NCLEX-RN Pharmacology Musculoskeletal
System Exam Questions & Rationales |
20 Original ATI & NGN-Style Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old female client with a new diagnosis of
osteoporosis is being discharged with a new prescription for
alendronate 70 mg orally once weekly.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of orange juice to
help it go down."
B. "I must remain upright for at least 30 minutes after taking
the pill."
C. "I can take this medication at bedtime to avoid any stomach
upset during the day."
,D. "I should chew the tablet thoroughly before swallowing to
speed up absorption."
Correct Answer
Correct Answer: B. "I must remain upright for at least 30
minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate that strongly binds to bone
but can cause severe esophageal irritation, ulceration, and
dysphagia 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, as calcium and acidity impair
absorption) on an empty stomach first thing in the morning.
The patient must remain fully upright (sitting or standing) for at
least 30 minutes and should not eat, drink, or take other
medications during this time. Taking it at bedtime is incorrect
because the patient may lie down, increasing aspiration and
esophageal irritation risk. Chewing the tablet is
contraindicated; it must be swallowed whole to prevent oral
and esophageal mucosal damage.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize contraindications and precautions for alendronate
therapy.
• Educate patients on strategies to prevent esophageal
irritation.
,Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 55-year-old male client is being treated for an acute gout
flare with colchicine. On day three of therapy, the client reports
severe, watery diarrhea and new-onset proximal muscle
weakness.
Question Stem
Which action should the nurse take first?
A. Administer an over-the-counter antidiarrheal medication as
prescribed.
B. Assess the client's serum uric acid level to evaluate
therapeutic effectiveness.
C. Encourage increased oral fluid intake to prevent dehydration
from diarrhea.
D. Hold the colchicine and notify the healthcare provider
immediately.
Correct Answer
Correct Answer: D. Hold the colchicine and notify the
healthcare provider immediately.
Detailed Rationale
Severe diarrhea and muscle weakness are early, classic signs of
colchicine toxicity. Colchicine has a narrow therapeutic index,
, and toxicity can rapidly progress to life-threatening
complications, including rhabdomyolysis, bone marrow
suppression, multiorgan failure, and death. The priority nursing
action is to hold the offending agent and notify the healthcare
provider for immediate evaluation and potential
discontinuation of the drug. While preventing dehydration is
important, it is secondary to stopping the toxic medication.
Administering antidiarrheals would mask a critical symptom of
toxicity. Serum uric acid levels do not guide the acute
management of colchicine toxicity and are often paradoxically
normal or elevated during an acute flare.
Learning Objective
• Recognize early signs of colchicine toxicity.
• Prioritize nursing interventions for adverse medication
reactions.
• Understand the narrow therapeutic index of colchicine.
Medication Safety Focus
Adverse effect recognition / High-alert medication
Question 3
Clinical Scenario
A 42-year-old female client with rheumatoid arthritis has been
taking methotrexate 15 mg orally once weekly for the past six
months. Routine laboratory results reveal: WBC 2,800/mm³,
Platelets 90,000/mm³, AST 65 U/L, and ALT 70 U/L.
System Exam Questions & Rationales |
20 Original ATI & NGN-Style Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old female client with a new diagnosis of
osteoporosis is being discharged with a new prescription for
alendronate 70 mg orally once weekly.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of orange juice to
help it go down."
B. "I must remain upright for at least 30 minutes after taking
the pill."
C. "I can take this medication at bedtime to avoid any stomach
upset during the day."
,D. "I should chew the tablet thoroughly before swallowing to
speed up absorption."
Correct Answer
Correct Answer: B. "I must remain upright for at least 30
minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate that strongly binds to bone
but can cause severe esophageal irritation, ulceration, and
dysphagia 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, as calcium and acidity impair
absorption) on an empty stomach first thing in the morning.
The patient must remain fully upright (sitting or standing) for at
least 30 minutes and should not eat, drink, or take other
medications during this time. Taking it at bedtime is incorrect
because the patient may lie down, increasing aspiration and
esophageal irritation risk. Chewing the tablet is
contraindicated; it must be swallowed whole to prevent oral
and esophageal mucosal damage.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize contraindications and precautions for alendronate
therapy.
• Educate patients on strategies to prevent esophageal
irritation.
,Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 55-year-old male client is being treated for an acute gout
flare with colchicine. On day three of therapy, the client reports
severe, watery diarrhea and new-onset proximal muscle
weakness.
Question Stem
Which action should the nurse take first?
A. Administer an over-the-counter antidiarrheal medication as
prescribed.
B. Assess the client's serum uric acid level to evaluate
therapeutic effectiveness.
C. Encourage increased oral fluid intake to prevent dehydration
from diarrhea.
D. Hold the colchicine and notify the healthcare provider
immediately.
Correct Answer
Correct Answer: D. Hold the colchicine and notify the
healthcare provider immediately.
Detailed Rationale
Severe diarrhea and muscle weakness are early, classic signs of
colchicine toxicity. Colchicine has a narrow therapeutic index,
, and toxicity can rapidly progress to life-threatening
complications, including rhabdomyolysis, bone marrow
suppression, multiorgan failure, and death. The priority nursing
action is to hold the offending agent and notify the healthcare
provider for immediate evaluation and potential
discontinuation of the drug. While preventing dehydration is
important, it is secondary to stopping the toxic medication.
Administering antidiarrheals would mask a critical symptom of
toxicity. Serum uric acid levels do not guide the acute
management of colchicine toxicity and are often paradoxically
normal or elevated during an acute flare.
Learning Objective
• Recognize early signs of colchicine toxicity.
• Prioritize nursing interventions for adverse medication
reactions.
• Understand the narrow therapeutic index of colchicine.
Medication Safety Focus
Adverse effect recognition / High-alert medication
Question 3
Clinical Scenario
A 42-year-old female client with rheumatoid arthritis has been
taking methotrexate 15 mg orally once weekly for the past six
months. Routine laboratory results reveal: WBC 2,800/mm³,
Platelets 90,000/mm³, AST 65 U/L, and ALT 70 U/L.
