NCLEX-RN Pharmacology Musculoskeletal
System Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes alendronate 70 mg orally
once weekly. The client has a history of gastroesophageal reflux
disease (GERD) and mild hypertension.
Question Stem
Which instruction should the nurse include in the client’s
medication teaching to ensure safe administration and
minimize adverse effects?
Options
A. Take the medication with a full glass of milk to prevent
stomach upset.
B. Take the medication at bedtime to reduce the risk of daytime
esophageal irritation.
C. Take the medication with 8 ounces of plain water and remain
upright for at least 30 minutes.
,D. Chew the tablet thoroughly before swallowing to enhance
absorption in the gastrointestinal tract.
Correct Answer
Correct Answer: C. Take the medication with 8 ounces of plain
water and remain upright for at least 30 minutes.
Detailed Rationale
Alendronate is a bisphosphonate that inhibits osteoclast-
mediated bone resorption. It is highly irritating to the
esophageal mucosa and can cause severe esophagitis,
esophageal ulcers, or strictures. To minimize this risk, the nurse
must teach the client to take the medication first thing in the
morning, on an empty stomach, with a full glass (8 ounces) of
plain water only. The client must remain fully upright (sitting or
standing) for at least 30 minutes and until after the first food of
the day to prevent esophageal reflux of the medication. Option
A is incorrect because calcium, magnesium, or aluminum
(found in milk or antacids) binds to alendronate and severely
decreases its absorption. Option B is incorrect because taking it
at bedtime increases the risk of recumbency-related
esophageal irritation. Option D is incorrect because
alendronate tablets must be swallowed whole; chewing can
cause oral or esophageal ulceration.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
, • Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on dietary and positional restrictions to
ensure medication efficacy and safety.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis (RA) has
been taking methotrexate 15 mg orally once weekly for the
past 3 months. He presents to the clinic for a routine follow-up.
Laboratory results reveal: WBC 2,800/mm³, platelets
160,000/mm³, AST 35 U/L, ALT 40 U/L, and serum creatinine
0.9 mg/dL.
Question Stem
Which laboratory finding requires the nurse’s immediate
intervention and notification of the provider?
Options
A. Platelets 160,000/mm³
B. AST 35 U/L
C. WBC 2,800/mm³
D. Serum creatinine 0.9 mg/dL
, Correct Answer
Correct Answer: C. WBC 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist, inhibiting DNA
synthesis. A major, life-threatening adverse effect is bone
marrow suppression, leading to leukopenia, thrombocytopenia,
and anemia. A WBC count of 2,800/mm³ indicates significant
leukopenia (normal range is typically 4,500–11,000/mm³),
placing the client at a high risk for severe, potentially fatal
infections. The nurse must withhold the next dose and notify
the provider immediately. Option A is incorrect because a
platelet count of 160,000/mm³ is within the normal range
(150,000–400,000/mm³). Options B and D are incorrect
because the AST, ALT, and creatinine levels are within normal
limits, indicating no current evidence of hepatotoxicity or
nephrotoxicity, which are other potential adverse effects of
methotrexate requiring monitoring.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing actions for abnormal laboratory findings
in clients taking DMARDs.
• Recognize the importance of routine laboratory
monitoring for clients on immunosuppressive therapy.
System Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes alendronate 70 mg orally
once weekly. The client has a history of gastroesophageal reflux
disease (GERD) and mild hypertension.
Question Stem
Which instruction should the nurse include in the client’s
medication teaching to ensure safe administration and
minimize adverse effects?
Options
A. Take the medication with a full glass of milk to prevent
stomach upset.
B. Take the medication at bedtime to reduce the risk of daytime
esophageal irritation.
C. Take the medication with 8 ounces of plain water and remain
upright for at least 30 minutes.
,D. Chew the tablet thoroughly before swallowing to enhance
absorption in the gastrointestinal tract.
Correct Answer
Correct Answer: C. Take the medication with 8 ounces of plain
water and remain upright for at least 30 minutes.
Detailed Rationale
Alendronate is a bisphosphonate that inhibits osteoclast-
mediated bone resorption. It is highly irritating to the
esophageal mucosa and can cause severe esophagitis,
esophageal ulcers, or strictures. To minimize this risk, the nurse
must teach the client to take the medication first thing in the
morning, on an empty stomach, with a full glass (8 ounces) of
plain water only. The client must remain fully upright (sitting or
standing) for at least 30 minutes and until after the first food of
the day to prevent esophageal reflux of the medication. Option
A is incorrect because calcium, magnesium, or aluminum
(found in milk or antacids) binds to alendronate and severely
decreases its absorption. Option B is incorrect because taking it
at bedtime increases the risk of recumbency-related
esophageal irritation. Option D is incorrect because
alendronate tablets must be swallowed whole; chewing can
cause oral or esophageal ulceration.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
, • Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on dietary and positional restrictions to
ensure medication efficacy and safety.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis (RA) has
been taking methotrexate 15 mg orally once weekly for the
past 3 months. He presents to the clinic for a routine follow-up.
Laboratory results reveal: WBC 2,800/mm³, platelets
160,000/mm³, AST 35 U/L, ALT 40 U/L, and serum creatinine
0.9 mg/dL.
Question Stem
Which laboratory finding requires the nurse’s immediate
intervention and notification of the provider?
Options
A. Platelets 160,000/mm³
B. AST 35 U/L
C. WBC 2,800/mm³
D. Serum creatinine 0.9 mg/dL
, Correct Answer
Correct Answer: C. WBC 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist, inhibiting DNA
synthesis. A major, life-threatening adverse effect is bone
marrow suppression, leading to leukopenia, thrombocytopenia,
and anemia. A WBC count of 2,800/mm³ indicates significant
leukopenia (normal range is typically 4,500–11,000/mm³),
placing the client at a high risk for severe, potentially fatal
infections. The nurse must withhold the next dose and notify
the provider immediately. Option A is incorrect because a
platelet count of 160,000/mm³ is within the normal range
(150,000–400,000/mm³). Options B and D are incorrect
because the AST, ALT, and creatinine levels are within normal
limits, indicating no current evidence of hepatotoxicity or
nephrotoxicity, which are other potential adverse effects of
methotrexate requiring monitoring.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing actions for abnormal laboratory findings
in clients taking DMARDs.
• Recognize the importance of routine laboratory
monitoring for clients on immunosuppressive therapy.
