NCLEX-RN Pharmacology Musculoskeletal
System Exam Questions & Rationales |
20 Original NGN Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old female is newly diagnosed with osteoporosis. The
healthcare provider prescribes alendronate 70 mg orally once weekly.
The nurse is providing discharge teaching regarding the proper
administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a glass of milk to prevent stomach
upset."
B. "I will remain upright for at least 30 minutes after taking the
medication."
C. "I can take this medication at bedtime to avoid daytime nausea."
D. "I will take this medication with my other morning pills to save time."
,Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes after
taking the medication."
Detailed Rationale
Alendronate is a bisphosphonate that can cause severe esophageal
irritation, esophagitis, and ulceration. To minimize this risk and ensure
adequate gastrointestinal absorption, the client must take it on an
empty stomach with a full glass of plain water (not milk, juice, or
coffee, as calcium and other minerals bind to the drug and prevent
absorption). Furthermore, the client must remain upright (sitting or
standing) for at least 30 minutes after ingestion to prevent esophageal
reflux. Taking it at bedtime is incorrect because the client must remain
upright. Taking it with other morning pills or milk decreases absorption
and significantly increases the risk of GI irritation. The nurse should also
assess the patient's ability to sit or stand for 30 minutes; if the patient
cannot, an alternative medication may be needed to ensure both
therapeutic efficacy and prevention of severe adverse effects.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of alendronate.
• Educate patients on preventing esophageal irritation associated
with bisphosphonate therapy.
Medication Safety Focus
Patient education / Medication administration
Question 2
,Clinical Scenario
A 54-year-old male with rheumatoid arthritis (RA) is starting
methotrexate therapy. The nurse reviews the patient's baseline
laboratory results before the first dose is administered.
Question Stem
Which laboratory finding requires the nurse to contact the healthcare
provider before administering the medication?
Options
A. Hemoglobin 13.5 g/dL
B. White blood cell (WBC) count 7,000/mm³
C. Aspartate aminotransferase (AST) 65 units/L
D. Serum creatinine 0.9 mg/dL
Correct Answer
Correct Answer: C. Aspartate aminotransferase (AST) 65 units/L
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
is hepatotoxic, myelosuppressive, and nephrotoxic. An AST of 65 units/L
is elevated (normal is typically 10-40 units/L), indicating potential liver
impairment. Since methotrexate is metabolized by the liver and can
cause dose-dependent hepatotoxicity, elevated baseline liver enzymes
require immediate provider notification and possible dose adjustment,
alternative therapy, or further hepatic workup. Hemoglobin, WBC, and
creatinine are within normal limits, indicating no immediate
contraindication based on those specific values. Regular, ongoing
monitoring of CBC, liver function tests (LFTs), and renal function is
essential throughout methotrexate therapy. Additionally, folic acid
supplementation is standard practice to reduce the incidence of
mucosal and hepatic toxicity without compromising the drug's efficacy.
Failure to monitor can lead to irreversible liver damage.
, Learning Objective
• Interpret baseline laboratory values prior to initiating
methotrexate therapy.
• Recognize the hepatotoxic potential of methotrexate.
• Prioritize nursing actions when abnormal liver function tests are
identified.
Medication Safety Focus
Monitoring parameters / Lab interpretation
Question 3
Clinical Scenario
A 45-year-old male is admitted to the medical unit with an acute gout
flare in his right big toe. The healthcare provider prescribes colchicine
0.6 mg orally.
Question Stem
Which assessment finding indicates to the nurse that the medication
should be withheld and the provider notified?
Options
A. Reporting of severe, watery diarrhea
B. Joint pain decreased from 8/10 to 4/10
C. Mild nausea after the first dose
D. Uric acid level of 7.5 mg/dL
Correct Answer
Correct Answer: A. Reporting of severe, watery diarrhea
Detailed Rationale
Colchicine is used for acute gout flares but has a narrow therapeutic
System Exam Questions & Rationales |
20 Original NGN Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old female is newly diagnosed with osteoporosis. The
healthcare provider prescribes alendronate 70 mg orally once weekly.
The nurse is providing discharge teaching regarding the proper
administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a glass of milk to prevent stomach
upset."
B. "I will remain upright for at least 30 minutes after taking the
medication."
C. "I can take this medication at bedtime to avoid daytime nausea."
D. "I will take this medication with my other morning pills to save time."
,Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes after
taking the medication."
Detailed Rationale
Alendronate is a bisphosphonate that can cause severe esophageal
irritation, esophagitis, and ulceration. To minimize this risk and ensure
adequate gastrointestinal absorption, the client must take it on an
empty stomach with a full glass of plain water (not milk, juice, or
coffee, as calcium and other minerals bind to the drug and prevent
absorption). Furthermore, the client must remain upright (sitting or
standing) for at least 30 minutes after ingestion to prevent esophageal
reflux. Taking it at bedtime is incorrect because the client must remain
upright. Taking it with other morning pills or milk decreases absorption
and significantly increases the risk of GI irritation. The nurse should also
assess the patient's ability to sit or stand for 30 minutes; if the patient
cannot, an alternative medication may be needed to ensure both
therapeutic efficacy and prevention of severe adverse effects.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of alendronate.
• Educate patients on preventing esophageal irritation associated
with bisphosphonate therapy.
Medication Safety Focus
Patient education / Medication administration
Question 2
,Clinical Scenario
A 54-year-old male with rheumatoid arthritis (RA) is starting
methotrexate therapy. The nurse reviews the patient's baseline
laboratory results before the first dose is administered.
Question Stem
Which laboratory finding requires the nurse to contact the healthcare
provider before administering the medication?
Options
A. Hemoglobin 13.5 g/dL
B. White blood cell (WBC) count 7,000/mm³
C. Aspartate aminotransferase (AST) 65 units/L
D. Serum creatinine 0.9 mg/dL
Correct Answer
Correct Answer: C. Aspartate aminotransferase (AST) 65 units/L
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
is hepatotoxic, myelosuppressive, and nephrotoxic. An AST of 65 units/L
is elevated (normal is typically 10-40 units/L), indicating potential liver
impairment. Since methotrexate is metabolized by the liver and can
cause dose-dependent hepatotoxicity, elevated baseline liver enzymes
require immediate provider notification and possible dose adjustment,
alternative therapy, or further hepatic workup. Hemoglobin, WBC, and
creatinine are within normal limits, indicating no immediate
contraindication based on those specific values. Regular, ongoing
monitoring of CBC, liver function tests (LFTs), and renal function is
essential throughout methotrexate therapy. Additionally, folic acid
supplementation is standard practice to reduce the incidence of
mucosal and hepatic toxicity without compromising the drug's efficacy.
Failure to monitor can lead to irreversible liver damage.
, Learning Objective
• Interpret baseline laboratory values prior to initiating
methotrexate therapy.
• Recognize the hepatotoxic potential of methotrexate.
• Prioritize nursing actions when abnormal liver function tests are
identified.
Medication Safety Focus
Monitoring parameters / Lab interpretation
Question 3
Clinical Scenario
A 45-year-old male is admitted to the medical unit with an acute gout
flare in his right big toe. The healthcare provider prescribes colchicine
0.6 mg orally.
Question Stem
Which assessment finding indicates to the nurse that the medication
should be withheld and the provider notified?
Options
A. Reporting of severe, watery diarrhea
B. Joint pain decreased from 8/10 to 4/10
C. Mild nausea after the first dose
D. Uric acid level of 7.5 mg/dL
Correct Answer
Correct Answer: A. Reporting of severe, watery diarrhea
Detailed Rationale
Colchicine is used for acute gout flares but has a narrow therapeutic
