NCLEX-RN Pharmacology Gastrointestinal
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 68-year-old female with a history of severe gastroesophageal
reflux disease (GERD) presents to the clinic complaining of new-
onset muscle cramps, palpitations, and profound fatigue. She
reports taking omeprazole 40 mg daily for the past 3 years. Her vital
signs are stable, but she appears fatigued.
Question Stem
Which laboratory finding should the nurse anticipate reviewing to
determine the primary cause of this patient's symptoms?
A. Serum calcium
B. Serum potassium
C. Serum magnesium
D. Serum sodium
Correct Answer
C. Serum magnesium
,Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole is
strongly associated with hypomagnesemia, which can manifest as
muscle cramps, palpitations, arrhythmias, and fatigue. The FDA
recommends checking serum magnesium levels before starting
long-term PPI therapy and periodically during treatment.
Hypomagnesemia can also lead to secondary hypocalcemia and
hypokalemia, making magnesium the primary laboratory value to
assess as the root cause. Option A (serum calcium) and Option D
(serum sodium) are not the primary direct adverse effects of PPIs,
though calcium absorption may be slightly decreased over time.
Option B (serum potassium) may be low secondary to
hypomagnesemia, but magnesium is the direct drug-induced
electrolyte imbalance to monitor. Nursing considerations include
educating patients to report symptoms of electrolyte imbalance,
such as muscle spasms or irregular heartbeats, and considering
magnesium supplementation if levels drop, rather than abruptly
discontinuing the PPI without provider guidance.
Learning Objective
• Identify the long-term adverse effects of proton pump
inhibitors.
• Recognize the clinical manifestations of hypomagnesemia.
• Prioritize appropriate laboratory monitoring for patients on
chronic PPI therapy.
Medication Safety Focus
Monitoring (Long-term adverse effects)
,Question 2
Clinical Scenario
A 78-year-old male with peptic ulcer disease and stage 3 chronic
kidney disease (eGFR 35 mL/min) is admitted to the medical-
surgical unit. The healthcare provider prescribes famotidine 20 mg
PO twice daily for gastric acid suppression.
Question Stem
Which action should the nurse prioritize when managing this
patient's medication regimen?
A. Request a prescription for a reduced dosage or extended dosing
interval.
B. Administer the medication with a full glass of milk to prevent
gastric irritation.
C. Monitor the patient's stool for occult blood daily.
D. Instruct the patient to chew the tablet thoroughly before
swallowing.
Correct Answer
A. Request a prescription for a reduced dosage or extended dosing
interval.
Detailed Rationale
Famotidine is a histamine H2-receptor antagonist primarily excreted
unchanged by the kidneys. In older adults, especially those with
chronic kidney disease (CKD), reduced renal clearance can lead to
drug accumulation. This accumulation significantly increases the
risk of central nervous system (CNS) toxicity, manifesting as
, confusion, delirium, hallucinations, and agitation. Therefore, the
nurse should prioritize requesting a prescription for a reduced
dosage or extended dosing interval based on the patient's estimated
glomerular filtration rate (eGFR). Option B is incorrect because
famotidine does not require milk for administration and may be
given without regard to meals. Option C is a general assessment for
ulcer disease but does not address the specific pharmacokinetic
risk of the prescribed drug in this patient. Option D is incorrect
because famotidine tablets are not designed to be chewed. Nursing
considerations include closely monitoring older adults with renal
impairment for sudden changes in mental status and advocating for
appropriate renal dose adjustments.
Learning Objective
• Recognize the pharmacokinetic changes of H2-receptor
antagonists in renal impairment.
• Identify signs of CNS toxicity in older adults taking famotidine.
• Advocate for appropriate renal dose adjustments to prevent
iatrogenic harm.
Medication Safety Focus
Renal impairment dosing / Older adults
Question 3
Clinical Scenario
A 55-year-old female is receiving highly emetogenic chemotherapy
for breast cancer. The healthcare provider prescribes IV
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 68-year-old female with a history of severe gastroesophageal
reflux disease (GERD) presents to the clinic complaining of new-
onset muscle cramps, palpitations, and profound fatigue. She
reports taking omeprazole 40 mg daily for the past 3 years. Her vital
signs are stable, but she appears fatigued.
Question Stem
Which laboratory finding should the nurse anticipate reviewing to
determine the primary cause of this patient's symptoms?
A. Serum calcium
B. Serum potassium
C. Serum magnesium
D. Serum sodium
Correct Answer
C. Serum magnesium
,Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole is
strongly associated with hypomagnesemia, which can manifest as
muscle cramps, palpitations, arrhythmias, and fatigue. The FDA
recommends checking serum magnesium levels before starting
long-term PPI therapy and periodically during treatment.
Hypomagnesemia can also lead to secondary hypocalcemia and
hypokalemia, making magnesium the primary laboratory value to
assess as the root cause. Option A (serum calcium) and Option D
(serum sodium) are not the primary direct adverse effects of PPIs,
though calcium absorption may be slightly decreased over time.
Option B (serum potassium) may be low secondary to
hypomagnesemia, but magnesium is the direct drug-induced
electrolyte imbalance to monitor. Nursing considerations include
educating patients to report symptoms of electrolyte imbalance,
such as muscle spasms or irregular heartbeats, and considering
magnesium supplementation if levels drop, rather than abruptly
discontinuing the PPI without provider guidance.
Learning Objective
• Identify the long-term adverse effects of proton pump
inhibitors.
• Recognize the clinical manifestations of hypomagnesemia.
• Prioritize appropriate laboratory monitoring for patients on
chronic PPI therapy.
Medication Safety Focus
Monitoring (Long-term adverse effects)
,Question 2
Clinical Scenario
A 78-year-old male with peptic ulcer disease and stage 3 chronic
kidney disease (eGFR 35 mL/min) is admitted to the medical-
surgical unit. The healthcare provider prescribes famotidine 20 mg
PO twice daily for gastric acid suppression.
Question Stem
Which action should the nurse prioritize when managing this
patient's medication regimen?
A. Request a prescription for a reduced dosage or extended dosing
interval.
B. Administer the medication with a full glass of milk to prevent
gastric irritation.
C. Monitor the patient's stool for occult blood daily.
D. Instruct the patient to chew the tablet thoroughly before
swallowing.
Correct Answer
A. Request a prescription for a reduced dosage or extended dosing
interval.
Detailed Rationale
Famotidine is a histamine H2-receptor antagonist primarily excreted
unchanged by the kidneys. In older adults, especially those with
chronic kidney disease (CKD), reduced renal clearance can lead to
drug accumulation. This accumulation significantly increases the
risk of central nervous system (CNS) toxicity, manifesting as
, confusion, delirium, hallucinations, and agitation. Therefore, the
nurse should prioritize requesting a prescription for a reduced
dosage or extended dosing interval based on the patient's estimated
glomerular filtration rate (eGFR). Option B is incorrect because
famotidine does not require milk for administration and may be
given without regard to meals. Option C is a general assessment for
ulcer disease but does not address the specific pharmacokinetic
risk of the prescribed drug in this patient. Option D is incorrect
because famotidine tablets are not designed to be chewed. Nursing
considerations include closely monitoring older adults with renal
impairment for sudden changes in mental status and advocating for
appropriate renal dose adjustments.
Learning Objective
• Recognize the pharmacokinetic changes of H2-receptor
antagonists in renal impairment.
• Identify signs of CNS toxicity in older adults taking famotidine.
• Advocate for appropriate renal dose adjustments to prevent
iatrogenic harm.
Medication Safety Focus
Renal impairment dosing / Older adults
Question 3
Clinical Scenario
A 55-year-old female is receiving highly emetogenic chemotherapy
for breast cancer. The healthcare provider prescribes IV
