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 osteoporosis and
gastroesophageal reflux disease (GERD) has been taking
omeprazole 40 mg daily for the past 2 years. During a routine
clinic visit, she reports a new onset of frequent, watery, foul-
smelling diarrhea over the past 3 days, accompanied by mild
lower abdominal cramping. Her vital signs are stable, and
she denies fever.
Question Stem
Which action should the nurse take first?
A. Instruct the client to increase her daily calcium and
vitamin D supplementation.
B. Advise the client to take an over-the-counter antidiarrheal
medication immediately.
,C. Notify the healthcare provider and anticipate an order for
a stool test for Clostridioides difficile.
D. Reassure the client that this is a common, harmless side
effect of long-term omeprazole therapy.
Correct Answer
C. Notify the healthcare provider and anticipate an order for
a stool test for Clostridioides difficile.
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like
omeprazole significantly increases the risk of Clostridioides
difficile (C. diff) infection due to the suppression of gastric
acid, which normally acts as a barrier to ingested pathogens.
The client’s new onset of frequent, watery, foul-smelling
diarrhea is a classic presentation of C. diff. The nurse’s
priority action is to notify the provider and anticipate
diagnostic testing (e.g., stool toxin assay) to confirm the
infection and initiate appropriate isolation and treatment
protocols. Option A is incorrect because while long-term PPI
use can decrease calcium absorption and increase fracture
risk, addressing the acute diarrhea is the immediate priority.
Option B is incorrect and potentially dangerous, as
antidiarrheal medications (like loperamide) are
contraindicated in suspected C. diff because they decrease
peristalsis, retaining the toxin and increasing the risk of toxic
,megacolon. Option D is incorrect because this is not a
harmless side effect; it requires prompt clinical evaluation to
prevent severe complications.
Learning Objective
• Identify the risk of Clostridioides difficile infection
associated with long-term proton pump inhibitor
therapy.
• Prioritize nursing interventions for a client presenting
with acute, watery diarrhea while on acid-suppressing
medications.
• Recognize contraindications for antidiarrheal
medications in the presence of suspected infectious
diarrhea.
Medication Safety Focus
Adverse effect recognition and infection control.
Question 2
Clinical Scenario
A 72-year-old male with stage 3 chronic kidney disease
(CKD) is admitted to the medical-surgical unit for a mild
upper gastrointestinal bleed. The healthcare provider
prescribes famotidine 20 mg IV every 12 hours. The client’s
most recent basic metabolic panel shows a blood urea
, nitrogen (BUN) of 45 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, since IV
famotidine is not affected by renal function.
B. Hold the medication and request a dose reduction from
the healthcare provider.
C. Substitute the famotidine with an oral magnesium
hydroxide antacid.
D. Administer the medication and monitor the client for
hypertensive crisis.
Correct Answer
B. Hold the medication and request a dose reduction from
the healthcare provider.
Detailed Rationale
Famotidine is an H2-receptor antagonist that is primarily
excreted unchanged by the kidneys. In clients with renal
impairment (indicated by elevated BUN and creatinine), the
drug can accumulate, leading to an increased risk of central
nervous system (CNS) toxicity, such as confusion, agitation,
or hallucinations, especially in older adults. The standard
dose must be reduced (e.g., by 50% or extending the dosing
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 osteoporosis and
gastroesophageal reflux disease (GERD) has been taking
omeprazole 40 mg daily for the past 2 years. During a routine
clinic visit, she reports a new onset of frequent, watery, foul-
smelling diarrhea over the past 3 days, accompanied by mild
lower abdominal cramping. Her vital signs are stable, and
she denies fever.
Question Stem
Which action should the nurse take first?
A. Instruct the client to increase her daily calcium and
vitamin D supplementation.
B. Advise the client to take an over-the-counter antidiarrheal
medication immediately.
,C. Notify the healthcare provider and anticipate an order for
a stool test for Clostridioides difficile.
D. Reassure the client that this is a common, harmless side
effect of long-term omeprazole therapy.
Correct Answer
C. Notify the healthcare provider and anticipate an order for
a stool test for Clostridioides difficile.
Detailed Rationale
Long-term use of proton pump inhibitors (PPIs) like
omeprazole significantly increases the risk of Clostridioides
difficile (C. diff) infection due to the suppression of gastric
acid, which normally acts as a barrier to ingested pathogens.
The client’s new onset of frequent, watery, foul-smelling
diarrhea is a classic presentation of C. diff. The nurse’s
priority action is to notify the provider and anticipate
diagnostic testing (e.g., stool toxin assay) to confirm the
infection and initiate appropriate isolation and treatment
protocols. Option A is incorrect because while long-term PPI
use can decrease calcium absorption and increase fracture
risk, addressing the acute diarrhea is the immediate priority.
Option B is incorrect and potentially dangerous, as
antidiarrheal medications (like loperamide) are
contraindicated in suspected C. diff because they decrease
peristalsis, retaining the toxin and increasing the risk of toxic
,megacolon. Option D is incorrect because this is not a
harmless side effect; it requires prompt clinical evaluation to
prevent severe complications.
Learning Objective
• Identify the risk of Clostridioides difficile infection
associated with long-term proton pump inhibitor
therapy.
• Prioritize nursing interventions for a client presenting
with acute, watery diarrhea while on acid-suppressing
medications.
• Recognize contraindications for antidiarrheal
medications in the presence of suspected infectious
diarrhea.
Medication Safety Focus
Adverse effect recognition and infection control.
Question 2
Clinical Scenario
A 72-year-old male with stage 3 chronic kidney disease
(CKD) is admitted to the medical-surgical unit for a mild
upper gastrointestinal bleed. The healthcare provider
prescribes famotidine 20 mg IV every 12 hours. The client’s
most recent basic metabolic panel shows a blood urea
, nitrogen (BUN) of 45 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, since IV
famotidine is not affected by renal function.
B. Hold the medication and request a dose reduction from
the healthcare provider.
C. Substitute the famotidine with an oral magnesium
hydroxide antacid.
D. Administer the medication and monitor the client for
hypertensive crisis.
Correct Answer
B. Hold the medication and request a dose reduction from
the healthcare provider.
Detailed Rationale
Famotidine is an H2-receptor antagonist that is primarily
excreted unchanged by the kidneys. In clients with renal
impairment (indicated by elevated BUN and creatinine), the
drug can accumulate, leading to an increased risk of central
nervous system (CNS) toxicity, such as confusion, agitation,
or hallucinations, especially in older adults. The standard
dose must be reduced (e.g., by 50% or extending the dosing
