NU 578 | UNIT 4
OBJECTIVE ASSESSMENT - EXAM
NU 578 Unit 4 Gastrointestinal
Pharmacology Study
Assessment 2026/2027
Gastrointestinal Pharmacology | 2026/2027
100 100%
QUESTIONS ANSWERS EDITION
TOPICS COVERED
GERD, peptic ulcer disease, and acid Laxatives, antidiarrheals, bowel
suppression preparation, and IBS therapy
H. pylori eradication and NSAID-ulcer IBD induction, maintenance, biologics,
prevention and monitoring
Antiemetics and prokinetic medication Hepatic encephalopathy, pancreatic
selection enzymes, cirrhosis, and medication
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 1 of 52 COVER PAGE - 1
, SECTION 1 | Acid Suppression, GERD, and Peptic Ulcer Disease | Q1-Q22 | NU 578 Unit 4 Gastrointestinal Pharmacology Study
Assessment 2026/2027
Q1 Question 1 of 100
Q1. A 46-year-old outpatient has daily heartburn and sour regurgitation despite avoiding late
meals. The prescriber starts omeprazole and asks how the patient should take the medication for
best symptom control.
A. Take the dose 30 to 60 minutes before breakfast each day.
B. Take the dose only after heartburn begins in the evening.
C. Crush the capsule and mix it with a full antacid dose.
D. Take the dose at bedtime with a high-fat snack.
Correct Answer: A
Rationale:
Proton pump inhibitors work best when taken before a meal so active pumps are inhibited. Taking the dose
only after symptoms begin is less effective for scheduled GERD control.
Q2 Question 2 of 100
Q2. A 72-year-old long-term care resident with chronic kidney disease is prescribed famotidine for
nocturnal reflux. Two days later the nurse notes new confusion and dizziness after routine doses.
A. Add cimetidine because it causes fewer central nervous system effects.
B. Request renal-dose adjustment or reassessment of the H2 blocker.
C. Give the medication with magnesium hydroxide to prevent confusion.
D. Switch immediately to daily misoprostol for bedtime symptoms.
Correct Answer: B
Rationale:
Famotidine and other H2 blockers require caution and dose adjustment in renal impairment because central
nervous system effects can occur. Cimetidine has more interaction and endocrine concerns, so it is not the
safer automatic substitute.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 2 of 52
, Q3 Question 3 of 100
Q3. A 58-year-old man taking warfarin develops dyspepsia and asks for an over-the-counter acid
reducer. He has a history of medication interactions and wants to avoid changes in
anticoagulation response.
A. Cimetidine is preferred because it has no clinically relevant drug interactions.
B. Misoprostol is preferred because it directly reduces warfarin metabolism.
C. Famotidine is generally preferred over cimetidine for fewer CYP-mediated interactions.
D. Aluminum hydroxide is preferred because it increases warfarin absorption predictably.
Correct Answer: C
Rationale:
Cimetidine inhibits several hepatic enzymes and can raise levels of drugs such as warfarin. Famotidine has
fewer CYP interactions and is often the safer H2 blocker in patients with complex regimens.
Q4 Question 4 of 100
Q4. A 34-year-old patient is treated for pneumonia with levofloxacin and also uses calcium
carbonate several times daily for reflux. The patient reports that the antibiotic seems to be
working poorly.
A. Take both agents together to buffer gastric irritation from the antibiotic.
B. Stop levofloxacin because antacids make fluoroquinolones toxic.
C. Switch calcium carbonate to magnesium trisilicate at the same dosing time.
D. Separate the antacid from levofloxacin by several hours to avoid reduced absorption.
Correct Answer: D
Rationale:
Antacids containing polyvalent cations can chelate fluoroquinolones and markedly reduce absorption.
Changing to another cation-containing antacid at the same time would not solve the interaction.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
Q5. A 41-year-old patient with a duodenal ulcer is prescribed sucralfate and asks why it must be
separated from other medications. The patient takes levothyroxine and several morning tablets.
A. Sucralfate forms a protective barrier and can bind other drugs, reducing their absorption.
B. Sucralfate permanently blocks acid pumps and duplicates PPI timing rules.
C. Sucralfate increases gastric acid secretion when taken with tablets.
D. Sucralfate requires food for activation and loses effect when fasting.
Correct Answer: A
Rationale:
Sucralfate coats ulcerated mucosa and can interfere with absorption of other oral medications. It does not
work by irreversible acid-pump blockade like a PPI.
Q6 Question 6 of 100
Q6. A 29-year-old patient with severe arthritis takes high-dose NSAIDs and is not pregnant but
has a high ulcer risk. The clinician considers misoprostol for gastroprotection.
A. Use misoprostol freely in pregnancy because it protects the fetus from ulcers.
B. Confirm reliable pregnancy prevention because misoprostol can cause uterine
contractions.
C. Avoid counseling about diarrhea because constipation is the expected effect.
D. Combine misoprostol with aspirin to reverse its prostaglandin activity.
Correct Answer: B
Rationale:
Misoprostol is a prostaglandin analog that can reduce NSAID ulcer risk but is contraindicated in pregnancy
because it may induce uterine contractions. Diarrhea and cramping are common adverse effects, not
constipation.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 4 of 52
OBJECTIVE ASSESSMENT - EXAM
NU 578 Unit 4 Gastrointestinal
Pharmacology Study
Assessment 2026/2027
Gastrointestinal Pharmacology | 2026/2027
100 100%
QUESTIONS ANSWERS EDITION
TOPICS COVERED
GERD, peptic ulcer disease, and acid Laxatives, antidiarrheals, bowel
suppression preparation, and IBS therapy
H. pylori eradication and NSAID-ulcer IBD induction, maintenance, biologics,
prevention and monitoring
Antiemetics and prokinetic medication Hepatic encephalopathy, pancreatic
selection enzymes, cirrhosis, and medication
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 1 of 52 COVER PAGE - 1
, SECTION 1 | Acid Suppression, GERD, and Peptic Ulcer Disease | Q1-Q22 | NU 578 Unit 4 Gastrointestinal Pharmacology Study
Assessment 2026/2027
Q1 Question 1 of 100
Q1. A 46-year-old outpatient has daily heartburn and sour regurgitation despite avoiding late
meals. The prescriber starts omeprazole and asks how the patient should take the medication for
best symptom control.
A. Take the dose 30 to 60 minutes before breakfast each day.
B. Take the dose only after heartburn begins in the evening.
C. Crush the capsule and mix it with a full antacid dose.
D. Take the dose at bedtime with a high-fat snack.
Correct Answer: A
Rationale:
Proton pump inhibitors work best when taken before a meal so active pumps are inhibited. Taking the dose
only after symptoms begin is less effective for scheduled GERD control.
Q2 Question 2 of 100
Q2. A 72-year-old long-term care resident with chronic kidney disease is prescribed famotidine for
nocturnal reflux. Two days later the nurse notes new confusion and dizziness after routine doses.
A. Add cimetidine because it causes fewer central nervous system effects.
B. Request renal-dose adjustment or reassessment of the H2 blocker.
C. Give the medication with magnesium hydroxide to prevent confusion.
D. Switch immediately to daily misoprostol for bedtime symptoms.
Correct Answer: B
Rationale:
Famotidine and other H2 blockers require caution and dose adjustment in renal impairment because central
nervous system effects can occur. Cimetidine has more interaction and endocrine concerns, so it is not the
safer automatic substitute.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 2 of 52
, Q3 Question 3 of 100
Q3. A 58-year-old man taking warfarin develops dyspepsia and asks for an over-the-counter acid
reducer. He has a history of medication interactions and wants to avoid changes in
anticoagulation response.
A. Cimetidine is preferred because it has no clinically relevant drug interactions.
B. Misoprostol is preferred because it directly reduces warfarin metabolism.
C. Famotidine is generally preferred over cimetidine for fewer CYP-mediated interactions.
D. Aluminum hydroxide is preferred because it increases warfarin absorption predictably.
Correct Answer: C
Rationale:
Cimetidine inhibits several hepatic enzymes and can raise levels of drugs such as warfarin. Famotidine has
fewer CYP interactions and is often the safer H2 blocker in patients with complex regimens.
Q4 Question 4 of 100
Q4. A 34-year-old patient is treated for pneumonia with levofloxacin and also uses calcium
carbonate several times daily for reflux. The patient reports that the antibiotic seems to be
working poorly.
A. Take both agents together to buffer gastric irritation from the antibiotic.
B. Stop levofloxacin because antacids make fluoroquinolones toxic.
C. Switch calcium carbonate to magnesium trisilicate at the same dosing time.
D. Separate the antacid from levofloxacin by several hours to avoid reduced absorption.
Correct Answer: D
Rationale:
Antacids containing polyvalent cations can chelate fluoroquinolones and markedly reduce absorption.
Changing to another cation-containing antacid at the same time would not solve the interaction.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
Q5. A 41-year-old patient with a duodenal ulcer is prescribed sucralfate and asks why it must be
separated from other medications. The patient takes levothyroxine and several morning tablets.
A. Sucralfate forms a protective barrier and can bind other drugs, reducing their absorption.
B. Sucralfate permanently blocks acid pumps and duplicates PPI timing rules.
C. Sucralfate increases gastric acid secretion when taken with tablets.
D. Sucralfate requires food for activation and loses effect when fasting.
Correct Answer: A
Rationale:
Sucralfate coats ulcerated mucosa and can interfere with absorption of other oral medications. It does not
work by irreversible acid-pump blockade like a PPI.
Q6 Question 6 of 100
Q6. A 29-year-old patient with severe arthritis takes high-dose NSAIDs and is not pregnant but
has a high ulcer risk. The clinician considers misoprostol for gastroprotection.
A. Use misoprostol freely in pregnancy because it protects the fetus from ulcers.
B. Confirm reliable pregnancy prevention because misoprostol can cause uterine
contractions.
C. Avoid counseling about diarrhea because constipation is the expected effect.
D. Combine misoprostol with aspirin to reverse its prostaglandin activity.
Correct Answer: B
Rationale:
Misoprostol is a prostaglandin analog that can reduce NSAID ulcer risk but is contraindicated in pregnancy
because it may induce uterine contractions. Diarrhea and cramping are common adverse effects, not
constipation.
NU 578 Unit 4 Gastrointestinal Pharmacology Study Assessment 2026/2027 | Passing Score: 80% | Page 4 of 52
