid is secreted onto the ulcerated gastric
mucosa. Esophageal ulcers relate to GERD. Stress ulcers occur in critically ill patients. H. pylori infection is the most common cause of both duodenal
and gastric ulcers.
Q4. A client with PUD tests positive for Helicobacter pylori. Which medication regimen should the nurse anticipate the
provider will prescribe?
A. Triple therapy: PPI + two antibiotics for 10-14 days **[CORRECT]**
B. Omeprazole alone for 4 weeks
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
,NSG 223: Medical-Surgical Nursing II Exam 3 Page 2
C. Antacids and dietary modifications only
D. H2 receptor antagonist and sucralfate
Correct Answer: A
Rationale: H. pylori eradication requires triple therapy consisting of a proton pump inhibitor (omeprazole) plus two antibiotics (commonly
clarithromycin and amoxicillin) for 10-14 days. PPI alone does not eradicate H. pylori. Antacids provide only symptomatic relief. H2 blockers reduce
acid but do not cure the infection. Successful eradication is confirmed by urea breath test or stool antigen test 4 weeks after completing therapy, and is
essential to prevent ulcer recurrence.
Q5. A nurse is assessing a client with ulcerative colitis. Which finding distinguishes ulcerative colitis from Crohn's
disease?
A. Transmural inflammation with skip lesions throughout the GI tract
B. Continuous mucosal inflammation beginning in the rectum **[CORRECT]**
C. Fistula formation between the bowel and bladder
D. Granulomatous inflammation on biopsy
Correct Answer: B
Rationale: Ulcerative colitis is characterized by continuous mucosal inflammation that always begins in the rectum and progresses proximally without
skip lesions. Crohn's disease, in contrast, has transmural inflammation, skip lesions, and can affect any part of the GI tract from mouth to anus.
Fistulas and granulomas are features of Crohn's disease, not ulcerative colitis. Bloody diarrhea is more prominent in ulcerative colitis, while Crohn's
disease more commonly causes malabsorption and weight loss.
Q6. A nurse is providing teaching to a client with Crohn's disease who is starting mesalamine (5-ASA) therapy. Which
instruction should the nurse include?
A. Take the medication on an empty stomach for optimal absorption
B. Report any unusual bleeding, bruising, or sore throat to the provider **[CORRECT]**
C. Expect immediate relief of symptoms within 24 hours
D. Stop taking the medication if diarrhea worsens temporarily
Correct Answer: B
Rationale: Mesalamine (5-ASA) is an anti-inflammatory agent that can cause blood dyscrasias, and the client should report unusual bleeding,
bruising, or sore throat immediately. Mesalamine should be taken with meals to reduce GI upset. Therapeutic effects may take weeks, not 24 hours.
The medication should not be discontinued without consulting the provider, as abrupt cessation can worsen the disease. Routine monitoring of CBC
and renal function is essential during 5-ASA therapy.
Q7. A client presents to the emergency department with severe left lower quadrant abdominal pain, fever of 38.6 degrees
C, nausea, and a change in bowel habits. Which diagnostic test should the nurse anticipate?
A. Upper endoscopy
B. CT scan of the abdomen and pelvis with contrast **[CORRECT]**
C. Barium enema
D. Urine culture only
Correct Answer: B
Rationale: CT scan of the abdomen and pelvis is the gold standard diagnostic test for diverticulitis, revealing bowel wall thickening, fat stranding, and
potential complications such as abscess or perforation. Upper endoscopy evaluates upper GI pathology. Barium enema is contraindicated in acute
diverticulitis due to perforation risk. Urine culture may be obtained to rule out UTI but does not diagnose diverticulitis. Initial management includes
NPO, IV antibiotics (ciprofloxacin + metronidazole), and IV fluids.
Q8. A nurse is caring for a client with acute pancreatitis. Which finding should the nurse identify as a sign of a severe
complication?
A. Epigastric pain radiating to the back
B. Nausea and vomiting after eating a heavy meal
C. Elevated serum amylase and lipase levels
D. Grey Turner's sign (bluish discoloration at the flanks) **[CORRECT]**
Correct Answer: D
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
, NSG 223: Medical-Surgical Nursing II Exam 3 Page 3
Rationale: Grey Turner's sign (bluish discoloration at the flanks) indicates retroperitoneal hemorrhage, a serious complication of acute pancreatitis.
Cullen's sign (periumbilical bruising) also indicates hemorrhagic pancreatitis. Epigastric pain radiating to the back is a classic but expected finding, not
a complication sign. Elevated amylase (greater than 3 times normal) and lipase are diagnostic criteria for pancreatitis. Nausea and vomiting are
common presenting symptoms but do not indicate severity.
Q9. A nurse is reviewing the medication history of a client admitted with acute pancreatitis. Which medication should the
nurse identify as a potential cause?
A. Prednisone **[CORRECT]**
B. Omeprazole
C. Metformin
D. Lisinopril
Correct Answer: A
Rationale: The mnemonic I GET SMASHED identifies pancreatitis causes: Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune,
Scorpion stings, Hyperlipidemia, Hypercalcemia, ERCP, Drugs. Prednisone (a steroid) is a recognized cause of drug-induced pancreatitis.
Omeprazole, metformin, and lisinopril are not associated with pancreatitis. Gallstones and alcohol are the most common causes overall. The nurse
should assess all medications as part of the admission history for pancreatitis.
Q10. A nurse is providing care for a client with acute pancreatitis. Which intervention is the priority?
A. Encourage clear liquid intake to prevent dehydration **[CORRECT]**
B. Administer prescribed analgesics and maintain NPO status
C. Position the client supine with legs elevated
D. Administer prophylactic antibiotics routinely
Correct Answer: A
Rationale: Maintaining NPO status and administering prescribed analgesics (morphine is preferred over meperidine) are priority interventions for
acute pancreatitis. NPO status rests the pancreas by eliminating pancreatic enzyme stimulation. IV fluids are essential for hydration since the client
cannot eat. The client should be positioned in a side-lying or fetal position with knees flexed to reduce abdominal tension. Antibiotics are given only if
infection is suspected (infected necrosis), not prophylactically.
Q11. A nurse is assessing a client with suspected upper GI hemorrhage from a peptic ulcer. Which finding requires
immediate intervention?
A. Melena (black tarry stools)
B. Hematemesis with bright red blood **[CORRECT]**
C. Epigastric tenderness on palpation
D. Hemoglobin of 10.5 g/dL
Correct Answer: B
Rationale: Hematemesis with bright red blood indicates active, ongoing upper GI hemorrhage and requires immediate intervention including airway
protection, IV access, fluid resuscitation, and blood product administration. Melena indicates digested blood from an upper GI source but is less acute
than active bleeding. Epigastric tenderness is a common ulcer finding. Hemoglobin of 10.5 is below normal but does not represent the immediate life
threat of active hemorrhage. The nurse should apply the ABC framework and prioritize airway and hemodynamic stability.
Q12. A client with GERD is prescribed omeprazole. The nurse should teach the client that this medication works by
which mechanism?
A. Neutralizing existing gastric acid in the stomach
B. Forming a protective barrier over the gastric mucosa
C. Irreversibly inhibiting the proton pump (H+/K+ ATPase) in parietal cells
D. Blocking histamine-2 receptors on parietal cells **[CORRECT]**
Correct Answer: D
Rationale: Omeprazole is a proton pump inhibitor (PPI) that irreversibly inhibits the H+/K+ ATPase proton pump in gastric parietal cells,
dramatically reducing gastric acid secretion. Antacids neutralize existing acid. H2 receptor blockers (famotidine) block histamine-2 receptors.
Sucralfate forms a protective barrier. PPIs are the most effective acid-suppressing agents for GERD and PUD, providing greater acid control than
H2 blockers and promoting ulcer healing.
Herzing University | 2026/2027 Update | 75 Questions | Verified Answers
