NCLEX-RN Musculoskeletal Pharmacology Practice
Questions & Rationales |
20 Original NGN Exam-Style MCQs |
Osteoporosis, Gout & Muscle Relaxants |
ATI, HESI & Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female is diagnosed with osteoporosis and receives a new
prescription for alendronate. The nurse is providing discharge
education regarding the proper administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of milk to protect my
stomach."
B. "I will remain upright for at least 30 minutes after taking it."
C. "I can take this medication at bedtime to avoid daytime stomach
upset."
D. "I will chew the tablet to ensure it dissolves quickly in my stomach."
Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes after
taking it."
,Detailed Rationale
Alendronate is a bisphosphonate used to treat osteoporosis by
inhibiting osteoclast-mediated bone resorption. It is poorly absorbed
and highly irritating to the esophageal mucosa. Therefore, it must be
taken first thing in the morning on an empty stomach with a full glass of
plain water (not milk, coffee, or juice, as calcium and other minerals
bind to the drug and significantly decrease absorption). The patient
must remain upright (sitting or standing) for at least 30 minutes to
prevent esophageal reflux, irritation, and ulceration. Chewing or
crushing the tablet is contraindicated as it increases local mucosal
irritation and alters the drug's pharmacokinetics. Option A is incorrect
because dairy products decrease absorption. Option C is incorrect
because lying down at bedtime increases the risk of severe esophageal
adverse effects. Option D is incorrect because the tablet must be
swallowed whole to ensure safe delivery to the stomach.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize nursing measures required to prevent esophageal
irritation and ulceration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male with rheumatoid arthritis has been taking
methotrexate for the past 6 months. Routine laboratory results are
reviewed during a follow-up clinic visit.
, Question Stem
Which laboratory finding requires immediate intervention by the
nurse?
A. WBC count 2,800/mm³
B. Platelet count 160,000/mm³
C. AST 25 units/L
D. Serum creatinine 0.9 mg/dL
Correct Answer
Correct Answer: A. WBC count 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
acts as a folic acid antagonist, inhibiting DNA synthesis and cellular
replication. Because it targets rapidly dividing cells, it commonly causes
bone marrow suppression, leading to leukopenia, thrombocytopenia,
and anemia. A white blood cell (WBC) count of 2,800/mm³ indicates
significant leukopenia (normal is 4,500–11,000/mm³), placing the client
at a high risk for life-threatening infections. This requires immediate
intervention, such as holding the medication and notifying the
healthcare provider. Option B is incorrect because a platelet count of
160,000/mm³ is within the normal range (150,000–400,000/mm³).
Option C is incorrect because an AST of 25 units/L is a normal liver
function value, and methotrexate hepatotoxicity would present with
elevated transaminases. Option D is incorrect because a serum
creatinine of 0.9 mg/dL is normal, indicating adequate renal function.
Learning Objective
• Interpret laboratory values associated with DMARD therapy.
• Prioritize nursing interventions for early signs of bone marrow
suppression.
Questions & Rationales |
20 Original NGN Exam-Style MCQs |
Osteoporosis, Gout & Muscle Relaxants |
ATI, HESI & Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female is diagnosed with osteoporosis and receives a new
prescription for alendronate. The nurse is providing discharge
education regarding the proper administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of milk to protect my
stomach."
B. "I will remain upright for at least 30 minutes after taking it."
C. "I can take this medication at bedtime to avoid daytime stomach
upset."
D. "I will chew the tablet to ensure it dissolves quickly in my stomach."
Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes after
taking it."
,Detailed Rationale
Alendronate is a bisphosphonate used to treat osteoporosis by
inhibiting osteoclast-mediated bone resorption. It is poorly absorbed
and highly irritating to the esophageal mucosa. Therefore, it must be
taken first thing in the morning on an empty stomach with a full glass of
plain water (not milk, coffee, or juice, as calcium and other minerals
bind to the drug and significantly decrease absorption). The patient
must remain upright (sitting or standing) for at least 30 minutes to
prevent esophageal reflux, irritation, and ulceration. Chewing or
crushing the tablet is contraindicated as it increases local mucosal
irritation and alters the drug's pharmacokinetics. Option A is incorrect
because dairy products decrease absorption. Option C is incorrect
because lying down at bedtime increases the risk of severe esophageal
adverse effects. Option D is incorrect because the tablet must be
swallowed whole to ensure safe delivery to the stomach.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize nursing measures required to prevent esophageal
irritation and ulceration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male with rheumatoid arthritis has been taking
methotrexate for the past 6 months. Routine laboratory results are
reviewed during a follow-up clinic visit.
, Question Stem
Which laboratory finding requires immediate intervention by the
nurse?
A. WBC count 2,800/mm³
B. Platelet count 160,000/mm³
C. AST 25 units/L
D. Serum creatinine 0.9 mg/dL
Correct Answer
Correct Answer: A. WBC count 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
acts as a folic acid antagonist, inhibiting DNA synthesis and cellular
replication. Because it targets rapidly dividing cells, it commonly causes
bone marrow suppression, leading to leukopenia, thrombocytopenia,
and anemia. A white blood cell (WBC) count of 2,800/mm³ indicates
significant leukopenia (normal is 4,500–11,000/mm³), placing the client
at a high risk for life-threatening infections. This requires immediate
intervention, such as holding the medication and notifying the
healthcare provider. Option B is incorrect because a platelet count of
160,000/mm³ is within the normal range (150,000–400,000/mm³).
Option C is incorrect because an AST of 25 units/L is a normal liver
function value, and methotrexate hepatotoxicity would present with
elevated transaminases. Option D is incorrect because a serum
creatinine of 0.9 mg/dL is normal, indicating adequate renal function.
Learning Objective
• Interpret laboratory values associated with DMARD therapy.
• Prioritize nursing interventions for early signs of bone marrow
suppression.
