NCLEX-RN Pharmacology Exam
Questions & Rationales
Gastrointestinal System
20 ATI & NGN-Style Practice MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old client with gastroesophageal reflux disease
(GERD) has been taking omeprazole 40 mg daily for 8 months.
The client reports increasing fatigue, muscle cramps, and
occasional palpitations. Laboratory results show magnesium 1.2
mg/dL (normal 1.7–2.2 mg/dL).
Question Stem
Which finding is the nurse's priority concern related to long-
term omeprazole therapy?
A. Mild constipation
B. Hypomagnesemia
,C. Dry mouth
D. Increased appetite
Correct Answer
Correct Answer: B. Hypomagnesemia
Detailed Rationale
Proton pump inhibitors (PPIs) such as omeprazole reduce
gastric acid secretion by inhibiting the hydrogen-potassium
ATPase pump in parietal cells. Long-term use has been
associated with hypomagnesemia, which can lead to serious
complications including cardiac dysrhythmias, muscle cramps,
seizures, and neuromuscular irritability. The client's laboratory
value and symptoms strongly suggest clinically significant
magnesium depletion requiring provider notification and
possible supplementation.
Option A is incorrect because constipation may occur but is
generally not life-threatening. Option C is incorrect because dry
mouth is not a major complication of chronic PPI therapy.
Option D is incorrect because increased appetite is not a
common adverse effect and is not a priority concern.
Nurses should monitor electrolytes in clients receiving
prolonged PPI therapy, especially older adults and those taking
diuretics. Additional concerns include osteoporosis-related
fractures, vitamin B12 deficiency, and increased risk of
,gastrointestinal infections. Patient education should emphasize
reporting muscle weakness, palpitations, and persistent fatigue.
Learning Objective
After completing this question, the learner should be able to:
• Identify serious adverse effects of long-term PPI therapy.
• Recognize manifestations of hypomagnesemia.
• Prioritize laboratory monitoring for clients receiving PPIs.
• Implement appropriate nursing interventions for
electrolyte abnormalities.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A nurse is preparing discharge teaching for a client prescribed
sucralfate for treatment of a duodenal ulcer.
Question Stem
Which statement by the client indicates correct understanding
of medication administration?
, A. "I will take this medication with meals."
B. "I should crush the medication and mix it with milk."
C. "I will take this medication on an empty stomach."
D. "I can take antacids at the same time."
Correct Answer
Correct Answer: C. "I will take this medication on an empty
stomach."
Detailed Rationale
Sucralfate forms a protective barrier over ulcerated tissue. For
optimal effectiveness, it should be administered on an empty
stomach, usually 1 hour before meals and at bedtime. Food can
interfere with the formation of the protective coating.
Option A is incorrect because administration with meals
decreases effectiveness. Option B is incorrect because milk is
not required and may interfere with absorption. Option D is
incorrect because antacids should generally be separated from
sucralfate by at least 30 minutes to avoid reducing its
therapeutic action.
Nursing education should focus on proper timing, adherence to
the dosing schedule, and avoiding simultaneous administration
with certain medications. Because sucralfate can interfere with
absorption of drugs such as digoxin, levothyroxine, and
fluoroquinolones, medication reconciliation is essential.
Questions & Rationales
Gastrointestinal System
20 ATI & NGN-Style Practice MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 52-year-old client with gastroesophageal reflux disease
(GERD) has been taking omeprazole 40 mg daily for 8 months.
The client reports increasing fatigue, muscle cramps, and
occasional palpitations. Laboratory results show magnesium 1.2
mg/dL (normal 1.7–2.2 mg/dL).
Question Stem
Which finding is the nurse's priority concern related to long-
term omeprazole therapy?
A. Mild constipation
B. Hypomagnesemia
,C. Dry mouth
D. Increased appetite
Correct Answer
Correct Answer: B. Hypomagnesemia
Detailed Rationale
Proton pump inhibitors (PPIs) such as omeprazole reduce
gastric acid secretion by inhibiting the hydrogen-potassium
ATPase pump in parietal cells. Long-term use has been
associated with hypomagnesemia, which can lead to serious
complications including cardiac dysrhythmias, muscle cramps,
seizures, and neuromuscular irritability. The client's laboratory
value and symptoms strongly suggest clinically significant
magnesium depletion requiring provider notification and
possible supplementation.
Option A is incorrect because constipation may occur but is
generally not life-threatening. Option C is incorrect because dry
mouth is not a major complication of chronic PPI therapy.
Option D is incorrect because increased appetite is not a
common adverse effect and is not a priority concern.
Nurses should monitor electrolytes in clients receiving
prolonged PPI therapy, especially older adults and those taking
diuretics. Additional concerns include osteoporosis-related
fractures, vitamin B12 deficiency, and increased risk of
,gastrointestinal infections. Patient education should emphasize
reporting muscle weakness, palpitations, and persistent fatigue.
Learning Objective
After completing this question, the learner should be able to:
• Identify serious adverse effects of long-term PPI therapy.
• Recognize manifestations of hypomagnesemia.
• Prioritize laboratory monitoring for clients receiving PPIs.
• Implement appropriate nursing interventions for
electrolyte abnormalities.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A nurse is preparing discharge teaching for a client prescribed
sucralfate for treatment of a duodenal ulcer.
Question Stem
Which statement by the client indicates correct understanding
of medication administration?
, A. "I will take this medication with meals."
B. "I should crush the medication and mix it with milk."
C. "I will take this medication on an empty stomach."
D. "I can take antacids at the same time."
Correct Answer
Correct Answer: C. "I will take this medication on an empty
stomach."
Detailed Rationale
Sucralfate forms a protective barrier over ulcerated tissue. For
optimal effectiveness, it should be administered on an empty
stomach, usually 1 hour before meals and at bedtime. Food can
interfere with the formation of the protective coating.
Option A is incorrect because administration with meals
decreases effectiveness. Option B is incorrect because milk is
not required and may interfere with absorption. Option D is
incorrect because antacids should generally be separated from
sucralfate by at least 30 minutes to avoid reducing its
therapeutic action.
Nursing education should focus on proper timing, adherence to
the dosing schedule, and avoiding simultaneous administration
with certain medications. Because sucralfate can interfere with
absorption of drugs such as digoxin, levothyroxine, and
fluoroquinolones, medication reconciliation is essential.
