NCLEX-RN Pharmacology Practice
Questions: Gastrointestinal System |
20 Original ATI & NGN-Style Nursing MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male with a history of gastroesophageal reflux disease
(GERD) has been taking omeprazole 40 mg daily for the past 3 years.
He presents to the clinic complaining of new-onset fatigue,
numbness and tingling in his bilateral feet, and a recent fall resulting
in a wrist fracture.
Question Stem
Which of the following actions should the nurse anticipate as the
priority to address the underlying cause of this patient's new
symptoms?
A. Administer a scheduled dose of intravenous magnesium sulfate.
B. Schedule the patient for an immediate dual-energy X-ray
absorptiometry (DEXA) scan.
C. Obtain a serum vitamin B12 level and complete blood count.
D. Discontinue omeprazole and initiate a trial of famotidine.
,Correct Answer
Correct Answer: C. Obtain a serum vitamin B12 level and complete
blood count.
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole
significantly reduces gastric acid secretion, which is necessary for
the absorption of vitamin B12 and calcium. Vitamin B12 deficiency
can manifest as fatigue, peripheral neuropathy (numbness and
tingling), and megaloblastic anemia. While the patient also has a
fracture (suggesting possible calcium malabsorption and
osteoporosis), assessing for B12 deficiency is the priority to address
the active neurological symptoms. Administering intravenous
magnesium sulfate (Option A) is incorrect because while
hypomagnesemia is a risk with long-term PPI use, it typically
presents with muscle cramps, tremors, or arrhythmias, not primarily
peripheral neuropathy. Scheduling a DEXA scan (Option B) is a
reasonable intervention for the fracture but does not address the
neurological symptoms. Discontinuing omeprazole (Option D) is a
long-term consideration that requires provider collaboration and
does not immediately address the diagnostic need for the current
symptoms.
Learning Objective
• Identify the adverse effects of long-term proton pump inhibitor
therapy.
• Recognize the clinical manifestations of vitamin B12 deficiency.
• Prioritize nursing assessments for patients on chronic acid-
suppressive therapy.
,Medication Safety Focus
Adverse effect
Question 2
Clinical Scenario
A 72-year-old female with a history of chronic kidney disease (stage
3) and peptic ulcer disease is prescribed famotidine 20 mg twice
daily for gastric acid suppression. Her most recent basic metabolic
panel shows a blood urea nitrogen (BUN) of 38 mg/dL and a serum
creatinine of 2.1 mg/dL.
Question Stem
Which action should the nurse take regarding this medication
order?
A. Administer the medication as prescribed, as famotidine is
primarily metabolized by the liver.
B. Administer the medication with a full glass of milk to enhance
absorption.
C. Request an order to change the medication to intravenous
cimetidine.
D. Hold the medication and contact the health care provider to
discuss a dosage reduction.
Correct Answer
Correct Answer: D. Hold the medication and contact the health care
provider to discuss a dosage reduction.
Detailed Rationale
Famotidine is an H2-receptor antagonist that is primarily excreted
, unchanged by the kidneys. In patients with renal impairment
(indicated by elevated BUN and creatinine), the drug can
accumulate, increasing the risk of adverse central nervous system
effects such as confusion, dizziness, and hallucinations, especially
in older adults. The nurse should hold the dose and contact the
provider to discuss a renal dosage adjustment, such as reducing the
dose or extending the dosing interval. Option A is incorrect because
famotidine is renally excreted, not hepatically metabolized. Option
B is incorrect; milk can temporarily buffer acid but does not
enhance famotidine absorption and may stimulate rebound acid
secretion. Option C is incorrect because cimetidine has a higher
risk of drug interactions and CNS side effects in older adults and
also requires renal dosing.
Learning Objective
• Recognize the pharmacokinetics of H2-receptor antagonists in
renal impairment.
• Identify the need for dosage adjustments in patients with
decreased kidney function.
• Prevent adverse central nervous system effects in older adult
patients.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 45-year-old male is admitted to the medical-surgical unit with a
urinary tract infection. He is prescribed ciprofloxacin 500 mg orally
Questions: Gastrointestinal System |
20 Original ATI & NGN-Style Nursing MCQs
with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male with a history of gastroesophageal reflux disease
(GERD) has been taking omeprazole 40 mg daily for the past 3 years.
He presents to the clinic complaining of new-onset fatigue,
numbness and tingling in his bilateral feet, and a recent fall resulting
in a wrist fracture.
Question Stem
Which of the following actions should the nurse anticipate as the
priority to address the underlying cause of this patient's new
symptoms?
A. Administer a scheduled dose of intravenous magnesium sulfate.
B. Schedule the patient for an immediate dual-energy X-ray
absorptiometry (DEXA) scan.
C. Obtain a serum vitamin B12 level and complete blood count.
D. Discontinue omeprazole and initiate a trial of famotidine.
,Correct Answer
Correct Answer: C. Obtain a serum vitamin B12 level and complete
blood count.
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole
significantly reduces gastric acid secretion, which is necessary for
the absorption of vitamin B12 and calcium. Vitamin B12 deficiency
can manifest as fatigue, peripheral neuropathy (numbness and
tingling), and megaloblastic anemia. While the patient also has a
fracture (suggesting possible calcium malabsorption and
osteoporosis), assessing for B12 deficiency is the priority to address
the active neurological symptoms. Administering intravenous
magnesium sulfate (Option A) is incorrect because while
hypomagnesemia is a risk with long-term PPI use, it typically
presents with muscle cramps, tremors, or arrhythmias, not primarily
peripheral neuropathy. Scheduling a DEXA scan (Option B) is a
reasonable intervention for the fracture but does not address the
neurological symptoms. Discontinuing omeprazole (Option D) is a
long-term consideration that requires provider collaboration and
does not immediately address the diagnostic need for the current
symptoms.
Learning Objective
• Identify the adverse effects of long-term proton pump inhibitor
therapy.
• Recognize the clinical manifestations of vitamin B12 deficiency.
• Prioritize nursing assessments for patients on chronic acid-
suppressive therapy.
,Medication Safety Focus
Adverse effect
Question 2
Clinical Scenario
A 72-year-old female with a history of chronic kidney disease (stage
3) and peptic ulcer disease is prescribed famotidine 20 mg twice
daily for gastric acid suppression. Her most recent basic metabolic
panel shows a blood urea nitrogen (BUN) of 38 mg/dL and a serum
creatinine of 2.1 mg/dL.
Question Stem
Which action should the nurse take regarding this medication
order?
A. Administer the medication as prescribed, as famotidine is
primarily metabolized by the liver.
B. Administer the medication with a full glass of milk to enhance
absorption.
C. Request an order to change the medication to intravenous
cimetidine.
D. Hold the medication and contact the health care provider to
discuss a dosage reduction.
Correct Answer
Correct Answer: D. Hold the medication and contact the health care
provider to discuss a dosage reduction.
Detailed Rationale
Famotidine is an H2-receptor antagonist that is primarily excreted
, unchanged by the kidneys. In patients with renal impairment
(indicated by elevated BUN and creatinine), the drug can
accumulate, increasing the risk of adverse central nervous system
effects such as confusion, dizziness, and hallucinations, especially
in older adults. The nurse should hold the dose and contact the
provider to discuss a renal dosage adjustment, such as reducing the
dose or extending the dosing interval. Option A is incorrect because
famotidine is renally excreted, not hepatically metabolized. Option
B is incorrect; milk can temporarily buffer acid but does not
enhance famotidine absorption and may stimulate rebound acid
secretion. Option C is incorrect because cimetidine has a higher
risk of drug interactions and CNS side effects in older adults and
also requires renal dosing.
Learning Objective
• Recognize the pharmacokinetics of H2-receptor antagonists in
renal impairment.
• Identify the need for dosage adjustments in patients with
decreased kidney function.
• Prevent adverse central nervous system effects in older adult
patients.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 45-year-old male is admitted to the medical-surgical unit with a
urinary tract infection. He is prescribed ciprofloxacin 500 mg orally
