NCLEX-RN Pharmacology Musculoskeletal
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes oral alendronate 70 mg
once weekly. The nurse is providing discharge teaching
regarding the proper administration of this medication.
Question Stem
Which statement by the client indicates an understanding of
the teaching?
Options
A. "I will take this medication with a glass of whole milk to
protect my stomach."
B. "I will take this medication at bedtime to avoid daytime side
effects."
C. "I will remain upright in a chair or standing for at least 30
,minutes after taking it."
D. "I will chew the tablet thoroughly to help it dissolve and
absorb faster."
Correct Answer
Correct Answer: C. "I will remain upright in a chair or standing
for at least 30 minutes after taking it."
Detailed Rationale
Alendronate is a bisphosphonate used to inhibit osteoclast-
mediated bone resorption. It is notoriously irritating to the
esophageal mucosa and can cause severe esophagitis or
esophageal ulcers if it becomes lodged or refluxes. 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), and
the client must remain fully upright (sitting or standing) for at
least 30 minutes and until after the first food of the day. Option
A is incorrect because calcium in milk binds to alendronate,
drastically reducing its absorption. Option B is incorrect
because lying down at bedtime increases the risk of esophageal
reflux and injury. Option D is incorrect because bisphosphonate
tablets must be swallowed whole; chewing can cause oral and
esophageal ulceration.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
alendronate.
,• Educate patients on measures to prevent bisphosphonate-
induced esophagitis.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 55-year-old male client with a history of gout is prescribed
allopurinol 300 mg daily for uric acid reduction. He has been
taking the medication for 10 days and calls the clinic to report
new symptoms.
Question Stem
Which finding reported by the client requires immediate
intervention by the nurse?
Options
A. A mild, transient increase in joint pain and swelling.
B. A new, widespread maculopapular rash on the trunk and
arms.
C. Occasional mild nausea after taking the morning dose.
D. A daily urine output of approximately 1,500 mL.
Correct Answer
Correct Answer: B. A new, widespread maculopapular rash on
the trunk and arms.
, Detailed Rationale
Allopurinol is a xanthine oxidase inhibitor used for chronic gout
management. A maculopapular rash is the most common early
sign of allopurinol hypersensitivity syndrome (AHS), a rare but
life-threatening condition that can progress to Stevens-Johnson
syndrome (SJS) or toxic epidermal necrolysis (TEN). The
medication must be discontinued immediately, and the
provider notified. Option A is an expected finding; initiating
urate-lowering therapy can mobilize uric acid crystals,
temporarily worsening acute flares (which is why colchicine or
an NSAID is often co-prescribed initially). Option C is a common,
non-life-threatening gastrointestinal side effect that can be
managed by taking the medication with food. Option D
represents a normal, healthy urine output, which is actually
desirable to help flush uric acid.
Learning Objective
• Recognize early signs of severe hypersensitivity reactions to
allopurinol.
• Differentiate between expected side effects and adverse
reactions requiring immediate intervention.
• Prioritize nursing actions for potentially life-threatening
dermatological reactions.
Medication Safety Focus
Adverse effect
Question 3
System Practice Questions |
20 Original ATI & NGN-Style MCQs with
Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes oral alendronate 70 mg
once weekly. The nurse is providing discharge teaching
regarding the proper administration of this medication.
Question Stem
Which statement by the client indicates an understanding of
the teaching?
Options
A. "I will take this medication with a glass of whole milk to
protect my stomach."
B. "I will take this medication at bedtime to avoid daytime side
effects."
C. "I will remain upright in a chair or standing for at least 30
,minutes after taking it."
D. "I will chew the tablet thoroughly to help it dissolve and
absorb faster."
Correct Answer
Correct Answer: C. "I will remain upright in a chair or standing
for at least 30 minutes after taking it."
Detailed Rationale
Alendronate is a bisphosphonate used to inhibit osteoclast-
mediated bone resorption. It is notoriously irritating to the
esophageal mucosa and can cause severe esophagitis or
esophageal ulcers if it becomes lodged or refluxes. 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), and
the client must remain fully upright (sitting or standing) for at
least 30 minutes and until after the first food of the day. Option
A is incorrect because calcium in milk binds to alendronate,
drastically reducing its absorption. Option B is incorrect
because lying down at bedtime increases the risk of esophageal
reflux and injury. Option D is incorrect because bisphosphonate
tablets must be swallowed whole; chewing can cause oral and
esophageal ulceration.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
alendronate.
,• Educate patients on measures to prevent bisphosphonate-
induced esophagitis.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 55-year-old male client with a history of gout is prescribed
allopurinol 300 mg daily for uric acid reduction. He has been
taking the medication for 10 days and calls the clinic to report
new symptoms.
Question Stem
Which finding reported by the client requires immediate
intervention by the nurse?
Options
A. A mild, transient increase in joint pain and swelling.
B. A new, widespread maculopapular rash on the trunk and
arms.
C. Occasional mild nausea after taking the morning dose.
D. A daily urine output of approximately 1,500 mL.
Correct Answer
Correct Answer: B. A new, widespread maculopapular rash on
the trunk and arms.
, Detailed Rationale
Allopurinol is a xanthine oxidase inhibitor used for chronic gout
management. A maculopapular rash is the most common early
sign of allopurinol hypersensitivity syndrome (AHS), a rare but
life-threatening condition that can progress to Stevens-Johnson
syndrome (SJS) or toxic epidermal necrolysis (TEN). The
medication must be discontinued immediately, and the
provider notified. Option A is an expected finding; initiating
urate-lowering therapy can mobilize uric acid crystals,
temporarily worsening acute flares (which is why colchicine or
an NSAID is often co-prescribed initially). Option C is a common,
non-life-threatening gastrointestinal side effect that can be
managed by taking the medication with food. Option D
represents a normal, healthy urine output, which is actually
desirable to help flush uric acid.
Learning Objective
• Recognize early signs of severe hypersensitivity reactions to
allopurinol.
• Differentiate between expected side effects and adverse
reactions requiring immediate intervention.
• Prioritize nursing actions for potentially life-threatening
dermatological reactions.
Medication Safety Focus
Adverse effect
Question 3
