NCLEX-RN Pharmacology Gastrointestinal
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old male client with a history of gastroesophageal reflux
disease (GERD) has been taking omeprazole 20 mg daily for the past
4 years. During a routine follow-up visit, he reports new-onset
muscle cramps in his calves and occasional palpitations. His vital
signs are stable, and his medical history is otherwise unremarkable.
Question Stem
Which laboratory value should the nurse prioritize reviewing to
evaluate the cause of this client's new symptoms?
A. Serum potassium
B. Blood urea nitrogen (BUN)
C. Serum magnesium
D. Serum sodium
Correct Answer
Correct Answer: C. Serum magnesium
,Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole is
strongly associated with hypomagnesemia, which can manifest as
muscle cramps, tremors, arrhythmias, and seizures. The FDA
recommends checking serum magnesium levels before starting
long-term PPI therapy and periodically during treatment. Option A is
incorrect because while hypokalemia can cause similar
neuromuscular symptoms, PPIs specifically impair intestinal
magnesium absorption, making hypomagnesemia the primary
pharmacological concern. Option B is incorrect because PPIs do
not typically cause acute renal failure or elevated BUN, although
chronic kidney disease can be a risk factor for magnesium
accumulation if hypomagnesemia is concurrently present. Option D
is incorrect because hyponatremia is not a direct adverse effect of
PPI therapy. Nursing considerations include monitoring for signs of
neuromuscular irritability and educating the client to report muscle
spasms or palpitations promptly. If hypomagnesemia is confirmed,
magnesium supplementation may be required, and discontinuation
or substitution of the PPI should be considered.
Learning Objective
• Identify hypomagnesemia as a potential long-term adverse
effect of proton pump inhibitors.
• Prioritize appropriate laboratory monitoring for clients on
chronic PPI therapy.
• Recognize clinical manifestations of electrolyte imbalances in
older adults.
,Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
An 82-year-old female client with a history of mild renal impairment
(eGFR 45 mL/min) is prescribed famotidine 20 mg twice daily for
dyspepsia. On the second day of therapy, the nurse notes that the
client is unusually restless and is making statements that do not
make sense.
Question Stem
Which assessment finding should the nurse report to the provider as
a potential adverse effect of this medication in this client?
A. New-onset confusion
B. Constipation
C. Dry mouth
D. Headache
Correct Answer
Correct Answer: A. New-onset confusion
Detailed Rationale
H2-receptor antagonists like famotidine are generally well-tolerated,
but in older adults, especially those with renal impairment, the drug
can cross the blood-brain barrier and cause central nervous system
(CNS) adverse effects, including new-onset confusion, delirium, or
hallucinations. Renal impairment decreases the clearance of
famotidine, increasing the risk of systemic toxicity. Option B is
, incorrect because constipation is more commonly associated with
antacids containing aluminum or calcium, not H2 blockers. Option
C is incorrect because dry mouth is a mild anticholinergic effect
more typical of first-generation antihistamines or tricyclic
antidepressants. Option D is incorrect because while headache can
occur with famotidine, it is not a priority finding requiring immediate
reporting compared to acute mental status changes. The nurse
should advocate for a renal dose adjustment and monitor the
client's mental status closely.
Learning Objective
• Recognize central nervous system adverse effects of H2-
receptor antagonists in older adults.
• Understand the impact of renal impairment on medication
clearance and toxicity risk.
• Prioritize reporting of acute mental status changes in geriatric
clients.
Medication Safety Focus
Adverse effect
Question 3
Clinical Scenario
A 55-year-old male client is receiving ondansetron 8 mg IV for
chemotherapy-induced nausea and vomiting. His medical history
includes a previous diagnosis of prolonged QT interval on an
electrocardiogram (ECG).
System Practice Questions |
20 ATI & NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old male client with a history of gastroesophageal reflux
disease (GERD) has been taking omeprazole 20 mg daily for the past
4 years. During a routine follow-up visit, he reports new-onset
muscle cramps in his calves and occasional palpitations. His vital
signs are stable, and his medical history is otherwise unremarkable.
Question Stem
Which laboratory value should the nurse prioritize reviewing to
evaluate the cause of this client's new symptoms?
A. Serum potassium
B. Blood urea nitrogen (BUN)
C. Serum magnesium
D. Serum sodium
Correct Answer
Correct Answer: C. Serum magnesium
,Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like omeprazole is
strongly associated with hypomagnesemia, which can manifest as
muscle cramps, tremors, arrhythmias, and seizures. The FDA
recommends checking serum magnesium levels before starting
long-term PPI therapy and periodically during treatment. Option A is
incorrect because while hypokalemia can cause similar
neuromuscular symptoms, PPIs specifically impair intestinal
magnesium absorption, making hypomagnesemia the primary
pharmacological concern. Option B is incorrect because PPIs do
not typically cause acute renal failure or elevated BUN, although
chronic kidney disease can be a risk factor for magnesium
accumulation if hypomagnesemia is concurrently present. Option D
is incorrect because hyponatremia is not a direct adverse effect of
PPI therapy. Nursing considerations include monitoring for signs of
neuromuscular irritability and educating the client to report muscle
spasms or palpitations promptly. If hypomagnesemia is confirmed,
magnesium supplementation may be required, and discontinuation
or substitution of the PPI should be considered.
Learning Objective
• Identify hypomagnesemia as a potential long-term adverse
effect of proton pump inhibitors.
• Prioritize appropriate laboratory monitoring for clients on
chronic PPI therapy.
• Recognize clinical manifestations of electrolyte imbalances in
older adults.
,Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
An 82-year-old female client with a history of mild renal impairment
(eGFR 45 mL/min) is prescribed famotidine 20 mg twice daily for
dyspepsia. On the second day of therapy, the nurse notes that the
client is unusually restless and is making statements that do not
make sense.
Question Stem
Which assessment finding should the nurse report to the provider as
a potential adverse effect of this medication in this client?
A. New-onset confusion
B. Constipation
C. Dry mouth
D. Headache
Correct Answer
Correct Answer: A. New-onset confusion
Detailed Rationale
H2-receptor antagonists like famotidine are generally well-tolerated,
but in older adults, especially those with renal impairment, the drug
can cross the blood-brain barrier and cause central nervous system
(CNS) adverse effects, including new-onset confusion, delirium, or
hallucinations. Renal impairment decreases the clearance of
famotidine, increasing the risk of systemic toxicity. Option B is
, incorrect because constipation is more commonly associated with
antacids containing aluminum or calcium, not H2 blockers. Option
C is incorrect because dry mouth is a mild anticholinergic effect
more typical of first-generation antihistamines or tricyclic
antidepressants. Option D is incorrect because while headache can
occur with famotidine, it is not a priority finding requiring immediate
reporting compared to acute mental status changes. The nurse
should advocate for a renal dose adjustment and monitor the
client's mental status closely.
Learning Objective
• Recognize central nervous system adverse effects of H2-
receptor antagonists in older adults.
• Understand the impact of renal impairment on medication
clearance and toxicity risk.
• Prioritize reporting of acute mental status changes in geriatric
clients.
Medication Safety Focus
Adverse effect
Question 3
Clinical Scenario
A 55-year-old male client is receiving ondansetron 8 mg IV for
chemotherapy-induced nausea and vomiting. His medical history
includes a previous diagnosis of prolonged QT interval on an
electrocardiogram (ECG).
