NCLEX-RN Gastrointestinal
Pharmacology Practice Questions with
Rationales
20 NGN & ATI-Style MCQs
Nursing Exam Prep
Question 1
Clinical Scenario
A 67-year-old woman with chronic gastroesophageal reflux
disease (GERD) has been taking omeprazole 40 mg orally once
daily for 10 months. She reports improved heartburn but now
complains of increasing fatigue, intermittent numbness in her
feet, and muscle cramps. Laboratory results reveal:
• Hemoglobin: 10.8 g/dL
• Magnesium: 1.3 mg/dL (low)
• Vitamin B12: Low
• Serum creatinine: Normal
The nurse reviews her medication history before administering
the morning dose.
,Question Stem
Which nursing action is the priority?
A. Administer the omeprazole as prescribed and reassure the
client that these findings are expected.
B. Hold the medication and notify the healthcare provider
about the laboratory findings and symptoms.
C. Instruct the client to begin taking calcium carbonate with
every meal.
D. Encourage the client to increase dietary potassium intake.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider about the laboratory findings and
symptoms.
Detailed Rationale
Long-term proton pump inhibitor (PPI) therapy, including
omeprazole, is associated with clinically significant adverse
effects such as hypomagnesemia, vitamin B12 deficiency,
reduced calcium absorption, and increased fracture risk. The
client's neurological symptoms (numbness), fatigue, anemia,
and low magnesium warrant prompt evaluation before another
dose is administered. The nurse should hold the medication and
notify the provider because continued therapy may worsen
,electrolyte abnormalities and neurological complications. The
provider may order magnesium replacement, vitamin B12
supplementation, or reassess the need for chronic PPI therapy.
• Option A: Incorrect. These are not expected benign effects
and require intervention.
• Option C: Incorrect. Calcium supplementation alone does
not address hypomagnesemia or vitamin B12 deficiency
and should not replace provider evaluation.
• Option D: Incorrect. Potassium intake will not correct the
client's primary abnormalities.
Nurses should monitor patients receiving prolonged PPI therapy
for magnesium levels, vitamin B12 deficiency, anemia, bone
health, and renal function while reinforcing the importance of
using the lowest effective dose for the shortest duration
appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize complications associated with long-term PPI
therapy.
• Identify assessment findings requiring provider
notification.
, • Prioritize nursing interventions for electrolyte
abnormalities.
• Monitor patients receiving chronic acid-suppressive
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 45-year-old man is admitted with a bleeding duodenal ulcer.
He is receiving a continuous pantoprazole intravenous infusion.
The nurse reviews the morning assessment:
• Blood pressure: 118/74 mm Hg
• Heart rate: 84/min
• Hemoglobin stable
• Reports mild nausea
• No abdominal pain
• Black stool noted overnight
Question Stem
Pharmacology Practice Questions with
Rationales
20 NGN & ATI-Style MCQs
Nursing Exam Prep
Question 1
Clinical Scenario
A 67-year-old woman with chronic gastroesophageal reflux
disease (GERD) has been taking omeprazole 40 mg orally once
daily for 10 months. She reports improved heartburn but now
complains of increasing fatigue, intermittent numbness in her
feet, and muscle cramps. Laboratory results reveal:
• Hemoglobin: 10.8 g/dL
• Magnesium: 1.3 mg/dL (low)
• Vitamin B12: Low
• Serum creatinine: Normal
The nurse reviews her medication history before administering
the morning dose.
,Question Stem
Which nursing action is the priority?
A. Administer the omeprazole as prescribed and reassure the
client that these findings are expected.
B. Hold the medication and notify the healthcare provider
about the laboratory findings and symptoms.
C. Instruct the client to begin taking calcium carbonate with
every meal.
D. Encourage the client to increase dietary potassium intake.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider about the laboratory findings and
symptoms.
Detailed Rationale
Long-term proton pump inhibitor (PPI) therapy, including
omeprazole, is associated with clinically significant adverse
effects such as hypomagnesemia, vitamin B12 deficiency,
reduced calcium absorption, and increased fracture risk. The
client's neurological symptoms (numbness), fatigue, anemia,
and low magnesium warrant prompt evaluation before another
dose is administered. The nurse should hold the medication and
notify the provider because continued therapy may worsen
,electrolyte abnormalities and neurological complications. The
provider may order magnesium replacement, vitamin B12
supplementation, or reassess the need for chronic PPI therapy.
• Option A: Incorrect. These are not expected benign effects
and require intervention.
• Option C: Incorrect. Calcium supplementation alone does
not address hypomagnesemia or vitamin B12 deficiency
and should not replace provider evaluation.
• Option D: Incorrect. Potassium intake will not correct the
client's primary abnormalities.
Nurses should monitor patients receiving prolonged PPI therapy
for magnesium levels, vitamin B12 deficiency, anemia, bone
health, and renal function while reinforcing the importance of
using the lowest effective dose for the shortest duration
appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize complications associated with long-term PPI
therapy.
• Identify assessment findings requiring provider
notification.
, • Prioritize nursing interventions for electrolyte
abnormalities.
• Monitor patients receiving chronic acid-suppressive
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 45-year-old man is admitted with a bleeding duodenal ulcer.
He is receiving a continuous pantoprazole intravenous infusion.
The nurse reviews the morning assessment:
• Blood pressure: 118/74 mm Hg
• Heart rate: 84/min
• Hemoglobin stable
• Reports mild nausea
• No abdominal pain
• Black stool noted overnight
Question Stem
