NCLEX-RN Pharmacology Musculoskeletal
System Practice Questions: 20 MCQs with
Detailed Rationales & Medication Safety
Question 1
Clinical Scenario
A 72-year-old woman with osteoporosis is prescribed
alendronate 70 mg orally once weekly. She has a history of
gastroesophageal reflux disease and reports difficulty
swallowing large tablets. The nurse is reviewing medication
administration instructions before the first dose.
Question Stem
Which instruction should the nurse provide to promote safe
administration of alendronate?
A. Take the medication with breakfast and a glass of milk.
B. Take the medication at bedtime with a full glass of water.
C. Take the medication immediately after waking with plain
water and remain upright for at least 30 minutes.
D. Crush the tablet and mix it with applesauce to improve
swallowing.
,Correct Answer
Correct Answer: C. Take the medication immediately after
waking with plain water and remain upright for at least 30
minutes.
Detailed Rationale
Alendronate is a bisphosphonate that decreases osteoclast-
mediated bone resorption, thereby increasing bone mineral
density and reducing fracture risk. It must be taken first thing in
the morning on an empty stomach with a full glass of plain
water. The patient should remain upright for at least 30
minutes to reduce the risk of esophageal irritation, ulceration,
and reflux. Food, beverages other than plain water, and many
medications reduce absorption. The tablet should not be
crushed or chewed.
Option A is incorrect because food and milk can significantly
reduce alendronate absorption, and taking it while eating does
not provide appropriate administration. Option B is incorrect
because bedtime administration increases the duration of
esophageal exposure and does not follow recommended
administration guidelines. Option D is incorrect because the
tablet should not be crushed or chewed, and mixing it with
food interferes with absorption.
The nurse should also assess the patient's ability to swallow the
medication safely and report significant esophageal disorders
or inability to remain upright. Patients should promptly report
,difficulty or pain with swallowing, new or worsening heartburn,
or chest pain.
Learning Objective
After completing this question, the learner should be able to:
• Explain the appropriate administration technique for oral
bisphosphonates.
• Identify factors that reduce alendronate absorption.
• Recognize strategies that reduce medication-related
esophageal injury.
Medication Safety Focus: Medication administration
Question 2
Clinical Scenario
A 68-year-old man with chronic low back pain is prescribed
cyclobenzaprine as needed for acute muscle spasms. His
medication reconciliation reveals that he also takes
diphenhydramine nightly for seasonal allergies and
occasionally drinks alcohol before bedtime. The patient reports
feeling "groggy" after taking cyclobenzaprine.
Question Stem
Which instruction is the nurse's priority?
A. Take cyclobenzaprine with grapefruit juice to improve
absorption.
, B. Avoid alcohol and use caution with other medications that
cause drowsiness.
C. Take an additional dose if muscle spasms continue after 1
hour.
D. Stop taking diphenhydramine permanently without
discussing it with the prescriber.
Correct Answer
Correct Answer: B. Avoid alcohol and use caution with other
medications that cause drowsiness.
Detailed Rationale
Cyclobenzaprine is a centrally acting skeletal muscle relaxant
that can cause significant central nervous system depression,
including drowsiness, dizziness, and impaired coordination.
Older adults are particularly vulnerable to sedation and falls.
Combining cyclobenzaprine with alcohol or other CNS
depressants, including sedating antihistamines such as
diphenhydramine, can increase sedation and impair
psychomotor function. The nurse should therefore prioritize
education about avoiding alcohol and reviewing all sedating
medications with the healthcare provider or pharmacist.
Option A is incorrect because grapefruit juice is not
recommended as a strategy to improve cyclobenzaprine
absorption and may contribute to drug-interaction concerns.
Option C is unsafe because the patient should not exceed the
prescribed dose; additional dosing may increase adverse CNS
System Practice Questions: 20 MCQs with
Detailed Rationales & Medication Safety
Question 1
Clinical Scenario
A 72-year-old woman with osteoporosis is prescribed
alendronate 70 mg orally once weekly. She has a history of
gastroesophageal reflux disease and reports difficulty
swallowing large tablets. The nurse is reviewing medication
administration instructions before the first dose.
Question Stem
Which instruction should the nurse provide to promote safe
administration of alendronate?
A. Take the medication with breakfast and a glass of milk.
B. Take the medication at bedtime with a full glass of water.
C. Take the medication immediately after waking with plain
water and remain upright for at least 30 minutes.
D. Crush the tablet and mix it with applesauce to improve
swallowing.
,Correct Answer
Correct Answer: C. Take the medication immediately after
waking with plain water and remain upright for at least 30
minutes.
Detailed Rationale
Alendronate is a bisphosphonate that decreases osteoclast-
mediated bone resorption, thereby increasing bone mineral
density and reducing fracture risk. It must be taken first thing in
the morning on an empty stomach with a full glass of plain
water. The patient should remain upright for at least 30
minutes to reduce the risk of esophageal irritation, ulceration,
and reflux. Food, beverages other than plain water, and many
medications reduce absorption. The tablet should not be
crushed or chewed.
Option A is incorrect because food and milk can significantly
reduce alendronate absorption, and taking it while eating does
not provide appropriate administration. Option B is incorrect
because bedtime administration increases the duration of
esophageal exposure and does not follow recommended
administration guidelines. Option D is incorrect because the
tablet should not be crushed or chewed, and mixing it with
food interferes with absorption.
The nurse should also assess the patient's ability to swallow the
medication safely and report significant esophageal disorders
or inability to remain upright. Patients should promptly report
,difficulty or pain with swallowing, new or worsening heartburn,
or chest pain.
Learning Objective
After completing this question, the learner should be able to:
• Explain the appropriate administration technique for oral
bisphosphonates.
• Identify factors that reduce alendronate absorption.
• Recognize strategies that reduce medication-related
esophageal injury.
Medication Safety Focus: Medication administration
Question 2
Clinical Scenario
A 68-year-old man with chronic low back pain is prescribed
cyclobenzaprine as needed for acute muscle spasms. His
medication reconciliation reveals that he also takes
diphenhydramine nightly for seasonal allergies and
occasionally drinks alcohol before bedtime. The patient reports
feeling "groggy" after taking cyclobenzaprine.
Question Stem
Which instruction is the nurse's priority?
A. Take cyclobenzaprine with grapefruit juice to improve
absorption.
, B. Avoid alcohol and use caution with other medications that
cause drowsiness.
C. Take an additional dose if muscle spasms continue after 1
hour.
D. Stop taking diphenhydramine permanently without
discussing it with the prescriber.
Correct Answer
Correct Answer: B. Avoid alcohol and use caution with other
medications that cause drowsiness.
Detailed Rationale
Cyclobenzaprine is a centrally acting skeletal muscle relaxant
that can cause significant central nervous system depression,
including drowsiness, dizziness, and impaired coordination.
Older adults are particularly vulnerable to sedation and falls.
Combining cyclobenzaprine with alcohol or other CNS
depressants, including sedating antihistamines such as
diphenhydramine, can increase sedation and impair
psychomotor function. The nurse should therefore prioritize
education about avoiding alcohol and reviewing all sedating
medications with the healthcare provider or pharmacist.
Option A is incorrect because grapefruit juice is not
recommended as a strategy to improve cyclobenzaprine
absorption and may contribute to drug-interaction concerns.
Option C is unsafe because the patient should not exceed the
prescribed dose; additional dosing may increase adverse CNS
