ESTUDYR
COMPREHENSIVE NCLEX-RN REVIEW UPDATED EXAM WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1.
A 52-year-old client reports frequent heartburn, especially when bending forward. Which mechanism
best explains a hiatal hernia?
A. Weakening of the lower esophageal mucosa
B. Increased intra-abdominal pressure causing the stomach to herniate through the diaphragm ✅
C. Hypersecretion of gastric acid
D. Delayed gastric emptying
Rationale: A hiatal hernia occurs when increased abdominal pressure forces part of the stomach upward
through the esophageal hiatus.
2.
Which symptom is most characteristic of a hiatal hernia?
A. Left lower quadrant pain
B. Melena
C. Reflux, dysphagia, and chest pain ✅
D. Steatorrhea
Rationale: Hiatal hernia commonly presents with gastroesophageal reflux, difficulty swallowing, and
substernal discomfort.
3.
Which risk factor contributes most to development of a hiatal hernia?
A. High‐fiber diet
B. Obesity and repeated Valsalva maneuvers (straining) ✅
C. Vegan diet
D. Sedentary lifestyle
Rationale: Obesity and chronic increased intrathoracic pressure from straining or heavy lifting
predispose to herniation.
,ESTUDYR
4.
Which diagnostic test confirms a sliding hiatal hernia?
A. Colonoscopy
B. Barium swallow radiograph ✅
C. Abdominal ultrasound
D. 24-hour pH monitoring
Rationale: A barium swallow visualizes the stomach’s position relative to the diaphragm and reveals
herniation.
5.
Initial conservative treatment for a small hiatal hernia includes:
A. High-fat diet
B. Elevating head of bed and eating small, frequent meals ✅
C. Lying flat after meals
D. Increasing alcohol intake
Rationale: Elevating the bed and smaller meals reduce reflux by using gravity and minimizing gastric
volume.
6.
In GERD, damage to the esophagus results from:
A. Delayed gastric emptying only
B. Backflow of acidic gastric contents due to lower esophageal sphincter dysfunction ✅
C. Pancreatic enzyme hypersecretion
D. Bile reflux into the stomach
Rationale: GERD arises when the LES fails, allowing acid to injure the esophageal mucosa.
7.
A classic symptom of GERD is:
A. Right upper quadrant pain
B. Dyspepsia (indigestion), regurgitation, and heartburn ✅
C. Hematemesis
D. Steatorrhea
,ESTUDYR
Rationale: GERD presents with retrosternal burning, acid regurgitation, and sometimes respiratory
symptoms.
8.
A modifiable risk factor for GERD is:
A. Family history
B. Age over 65
C. Smoking ✅
D. Male gender
Rationale: Smoking decreases LES tone and promotes reflux; cessation reduces GERD severity.
9.
First-line pharmacologic therapy for GERD includes:
A. Beta-blockers
B. Anticholinergics
C. Proton pump inhibitors (PPIs) or H₂-blockers ✅
D. Opioids
Rationale: PPIs and H₂ antagonists reduce acid production, alleviating symptoms and mucosal injury.
10.
Peptic ulcer disease (PUD) is characterized by:
A. Serosal inflammation
B. Submucosal thickening
C. Erosion of the mucosal lining in stomach or duodenum ✅
D. Mucosal hyperplasia
Rationale: PUD results from imbalance between mucosal defense and acid, leading to ulceration.
11.
A duodenal ulcer typically causes:
A. Pain worsened by food
B. Relief of pain with food intake ✅
, ESTUDYR
C. Pain radiating to left shoulder
D. Burning epigastric pain that awakens at night
Rationale: Duodenal ulcer pain often improves with eating as food buffers acid; may recur hours later.
12.
Definitive testing for Helicobacter pylori in PUD is:
A. Serum gastrin level
B. Urea breath test or endoscopic biopsy ✅
C. Fecal occult blood
D. Abdominal CT
Rationale: Urea breath tests and biopsy with urease testing directly detect H. pylori infection.
13.
A client with mild diverticulitis should be managed initially with:
A. High-fiber diet and laxatives
B. NPO status, IV fluids, and broad-spectrum antibiotics ✅
C. Immediate colon resection
D. High-fat, low-fiber diet
Rationale: Bowel rest and antibiotics reduce inflammation; surgery reserved for complications.
14.
In Crohn’s disease, the hallmark finding is:
A. Continuous mucosal inflammation
B. Transmural inflammation with “skip” lesions ✅
C. Pseudopolyps only
D. Rectal sparing
Rationale: Crohn’s involves full-thickness GI wall segments interspersed with healthy tissue.
15.
Ulcerative colitis differs from Crohn’s by:
A. Involvement of any GI segment
COMPREHENSIVE NCLEX-RN REVIEW UPDATED EXAM WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1.
A 52-year-old client reports frequent heartburn, especially when bending forward. Which mechanism
best explains a hiatal hernia?
A. Weakening of the lower esophageal mucosa
B. Increased intra-abdominal pressure causing the stomach to herniate through the diaphragm ✅
C. Hypersecretion of gastric acid
D. Delayed gastric emptying
Rationale: A hiatal hernia occurs when increased abdominal pressure forces part of the stomach upward
through the esophageal hiatus.
2.
Which symptom is most characteristic of a hiatal hernia?
A. Left lower quadrant pain
B. Melena
C. Reflux, dysphagia, and chest pain ✅
D. Steatorrhea
Rationale: Hiatal hernia commonly presents with gastroesophageal reflux, difficulty swallowing, and
substernal discomfort.
3.
Which risk factor contributes most to development of a hiatal hernia?
A. High‐fiber diet
B. Obesity and repeated Valsalva maneuvers (straining) ✅
C. Vegan diet
D. Sedentary lifestyle
Rationale: Obesity and chronic increased intrathoracic pressure from straining or heavy lifting
predispose to herniation.
,ESTUDYR
4.
Which diagnostic test confirms a sliding hiatal hernia?
A. Colonoscopy
B. Barium swallow radiograph ✅
C. Abdominal ultrasound
D. 24-hour pH monitoring
Rationale: A barium swallow visualizes the stomach’s position relative to the diaphragm and reveals
herniation.
5.
Initial conservative treatment for a small hiatal hernia includes:
A. High-fat diet
B. Elevating head of bed and eating small, frequent meals ✅
C. Lying flat after meals
D. Increasing alcohol intake
Rationale: Elevating the bed and smaller meals reduce reflux by using gravity and minimizing gastric
volume.
6.
In GERD, damage to the esophagus results from:
A. Delayed gastric emptying only
B. Backflow of acidic gastric contents due to lower esophageal sphincter dysfunction ✅
C. Pancreatic enzyme hypersecretion
D. Bile reflux into the stomach
Rationale: GERD arises when the LES fails, allowing acid to injure the esophageal mucosa.
7.
A classic symptom of GERD is:
A. Right upper quadrant pain
B. Dyspepsia (indigestion), regurgitation, and heartburn ✅
C. Hematemesis
D. Steatorrhea
,ESTUDYR
Rationale: GERD presents with retrosternal burning, acid regurgitation, and sometimes respiratory
symptoms.
8.
A modifiable risk factor for GERD is:
A. Family history
B. Age over 65
C. Smoking ✅
D. Male gender
Rationale: Smoking decreases LES tone and promotes reflux; cessation reduces GERD severity.
9.
First-line pharmacologic therapy for GERD includes:
A. Beta-blockers
B. Anticholinergics
C. Proton pump inhibitors (PPIs) or H₂-blockers ✅
D. Opioids
Rationale: PPIs and H₂ antagonists reduce acid production, alleviating symptoms and mucosal injury.
10.
Peptic ulcer disease (PUD) is characterized by:
A. Serosal inflammation
B. Submucosal thickening
C. Erosion of the mucosal lining in stomach or duodenum ✅
D. Mucosal hyperplasia
Rationale: PUD results from imbalance between mucosal defense and acid, leading to ulceration.
11.
A duodenal ulcer typically causes:
A. Pain worsened by food
B. Relief of pain with food intake ✅
, ESTUDYR
C. Pain radiating to left shoulder
D. Burning epigastric pain that awakens at night
Rationale: Duodenal ulcer pain often improves with eating as food buffers acid; may recur hours later.
12.
Definitive testing for Helicobacter pylori in PUD is:
A. Serum gastrin level
B. Urea breath test or endoscopic biopsy ✅
C. Fecal occult blood
D. Abdominal CT
Rationale: Urea breath tests and biopsy with urease testing directly detect H. pylori infection.
13.
A client with mild diverticulitis should be managed initially with:
A. High-fiber diet and laxatives
B. NPO status, IV fluids, and broad-spectrum antibiotics ✅
C. Immediate colon resection
D. High-fat, low-fiber diet
Rationale: Bowel rest and antibiotics reduce inflammation; surgery reserved for complications.
14.
In Crohn’s disease, the hallmark finding is:
A. Continuous mucosal inflammation
B. Transmural inflammation with “skip” lesions ✅
C. Pseudopolyps only
D. Rectal sparing
Rationale: Crohn’s involves full-thickness GI wall segments interspersed with healthy tissue.
15.
Ulcerative colitis differs from Crohn’s by:
A. Involvement of any GI segment
