NCLEX-RN Pharmacology Musculoskeletal
System Exam |
20 Original NGN-Style Practice Questions with
Rationales
Question 1
Clinical Scenario
A 68-year-old female client with a history of osteoarthritis of
the knees, hypertension, and a myocardial infarction 2 years
ago is prescribed celecoxib for joint pain.
Question Stem
Which finding in the client's history requires the nurse to
contact the provider before administering the first dose?
A. Osteoarthritis of the knees
B. History of myocardial infarction 2 years ago
C. Seasonal environmental allergies
D. Mild intermittent asthma
Correct Answer
Correct Answer: B. History of myocardial infarction 2 years ago
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor used for pain and
,inflammation. However, it carries a Black Box Warning for an
increased risk of serious cardiovascular thrombotic events,
including myocardial infarction and stroke, which can be fatal.
This risk increases with the duration of use and in patients with
preexisting cardiovascular disease. A history of myocardial
infarction is a major red flag and often an absolute
contraindication, requiring the nurse to contact the provider
before administration. Osteoarthritis of the knees (Option A) is
the actual indication for the medication. Seasonal allergies
(Option C) are not a contraindication. While NSAIDs can
sometimes exacerbate asthma (Option D), the absolute priority
and most life-threatening contraindication here is the history of
myocardial infarction due to the Black Box Warning. The nurse
must advocate for an alternative analgesic to ensure patient
safety.
Learning Objective
After completing this question, the learner should be able to:
• Identify cardiovascular contraindications for COX-2 inhibitors.
• Prioritize nursing assessments for patients with a history of
myocardial infarction.
Medication Safety Focus
Black Box Warning
Question 2
,Clinical Scenario
A 45-year-old male client with rheumatoid arthritis has been
taking methotrexate for the past 6 months. The nurse is
reviewing the client's recent laboratory results.
Question Stem
Which laboratory finding requires immediate intervention by
the nurse?
A. Aspartate aminotransferase (AST) 65 U/L
B. Platelets 160,000/mm³
C. White blood cells (WBC) 2,800/mm³
D. Fasting blood glucose 110 mg/dL
Correct Answer
Correct Answer: C. White blood cells (WBC) 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and a potent immunosuppressant. One of its most
severe and life-threatening adverse effects is bone marrow
suppression, which can manifest as leukopenia,
thrombocytopenia, or anemia. A white blood cell (WBC) count
of 2,800/mm³ is significantly below the normal range (4,500–
11,000/mm³) and indicates severe immunosuppression, placing
the client at high risk for life-threatening infections. This is a
critical finding that requires immediate intervention, holding
the medication, and notifying the healthcare provider. An AST
of 65 U/L (Option A) is mildly elevated and warrants
monitoring, as methotrexate is hepatotoxic, but it is not as
, immediately life-threatening as severe leukopenia. Platelets of
160,000/mm³ (Option B) are within the lower end of the
normal range. Fasting blood glucose of 110 mg/dL (Option D) is
slightly elevated but not a direct, acute adverse effect of
methotrexate.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of bone marrow
suppression.
• Prioritize nursing interventions for life-threatening adverse
effects of methotrexate.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 32-year-old female client with severe rheumatoid arthritis is
scheduled to begin therapy with adalimumab.
Question Stem
Which action should the nurse prioritize before initiating this
therapy?
A. Administer a live attenuated influenza vaccine
B. Instruct the client to take the medication with a high-fat
meal
System Exam |
20 Original NGN-Style Practice Questions with
Rationales
Question 1
Clinical Scenario
A 68-year-old female client with a history of osteoarthritis of
the knees, hypertension, and a myocardial infarction 2 years
ago is prescribed celecoxib for joint pain.
Question Stem
Which finding in the client's history requires the nurse to
contact the provider before administering the first dose?
A. Osteoarthritis of the knees
B. History of myocardial infarction 2 years ago
C. Seasonal environmental allergies
D. Mild intermittent asthma
Correct Answer
Correct Answer: B. History of myocardial infarction 2 years ago
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor used for pain and
,inflammation. However, it carries a Black Box Warning for an
increased risk of serious cardiovascular thrombotic events,
including myocardial infarction and stroke, which can be fatal.
This risk increases with the duration of use and in patients with
preexisting cardiovascular disease. A history of myocardial
infarction is a major red flag and often an absolute
contraindication, requiring the nurse to contact the provider
before administration. Osteoarthritis of the knees (Option A) is
the actual indication for the medication. Seasonal allergies
(Option C) are not a contraindication. While NSAIDs can
sometimes exacerbate asthma (Option D), the absolute priority
and most life-threatening contraindication here is the history of
myocardial infarction due to the Black Box Warning. The nurse
must advocate for an alternative analgesic to ensure patient
safety.
Learning Objective
After completing this question, the learner should be able to:
• Identify cardiovascular contraindications for COX-2 inhibitors.
• Prioritize nursing assessments for patients with a history of
myocardial infarction.
Medication Safety Focus
Black Box Warning
Question 2
,Clinical Scenario
A 45-year-old male client with rheumatoid arthritis has been
taking methotrexate for the past 6 months. The nurse is
reviewing the client's recent laboratory results.
Question Stem
Which laboratory finding requires immediate intervention by
the nurse?
A. Aspartate aminotransferase (AST) 65 U/L
B. Platelets 160,000/mm³
C. White blood cells (WBC) 2,800/mm³
D. Fasting blood glucose 110 mg/dL
Correct Answer
Correct Answer: C. White blood cells (WBC) 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and a potent immunosuppressant. One of its most
severe and life-threatening adverse effects is bone marrow
suppression, which can manifest as leukopenia,
thrombocytopenia, or anemia. A white blood cell (WBC) count
of 2,800/mm³ is significantly below the normal range (4,500–
11,000/mm³) and indicates severe immunosuppression, placing
the client at high risk for life-threatening infections. This is a
critical finding that requires immediate intervention, holding
the medication, and notifying the healthcare provider. An AST
of 65 U/L (Option A) is mildly elevated and warrants
monitoring, as methotrexate is hepatotoxic, but it is not as
, immediately life-threatening as severe leukopenia. Platelets of
160,000/mm³ (Option B) are within the lower end of the
normal range. Fasting blood glucose of 110 mg/dL (Option D) is
slightly elevated but not a direct, acute adverse effect of
methotrexate.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of bone marrow
suppression.
• Prioritize nursing interventions for life-threatening adverse
effects of methotrexate.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 32-year-old female client with severe rheumatoid arthritis is
scheduled to begin therapy with adalimumab.
Question Stem
Which action should the nurse prioritize before initiating this
therapy?
A. Administer a live attenuated influenza vaccine
B. Instruct the client to take the medication with a high-fat
meal
