NCLEX-RN Pharmacology Musculoskeletal System
Exam Questions & Rationales
| 20 Original NCLEX Next Generation (NGN)
Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with osteoporosis and is
prescribed alendronate 70 mg orally once weekly. She has no other
significant medical history.
Question Stem
Which statement by the client indicates an understanding of the
medication teaching?
A. "I will take this medication with a full glass of orange juice to help it
go down."
B. "I will remain upright in a chair or standing for at least 30 minutes
after taking the pill."
C. "I can take this medication at bedtime to avoid any daytime stomach
upset."
D. "I will take my daily calcium supplement at the exact same time as
this medication."
,Correct Answer
Correct Answer: B. "I will remain upright in a chair or standing for at
least 30 minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate that inhibits osteoclast-mediated
bone resorption. It is poorly absorbed and highly irritating to the
esophageal mucosa. To ensure adequate absorption and prevent
severe esophagitis or esophageal ulcers, the client must take the
medication first thing in the morning with a full glass of plain water (not
orange juice, as calcium-fortified juices bind to the drug and prevent
absorption). The client must also remain fully upright (sitting or
standing) for at least 30 minutes and until after the first food of the
day. Taking it at bedtime (Option C) is incorrect because lying down
increases the risk of esophageal reflux and irritation. Taking calcium
supplements simultaneously (Option D) is incorrect because calcium,
antacids, and multivitamins significantly decrease alendronate
absorption; they should be separated by at least 30 to 60 minutes.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of alendronate.
• Educate patients on strategies to prevent esophageal irritation.
Medication Safety Focus
Medication administration
Question 2
, Clinical Scenario
A 54-year-old male client with severe rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. He is admitted to the medical-
surgical unit for an unrelated minor procedure.
Question Stem
Which action by the nurse is most critical to prevent a medication error
before administering this high-alert medication?
A. Verify the dose is calculated in milligrams, not micrograms.
B. Confirm with the provider and pharmacy that the frequency is
weekly, not daily.
C. Ensure the client has taken a folic acid supplement 1 hour prior to
this dose.
D. Check that the client's last meal was at least 2 hours ago.
Correct Answer
Correct Answer: B. Confirm with the provider and pharmacy that the
frequency is weekly, not daily.
Detailed Rationale
Methotrexate is a high-alert medication when used for non-oncologic
conditions (e.g., rheumatoid arthritis, psoriasis) because the standard
dosing frequency is once weekly. A frequent, well-documented, and
potentially fatal medication error is prescribing or administering it daily,
which leads to severe myelosuppression, hepatotoxicity, and mucosal
ulceration. The nurse’s most critical safety action is to independently
verify that the order explicitly states "weekly" and to clarify any
ambiguity with the prescriber and pharmacist before administration.
While folic acid supplementation is standard to reduce methotrexate
toxicity (making Option C plausible), it does not supersede the
imperative to verify the dosing frequency. Option A is incorrect because
methotrexate for RA is appropriately dosed in milligrams. Option D is
Exam Questions & Rationales
| 20 Original NCLEX Next Generation (NGN)
Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with osteoporosis and is
prescribed alendronate 70 mg orally once weekly. She has no other
significant medical history.
Question Stem
Which statement by the client indicates an understanding of the
medication teaching?
A. "I will take this medication with a full glass of orange juice to help it
go down."
B. "I will remain upright in a chair or standing for at least 30 minutes
after taking the pill."
C. "I can take this medication at bedtime to avoid any daytime stomach
upset."
D. "I will take my daily calcium supplement at the exact same time as
this medication."
,Correct Answer
Correct Answer: B. "I will remain upright in a chair or standing for at
least 30 minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate that inhibits osteoclast-mediated
bone resorption. It is poorly absorbed and highly irritating to the
esophageal mucosa. To ensure adequate absorption and prevent
severe esophagitis or esophageal ulcers, the client must take the
medication first thing in the morning with a full glass of plain water (not
orange juice, as calcium-fortified juices bind to the drug and prevent
absorption). The client must also remain fully upright (sitting or
standing) for at least 30 minutes and until after the first food of the
day. Taking it at bedtime (Option C) is incorrect because lying down
increases the risk of esophageal reflux and irritation. Taking calcium
supplements simultaneously (Option D) is incorrect because calcium,
antacids, and multivitamins significantly decrease alendronate
absorption; they should be separated by at least 30 to 60 minutes.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of alendronate.
• Educate patients on strategies to prevent esophageal irritation.
Medication Safety Focus
Medication administration
Question 2
, Clinical Scenario
A 54-year-old male client with severe rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. He is admitted to the medical-
surgical unit for an unrelated minor procedure.
Question Stem
Which action by the nurse is most critical to prevent a medication error
before administering this high-alert medication?
A. Verify the dose is calculated in milligrams, not micrograms.
B. Confirm with the provider and pharmacy that the frequency is
weekly, not daily.
C. Ensure the client has taken a folic acid supplement 1 hour prior to
this dose.
D. Check that the client's last meal was at least 2 hours ago.
Correct Answer
Correct Answer: B. Confirm with the provider and pharmacy that the
frequency is weekly, not daily.
Detailed Rationale
Methotrexate is a high-alert medication when used for non-oncologic
conditions (e.g., rheumatoid arthritis, psoriasis) because the standard
dosing frequency is once weekly. A frequent, well-documented, and
potentially fatal medication error is prescribing or administering it daily,
which leads to severe myelosuppression, hepatotoxicity, and mucosal
ulceration. The nurse’s most critical safety action is to independently
verify that the order explicitly states "weekly" and to clarify any
ambiguity with the prescriber and pharmacist before administration.
While folic acid supplementation is standard to reduce methotrexate
toxicity (making Option C plausible), it does not supersede the
imperative to verify the dosing frequency. Option A is incorrect because
methotrexate for RA is appropriately dosed in milligrams. Option D is
