NCLEX-RN Musculoskeletal Pharmacology
Practice Questions |
20 Original NGN-Style MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old female client is diagnosed with osteoporosis after
a DEXA scan reveals a T-score of -2.8. The provider prescribes
alendronate 70 mg orally once weekly. The client has a history
of mild gastroesophageal reflux disease (GERD) but is currently
asymptomatic.
Question Stem
Which statement by the client indicates an understanding of
the medication teaching?
Options
A. "I will take this medication with my morning coffee and a
small piece of toast."
B. "I will take the tablet with a full glass of plain water and
remain upright for at least 30 minutes."
,C. "I will take this medication at bedtime to avoid any stomach
upset during the day."
D. "If the tablet is too large to swallow, I will crush it and mix it
with applesauce."
Correct Answer
Correct Answer: B. "I will take the tablet with a full glass of
plain water and remain upright for at least 30 minutes."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis. It is poorly absorbed and highly irritating to the
esophageal mucosa. Therefore, the client must take it with a
full glass of plain water (not coffee, juice, or mineral water) on
an empty stomach, first thing in the morning. The client must
remain upright (sitting or standing) for at least 30 minutes after
administration to prevent esophageal reflux and ulceration.
Option A is incorrect because food, beverages other than plain
water, and other medications significantly decrease
alendronate absorption. Option C is incorrect because taking it
at bedtime increases the risk of esophageal irritation due to
recumbency. Option D is incorrect because bisphosphonate
tablets should never be crushed, chewed, or dissolved, as this
increases the risk of severe esophageal irritation and alters the
drug's pharmacokinetics. Nursing considerations include
assessing the client's ability to sit or stand upright for 30
minutes before prescribing. Patient teaching must emphasize
,adherence to these administration guidelines to maximize
therapeutic efficacy and minimize adverse effects. Monitoring
requirements include assessing for new or worsening
heartburn, dysphagia, or retrosternal pain, which may indicate
esophageal injury.
Learning Objective
Identify the correct administration technique for oral
bisphosphonates.
Recognize the risk of esophageal irritation associated with
alendronate.
Educate patients on lifestyle and positioning modifications to
ensure medication safety.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 45-year-old male client with severe rheumatoid arthritis (RA)
is receiving methotrexate 15 mg orally once weekly. He also
takes a daily folic acid supplement. Routine laboratory results
are drawn: WBC 2,800/mm³, AST 65 U/L, ALT 72 U/L, and
serum creatinine 1.1 mg/dL. The client is due for his weekly
methotrexate dose this morning.
Question Stem
, Which action should the nurse take first?
Options
A. Administer the scheduled methotrexate dose with a glass of
water.
B. Encourage the client to increase oral fluid intake to 3 liters
per day.
C. Withhold the methotrexate dose and notify the health care
provider.
D. Administer an additional dose of folic acid to prevent
toxicity.
Correct Answer
Correct Answer: C. Withhold the methotrexate dose and notify
the health care provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses the immune system and can cause
significant bone marrow suppression and hepatotoxicity. The
client’s laboratory results indicate leukopenia (WBC <
4,000/mm³) and elevated liver enzymes (AST and ALT > normal
limits), which are signs of methotrexate toxicity. The nurse’s
priority action is to withhold the medication and notify the
provider to prevent further, potentially life-threatening
immunosuppression or liver damage. Option A is incorrect
because administering the drug would exacerbate the existing
Practice Questions |
20 Original NGN-Style MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old female client is diagnosed with osteoporosis after
a DEXA scan reveals a T-score of -2.8. The provider prescribes
alendronate 70 mg orally once weekly. The client has a history
of mild gastroesophageal reflux disease (GERD) but is currently
asymptomatic.
Question Stem
Which statement by the client indicates an understanding of
the medication teaching?
Options
A. "I will take this medication with my morning coffee and a
small piece of toast."
B. "I will take the tablet with a full glass of plain water and
remain upright for at least 30 minutes."
,C. "I will take this medication at bedtime to avoid any stomach
upset during the day."
D. "If the tablet is too large to swallow, I will crush it and mix it
with applesauce."
Correct Answer
Correct Answer: B. "I will take the tablet with a full glass of
plain water and remain upright for at least 30 minutes."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis. It is poorly absorbed and highly irritating to the
esophageal mucosa. Therefore, the client must take it with a
full glass of plain water (not coffee, juice, or mineral water) on
an empty stomach, first thing in the morning. The client must
remain upright (sitting or standing) for at least 30 minutes after
administration to prevent esophageal reflux and ulceration.
Option A is incorrect because food, beverages other than plain
water, and other medications significantly decrease
alendronate absorption. Option C is incorrect because taking it
at bedtime increases the risk of esophageal irritation due to
recumbency. Option D is incorrect because bisphosphonate
tablets should never be crushed, chewed, or dissolved, as this
increases the risk of severe esophageal irritation and alters the
drug's pharmacokinetics. Nursing considerations include
assessing the client's ability to sit or stand upright for 30
minutes before prescribing. Patient teaching must emphasize
,adherence to these administration guidelines to maximize
therapeutic efficacy and minimize adverse effects. Monitoring
requirements include assessing for new or worsening
heartburn, dysphagia, or retrosternal pain, which may indicate
esophageal injury.
Learning Objective
Identify the correct administration technique for oral
bisphosphonates.
Recognize the risk of esophageal irritation associated with
alendronate.
Educate patients on lifestyle and positioning modifications to
ensure medication safety.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 45-year-old male client with severe rheumatoid arthritis (RA)
is receiving methotrexate 15 mg orally once weekly. He also
takes a daily folic acid supplement. Routine laboratory results
are drawn: WBC 2,800/mm³, AST 65 U/L, ALT 72 U/L, and
serum creatinine 1.1 mg/dL. The client is due for his weekly
methotrexate dose this morning.
Question Stem
, Which action should the nurse take first?
Options
A. Administer the scheduled methotrexate dose with a glass of
water.
B. Encourage the client to increase oral fluid intake to 3 liters
per day.
C. Withhold the methotrexate dose and notify the health care
provider.
D. Administer an additional dose of folic acid to prevent
toxicity.
Correct Answer
Correct Answer: C. Withhold the methotrexate dose and notify
the health care provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses the immune system and can cause
significant bone marrow suppression and hepatotoxicity. The
client’s laboratory results indicate leukopenia (WBC <
4,000/mm³) and elevated liver enzymes (AST and ALT > normal
limits), which are signs of methotrexate toxicity. The nurse’s
priority action is to withhold the medication and notify the
provider to prevent further, potentially life-threatening
immunosuppression or liver damage. Option A is incorrect
because administering the drug would exacerbate the existing
