NCLEX-RN Pharmacology Gastrointestinal
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 68-year-old female with a history of gastroesophageal reflux
disease (GERD) has been taking omeprazole 20 mg daily for the past
3 years. During a routine follow-up visit, she reports new symptoms.
Question Stem
Which assessment finding should the nurse prioritize reporting to
the provider?
Options
A. Occasional headache
B. Intermittent dry cough
C. New onset of numbness and tingling in extremities
D. Mild weight gain
,Correct Answer
Correct Answer: C. New onset of numbness and tingling in
extremities
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, calcium, and magnesium. Vitamin
B12 deficiency can manifest as peripheral neuropathy (numbness
and tingling in extremities), cognitive changes, and megaloblastic
anemia. The nurse must prioritize reporting this finding, as it
indicates a potential serious adverse effect requiring intervention,
such as B12 supplementation or medication reevaluation. Option A
(occasional headache) is a common, mild side effect of PPIs that
does not require immediate reporting. Option B (intermittent dry
cough) is more commonly associated with ACE inhibitors, not PPIs.
Option D (mild weight gain) is not a recognized direct adverse effect
of omeprazole. Nursing considerations for patients on long-term PPI
therapy include monitoring for signs of nutrient deficiencies,
assessing bone density due to the increased risk of osteoporotic
fractures, and encouraging dietary sources of B12 and calcium.
Patient teaching should emphasize the importance of regular
follow-up and reporting any new neurological symptoms. This
question requires clinical judgment to differentiate between benign
side effects and signs of a significant, cumulative pharmacological
adverse effect.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs of vitamin B12 deficiency associated with
,long-term proton pump inhibitor use.
• Prioritize the reporting of neurological assessment findings in
patients on chronic acid-suppression therapy.
• Educate patients on the importance of routine monitoring and
dietary considerations during long-term PPI therapy.
Medication Safety Focus
Adverse effect
Question 2
Clinical Scenario
A 54-year-old male is receiving intravenous ondansetron for
postoperative nausea and vomiting. His medical history includes
heart failure, and his morning laboratory results show a potassium
level of 3.2 mEq/L.
Question Stem
Which action should the nurse take first?
Options
A. Request an order for a stat ECG and potassium replacement
B. Administer the ondansetron as prescribed
C. Switch the medication to oral promethazine
D. Assess the patient's blood pressure
Correct Answer
Correct Answer: A. Request an order for a stat ECG and potassium
replacement
, Detailed Rationale
Ondansetron, a serotonin (5-HT3) receptor antagonist, carries a risk
of dose-dependent QT interval prolongation, which can lead to life-
threatening arrhythmias such as Torsades de Pointes. This risk is
significantly exacerbated by electrolyte imbalances, particularly
hypokalemia (K+ 3.2 mEq/L) and hypomagnesemia, as well as in
patients with underlying heart conditions. The priority nursing action
is to withhold the medication and request a stat ECG and potassium
replacement to mitigate this lethal risk. Option B is unsafe because
administering ondansetron without correcting the hypokalemia or
checking the QT interval could precipitate a fatal arrhythmia. Option
C is incorrect because promethazine also carries risks of QT
prolongation and excessive sedation, and switching medications
does not address the underlying electrolyte imbalance. Option D is
a reasonable assessment but does not address the immediate, life-
threatening risk posed by the combination of ondansetron and
hypokalemia. Medication safety principles dictate that nurses must
review relevant laboratory values and cardiac history before
administering medications known to affect cardiac conduction.
Learning Objective
After completing this question, the learner should be able to:
• Identify the risk of QT prolongation associated with ondansetron
administration.
• Recognize hypokalemia as a major contributing factor to
medication-induced arrhythmias.
• Prioritize nursing interventions to prevent life-threatening cardiac
adverse effects.
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 68-year-old female with a history of gastroesophageal reflux
disease (GERD) has been taking omeprazole 20 mg daily for the past
3 years. During a routine follow-up visit, she reports new symptoms.
Question Stem
Which assessment finding should the nurse prioritize reporting to
the provider?
Options
A. Occasional headache
B. Intermittent dry cough
C. New onset of numbness and tingling in extremities
D. Mild weight gain
,Correct Answer
Correct Answer: C. New onset of numbness and tingling in
extremities
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, calcium, and magnesium. Vitamin
B12 deficiency can manifest as peripheral neuropathy (numbness
and tingling in extremities), cognitive changes, and megaloblastic
anemia. The nurse must prioritize reporting this finding, as it
indicates a potential serious adverse effect requiring intervention,
such as B12 supplementation or medication reevaluation. Option A
(occasional headache) is a common, mild side effect of PPIs that
does not require immediate reporting. Option B (intermittent dry
cough) is more commonly associated with ACE inhibitors, not PPIs.
Option D (mild weight gain) is not a recognized direct adverse effect
of omeprazole. Nursing considerations for patients on long-term PPI
therapy include monitoring for signs of nutrient deficiencies,
assessing bone density due to the increased risk of osteoporotic
fractures, and encouraging dietary sources of B12 and calcium.
Patient teaching should emphasize the importance of regular
follow-up and reporting any new neurological symptoms. This
question requires clinical judgment to differentiate between benign
side effects and signs of a significant, cumulative pharmacological
adverse effect.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs of vitamin B12 deficiency associated with
,long-term proton pump inhibitor use.
• Prioritize the reporting of neurological assessment findings in
patients on chronic acid-suppression therapy.
• Educate patients on the importance of routine monitoring and
dietary considerations during long-term PPI therapy.
Medication Safety Focus
Adverse effect
Question 2
Clinical Scenario
A 54-year-old male is receiving intravenous ondansetron for
postoperative nausea and vomiting. His medical history includes
heart failure, and his morning laboratory results show a potassium
level of 3.2 mEq/L.
Question Stem
Which action should the nurse take first?
Options
A. Request an order for a stat ECG and potassium replacement
B. Administer the ondansetron as prescribed
C. Switch the medication to oral promethazine
D. Assess the patient's blood pressure
Correct Answer
Correct Answer: A. Request an order for a stat ECG and potassium
replacement
, Detailed Rationale
Ondansetron, a serotonin (5-HT3) receptor antagonist, carries a risk
of dose-dependent QT interval prolongation, which can lead to life-
threatening arrhythmias such as Torsades de Pointes. This risk is
significantly exacerbated by electrolyte imbalances, particularly
hypokalemia (K+ 3.2 mEq/L) and hypomagnesemia, as well as in
patients with underlying heart conditions. The priority nursing action
is to withhold the medication and request a stat ECG and potassium
replacement to mitigate this lethal risk. Option B is unsafe because
administering ondansetron without correcting the hypokalemia or
checking the QT interval could precipitate a fatal arrhythmia. Option
C is incorrect because promethazine also carries risks of QT
prolongation and excessive sedation, and switching medications
does not address the underlying electrolyte imbalance. Option D is
a reasonable assessment but does not address the immediate, life-
threatening risk posed by the combination of ondansetron and
hypokalemia. Medication safety principles dictate that nurses must
review relevant laboratory values and cardiac history before
administering medications known to affect cardiac conduction.
Learning Objective
After completing this question, the learner should be able to:
• Identify the risk of QT prolongation associated with ondansetron
administration.
• Recognize hypokalemia as a major contributing factor to
medication-induced arrhythmias.
• Prioritize nursing interventions to prevent life-threatening cardiac
adverse effects.
