Upper GI Disorders
A patient reports burning epigastric pain relieved by eating. Which disorder is suspected?
A. Gastric ulcer
B. Duodenal ulcer
C. GERD
D. Pancreatitis
Answer: B
Rationale: Duodenal ulcers improve with food, while gastric ulcers worsen with food.
Which findings in a patient with suspected small bowel obstruction require immediate provider notification? (Select all that apply)
A. Absent bowel sounds
B. Severe abdominal distention
C. Projectile vomiting
D. Mild cramping after meals
E. Hematemesis
Answer: A, B, C
Rationale: Bowel obstruction presents with distention, absent sounds, and vomiting → high risk for perforation.
A patient develops severe epigastric pain that radiates to the back and worsens after eating fatty food. Which condition is most likely?
A. Gastritis
B. Pancreatitis
C. Cholecystitis
D. Peptic ulcer disease
Answer: C
Rationale: Pain after fatty meals in RUQ/epigastric area suggests gallbladder inflammation (cholecystitis).
A patient with femur fracture has severe pain unrelieved by opioids, pallor, and numb toes. Which complication is suspected?
A. DVT
B. Compartment syndrome
C. Osteomyelitis
D. Fat embolism
Answer: B
Rationale: Classic “5 Ps” = compartment syndrome.
Which finding in a post-knee replacement patient on anticoagulants is most concerning?
A. Pain 5/10
B. Bruising at IV site
C. Hematuria
D. Temp 99°F
Answer: C
Rationale: Indicates bleeding risk.
A patient with peptic ulcer disease is at risk for which complications? select all that apply
A. Perforation
B. GI bleeding
C. Dumping syndrome
D. Gastric outlet obstruction
E. GERD
Answer: A, B, D
Rationale: Peptic ulcers may bleed, perforate, or obstruct. Dumping syndrome is post-gastrectomy; GERD is separate condition.
Which post-op appendectomy finding requires immediate action?
A. Pain at incision site 5/10
B. Temp 100.9°F
C. Tachycardia with rigid abdomen
D. Serosanguinous drainage on dressing
Answer: C
Rationale: Rigid abdomen + tachycardia suggests peritonitis, a surgical emergency.
A patient with Crohn’s disease presents with weight loss and diarrhea. Which teaching is most important?
A. “Avoid foods that trigger symptoms.”
B. “Add more high-fiber foods to diet.”
C. “Take antacids daily.”
D. “Stop taking immunosuppressants if you feel better.”
Answer: A
Rationale: Crohn’s diet individualized; avoid triggers, not high fiber during flare.
Which finding in a post-hip replacement patient requires immediate action?
A. Pain 7/10 with movement
B. Temp 100.8°F
C. Shortness of breath and chest pain
D. Drainage on dressing
Answer: C
Rationale: Chest pain/SOB = possible embolism.
Prevention of osteoporosis progression includes: select all that apply
A. Stop smoking
B. Limit alcohol
C. Take vitamin D supplements
D. Avoid all exercise
E. Increase caffeine
Answer: A, B, C
Rationale: Lifestyle & supplements help bone density.
A patient with GERD is teaching back lifestyle changes. Which statement shows understanding?
A. “I should lie down right after eating.”
B. “I’ll avoid caffeine and spicy food.”
C. “I should eat a large meal before bed.”
D. “I don’t need to lose weight.”
Answer: B
Rationale: Caffeine, alcohol, fatty and spicy foods worsen GERD.
A patient with ulcerative colitis reports 10 bloody stools/day and dizziness. Which is the priority intervention?
A. Monitor bowel sounds
B. Administer high-fiber diet
C. Start IV fluids
D. Give antidiarrheal
Answer: C
Rationale: Hypovolemia from fluid/blood loss → fluids first.
Patient with suspected perforated duodenal ulcer presents with sudden severe abdominal pain, rigid abdomen, and absent bowel sounds. What is the priority action?
A. Insert NG tube and start suction
B. Notify provider immediately
C. Start patient on clear liquids
D. Administer stool softener
Answer: B
Rationale: This is a surgical emergency.
Hip replacement patient suddenly develops SOB, chest pain, confusion. Which is most likely?
A. Fat embolism
B. Pneumonia
C. Atelectasis
D. Infection
Answer: A
Rationale: Triad = fat embolism.
Patient with chronic back pain, loss of height, kyphosis likely has:
A. Osteoporosis
B. Scoliosis
C. Osteoarthritis
D. Herniated disc
Answer: A
Rationale: Vertebral fractures common in osteoporosis.
A post-gastrectomy patient becomes dizzy, diaphoretic, and tachycardic after eating sweets. What is the best instruction?
A. Eat frequent small meals with high carbs
B. Lie flat after meals
C. Eat meals high in protein and low in simple sugars
D. Drink fluids with meals
Answer: C
Rationale: Prevent dumping syndrome by limiting sugar, increasing protein, and separating fluids from meals.
Which dietary instructions are appropriate for diverticulitis during an acute flare? select all that apply
A. High fiber
B. Low fiber/clear liquid
C. Avoid nuts and seeds
D. Increase dairy
E. Increase fluids
Answer: B, C, E
Rationale: Low fiber during flare, no nuts/seeds, fluids prevent constipation.
Which finding indicates a complication of cholecystitis?
A. Mild nausea after fatty meal
B. Yellow sclera
C. Pain radiating to right shoulder
D. Fever 100.5°F
Answer: B
Rationale: Jaundice suggests obstruction of bile duct, complication of cholecystitis.
A patient with an arm cast reports tingling and pallor. What should the nurse do first?
A. Document findings
B. Reassure patient
C. Assess circulation and notify provider
D. Elevate extremity only
Answer: C
Rationale: Possible compartment syndrome.
External fixation site has redness, swelling, purulent drainage. Nurse should:
A. Document only
B. Reassure patient
C. Notify provider
D. Encourage ambulation
Answer: C
Rationale: Indicates infection at pin site.
Which patient statements about GERD require further teaching?
A. “I’ll elevate HOB when sleeping.”
B. “I should drink coffee every morning.”
C. “I’ll avoid lying down after meals.”
D. “I can eat smaller meals more often.”
E. “I’ll avoid alcohol.”
Answer: B
Rationale: Coffee worsens reflux.
Which symptoms suggest large bowel obstruction rather than small bowel obstruction?
A. Persistent vomiting
B. Gradual abdominal distention
C. Cramping lower abdominal pain
D. Constipation only
E. Rapid dehydration
Answer: B, C, D
Rationale: Large bowel obstruction = distention, pain, constipation; small bowel = vomiting & dehydration.
A patient with acute pancreatitis is NPO. Which action is most appropriate?
A. Advance to clear liquids quickly
B. Provide total parenteral nutrition if prolonged NPO
C. Encourage frequent snacks
D. Provide milk and bread
Answer: B
Rationale: Pancreatitis requires bowel rest; TPN if prolonged NPO.
Long bone fracture + dyspnea, confusion, petechiae. Which complication?
A. DVT
B. Pneumonia
C. Fat embolism
D. ARDS
Answer: C
Rationale: Petechiae = hallmark of fat embolism.
What principle guides prevention of complications from immobility after fractures or abdominal surgery?
A. Strict bed rest
B. Early ambulation
C. NPO diet
D. Pain control only
Answer: B
Rationale: Ambulation prevents pneumonia, DVT, ileus.