NCLEX-RN Pharmacology Musculoskeletal
System Exam Questions with Rationales |
20 Original NGN-Style Practice MCQs
Question 1
Clinical Scenario
A 68-year-old female with a new diagnosis of postmenopausal
osteoporosis is being discharged with a prescription for oral
alendronate 70 mg once weekly. She has no history of
esophageal disorders and lives independently.
Question Stem
Which instruction should the nurse prioritize including in the
patient’s medication teaching?
Options
A. Take the medication with a full glass of orange juice to
enhance absorption.
B. Remain upright (sitting or standing) for at least 30 minutes
after taking the medication.
C. Take the medication at bedtime to minimize daytime
gastrointestinal upset.
D. Chew the tablet thoroughly before swallowing to aid in
digestion.
,Correct Answer
Correct Answer: B. Remain upright (sitting or standing) for at
least 30 minutes after taking the medication.
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. The correct answer is B because alendronate can
cause severe esophageal irritation, ulceration, and erosions if it
becomes lodged in the esophagus. To minimize this risk,
patients must take the medication with a full glass of plain
water (not orange juice, mineral water, or coffee, as these can
decrease absorption) on an empty stomach first thing in the
morning. The patient must remain upright for at least 30
minutes and until after their first food of the day to facilitate
gastric emptying and prevent esophageal reflux. Option A is
incorrect because acidic beverages impair absorption and
increase mucosal irritation. Option C is incorrect because taking
it at bedtime increases the risk of esophageal exposure if the
patient lies down. Option D is incorrect because
bisphosphonate tablets must be swallowed whole, not chewed
or crushed, to prevent oral and esophageal damage. Nursing
considerations include assessing the patient's ability to sit
upright for 30 minutes and evaluating for pre-existing
esophageal abnormalities (e.g., stricture, achalasia), which are
contraindications. Patient teaching should emphasize strict
adherence to these administration guidelines to ensure
medication safety and efficacy.
,Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the specific timing and positioning
required for safe medication ingestion.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 72-year-old male with a history of myocardial infarction (MI)
2 years ago and osteoarthritis of the knees is prescribed
celecoxib 200 mg daily for pain management. His current vital
signs are stable, and he reports a pain level of 6/10.
Question Stem
Which action should the nurse take first regarding this
prescription?
Options
A. Administer the medication as prescribed and reassess pain in
1 hour.
B. Instruct the patient to take the medication with a full meal to
prevent ulcers.
, C. Contact the healthcare provider to question the prescription.
D. Assess the patient's current bowel sounds and abdominal
tenderness.
Correct Answer
Correct Answer: C. Contact the healthcare provider to question
the prescription.
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor NSAID. While it has a
lower risk of gastrointestinal bleeding compared to
nonselective NSAIDs, it carries a Black Box Warning for an
increased risk of serious cardiovascular thrombotic events,
including myocardial infarction and stroke. The correct answer
is C because the patient has a significant history of MI, making
celecoxib highly concerning and potentially contraindicated.
The nurse’s priority is to advocate for patient safety by
contacting the provider to discuss alternative analgesic options
(e.g., acetaminophen, topical agents, or physical therapy).
Option A is incorrect and unsafe, as administering the drug
could precipitate another cardiovascular event. Option B, while
generally good advice for NSAIDs, does not mitigate the
cardiovascular risk, which is the primary concern here. Option D
is a valid nursing assessment for GI risk but is not the first
action when a clear, life-threatening contraindication exists in
the medical history. Clinical reasoning dictates that preventing
a recurrent MI takes precedence over routine administration or
assessment. Monitoring requirements for any NSAID include
System Exam Questions with Rationales |
20 Original NGN-Style Practice MCQs
Question 1
Clinical Scenario
A 68-year-old female with a new diagnosis of postmenopausal
osteoporosis is being discharged with a prescription for oral
alendronate 70 mg once weekly. She has no history of
esophageal disorders and lives independently.
Question Stem
Which instruction should the nurse prioritize including in the
patient’s medication teaching?
Options
A. Take the medication with a full glass of orange juice to
enhance absorption.
B. Remain upright (sitting or standing) for at least 30 minutes
after taking the medication.
C. Take the medication at bedtime to minimize daytime
gastrointestinal upset.
D. Chew the tablet thoroughly before swallowing to aid in
digestion.
,Correct Answer
Correct Answer: B. Remain upright (sitting or standing) for at
least 30 minutes after taking the medication.
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. The correct answer is B because alendronate can
cause severe esophageal irritation, ulceration, and erosions if it
becomes lodged in the esophagus. To minimize this risk,
patients must take the medication with a full glass of plain
water (not orange juice, mineral water, or coffee, as these can
decrease absorption) on an empty stomach first thing in the
morning. The patient must remain upright for at least 30
minutes and until after their first food of the day to facilitate
gastric emptying and prevent esophageal reflux. Option A is
incorrect because acidic beverages impair absorption and
increase mucosal irritation. Option C is incorrect because taking
it at bedtime increases the risk of esophageal exposure if the
patient lies down. Option D is incorrect because
bisphosphonate tablets must be swallowed whole, not chewed
or crushed, to prevent oral and esophageal damage. Nursing
considerations include assessing the patient's ability to sit
upright for 30 minutes and evaluating for pre-existing
esophageal abnormalities (e.g., stricture, achalasia), which are
contraindications. Patient teaching should emphasize strict
adherence to these administration guidelines to ensure
medication safety and efficacy.
,Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the specific timing and positioning
required for safe medication ingestion.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 72-year-old male with a history of myocardial infarction (MI)
2 years ago and osteoarthritis of the knees is prescribed
celecoxib 200 mg daily for pain management. His current vital
signs are stable, and he reports a pain level of 6/10.
Question Stem
Which action should the nurse take first regarding this
prescription?
Options
A. Administer the medication as prescribed and reassess pain in
1 hour.
B. Instruct the patient to take the medication with a full meal to
prevent ulcers.
, C. Contact the healthcare provider to question the prescription.
D. Assess the patient's current bowel sounds and abdominal
tenderness.
Correct Answer
Correct Answer: C. Contact the healthcare provider to question
the prescription.
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor NSAID. While it has a
lower risk of gastrointestinal bleeding compared to
nonselective NSAIDs, it carries a Black Box Warning for an
increased risk of serious cardiovascular thrombotic events,
including myocardial infarction and stroke. The correct answer
is C because the patient has a significant history of MI, making
celecoxib highly concerning and potentially contraindicated.
The nurse’s priority is to advocate for patient safety by
contacting the provider to discuss alternative analgesic options
(e.g., acetaminophen, topical agents, or physical therapy).
Option A is incorrect and unsafe, as administering the drug
could precipitate another cardiovascular event. Option B, while
generally good advice for NSAIDs, does not mitigate the
cardiovascular risk, which is the primary concern here. Option D
is a valid nursing assessment for GI risk but is not the first
action when a clear, life-threatening contraindication exists in
the medical history. Clinical reasoning dictates that preventing
a recurrent MI takes precedence over routine administration or
assessment. Monitoring requirements for any NSAID include
