NCLEX-RN Gastrointestinal Pharmacology
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales PDF
Question 1
Clinical Scenario
A 68-year-old female with a history of gastroesophageal reflux
disease (GERD) presents to the clinic complaining of new-onset
fatigue, dizziness, and numbness and tingling in her bilateral feet.
Her medical record indicates she has been taking omeprazole 20
mg daily for the past 3 years. Vital signs are stable.
Question Stem
Which laboratory value should the nurse anticipate reviewing to
determine the most likely cause of these new symptoms?
A. Serum magnesium
B. Vitamin B12
C. Serum calcium
D. Liver function tests
,Correct Answer
Correct Answer: B. Vitamin B12
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole
significantly reduces gastric acid secretion. Gastric acid is essential
for cleaving vitamin B12 from dietary proteins, allowing it to bind to
intrinsic factor for absorption in the ileum. Prolonged PPI therapy
can lead to vitamin B12 deficiency, which clinically manifests as
megaloblastic anemia (fatigue, dizziness) and peripheral neuropathy
(numbness and tingling in the extremities). While long-term PPI use
can also decrease the absorption of magnesium and calcium
(increasing the risk of hypomagnesemia and osteoporosis), these
deficiencies typically present with muscle cramps, arrhythmias, or
fractures, not classic peripheral neuropathy. Liver function tests are
not routinely indicated for PPI monitoring unless hepatotoxicity is
specifically suspected. The nurse should advocate for periodic B12
level monitoring in patients on long-term PPI therapy and educate
them on dietary sources or supplementation if needed.
Learning Objective
• Identify the adverse effects associated with long-term proton
pump inhibitor therapy.
• Recognize the clinical manifestations of vitamin B12
deficiency.
• Prioritize appropriate laboratory monitoring for patients on
chronic acid-suppressing medications.
,Medication Safety Focus
Monitoring parameters
Question 2
Clinical Scenario
An 82-year-old male is admitted to the medical-surgical unit for a
urinary tract infection. His medical history includes mild cognitive
impairment and stage 2 chronic kidney disease. The provider
prescribes famotidine 20 mg IV daily for stress ulcer prophylaxis.
Question Stem
Which assessment finding requires immediate notification of the
healthcare provider?
A. Reports of a mild, intermittent headache
B. New onset of confusion and agitation
C. Decreased, but present, bowel sounds
D. Heart rate of 88 beats per minute
Correct Answer
Correct Answer: B. New onset of confusion and agitation
Detailed Rationale
Histamine-2 (H2) receptor antagonists, such as famotidine, can
cross the blood-brain barrier. Older adults, especially those with
pre-existing cognitive impairment or renal dysfunction (which
decreases drug clearance), are at a significantly higher risk for
central nervous system (CNS) adverse effects. These can range from
mild confusion and dizziness to severe agitation, delirium, or
hallucinations. New-onset confusion in this population is a red flag
, that requires immediate provider notification to evaluate for
medication toxicity and consider dose adjustment or
discontinuation. A mild headache is a common, non-urgent side
effect. Decreased bowel sounds may be expected in an older, less
mobile adult and are not an acute emergency. A heart rate of 88/min
is within normal limits and does not indicate an adverse reaction to
famotidine.
Learning Objective
• Recognize the increased risk of CNS adverse effects of H2
receptor antagonists in older adults.
• Prioritize nursing assessments for medication-induced
delirium in vulnerable populations.
• Understand the impact of renal impairment on medication
clearance and toxicity.
Medication Safety Focus
Adverse effect recognition
Question 3
Clinical Scenario
A 54-year-old female is receiving her second cycle of chemotherapy
for breast cancer. She complains of severe nausea. The provider
prescribes ondansetron 8 mg IV push. A recent electrocardiogram
(ECG) reveals a QT interval of 480 milliseconds.
Question Stem
Which action should the nurse take first?
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales PDF
Question 1
Clinical Scenario
A 68-year-old female with a history of gastroesophageal reflux
disease (GERD) presents to the clinic complaining of new-onset
fatigue, dizziness, and numbness and tingling in her bilateral feet.
Her medical record indicates she has been taking omeprazole 20
mg daily for the past 3 years. Vital signs are stable.
Question Stem
Which laboratory value should the nurse anticipate reviewing to
determine the most likely cause of these new symptoms?
A. Serum magnesium
B. Vitamin B12
C. Serum calcium
D. Liver function tests
,Correct Answer
Correct Answer: B. Vitamin B12
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole
significantly reduces gastric acid secretion. Gastric acid is essential
for cleaving vitamin B12 from dietary proteins, allowing it to bind to
intrinsic factor for absorption in the ileum. Prolonged PPI therapy
can lead to vitamin B12 deficiency, which clinically manifests as
megaloblastic anemia (fatigue, dizziness) and peripheral neuropathy
(numbness and tingling in the extremities). While long-term PPI use
can also decrease the absorption of magnesium and calcium
(increasing the risk of hypomagnesemia and osteoporosis), these
deficiencies typically present with muscle cramps, arrhythmias, or
fractures, not classic peripheral neuropathy. Liver function tests are
not routinely indicated for PPI monitoring unless hepatotoxicity is
specifically suspected. The nurse should advocate for periodic B12
level monitoring in patients on long-term PPI therapy and educate
them on dietary sources or supplementation if needed.
Learning Objective
• Identify the adverse effects associated with long-term proton
pump inhibitor therapy.
• Recognize the clinical manifestations of vitamin B12
deficiency.
• Prioritize appropriate laboratory monitoring for patients on
chronic acid-suppressing medications.
,Medication Safety Focus
Monitoring parameters
Question 2
Clinical Scenario
An 82-year-old male is admitted to the medical-surgical unit for a
urinary tract infection. His medical history includes mild cognitive
impairment and stage 2 chronic kidney disease. The provider
prescribes famotidine 20 mg IV daily for stress ulcer prophylaxis.
Question Stem
Which assessment finding requires immediate notification of the
healthcare provider?
A. Reports of a mild, intermittent headache
B. New onset of confusion and agitation
C. Decreased, but present, bowel sounds
D. Heart rate of 88 beats per minute
Correct Answer
Correct Answer: B. New onset of confusion and agitation
Detailed Rationale
Histamine-2 (H2) receptor antagonists, such as famotidine, can
cross the blood-brain barrier. Older adults, especially those with
pre-existing cognitive impairment or renal dysfunction (which
decreases drug clearance), are at a significantly higher risk for
central nervous system (CNS) adverse effects. These can range from
mild confusion and dizziness to severe agitation, delirium, or
hallucinations. New-onset confusion in this population is a red flag
, that requires immediate provider notification to evaluate for
medication toxicity and consider dose adjustment or
discontinuation. A mild headache is a common, non-urgent side
effect. Decreased bowel sounds may be expected in an older, less
mobile adult and are not an acute emergency. A heart rate of 88/min
is within normal limits and does not indicate an adverse reaction to
famotidine.
Learning Objective
• Recognize the increased risk of CNS adverse effects of H2
receptor antagonists in older adults.
• Prioritize nursing assessments for medication-induced
delirium in vulnerable populations.
• Understand the impact of renal impairment on medication
clearance and toxicity.
Medication Safety Focus
Adverse effect recognition
Question 3
Clinical Scenario
A 54-year-old female is receiving her second cycle of chemotherapy
for breast cancer. She complains of severe nausea. The provider
prescribes ondansetron 8 mg IV push. A recent electrocardiogram
(ECG) reveals a QT interval of 480 milliseconds.
Question Stem
Which action should the nurse take first?
