NCLEX-RN Pharmacology Musculoskeletal System Exam
Questions & Answers |
20 NGN-Style Practice Tests with Rationales |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for 6 months. During a clinic
visit, she reports mouth sores, fatigue, and easy bruising. Laboratory
results show WBC 2,800/mm³, hemoglobin 9.8 g/dL, and platelet count
85,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled methotrexate dose
B. Encourage increased dietary protein intake
C. Notify the provider about possible bone marrow suppression
D. Reassure the client that these findings are expected
Correct Answer
Correct Answer: C. Notify the provider about possible bone marrow
suppression
Detailed Rationale
,Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
inhibits folate metabolism and suppresses immune activity. A serious
adverse effect is bone marrow suppression, evidenced by leukopenia,
anemia, thrombocytopenia, oral ulcers, and fatigue. The client's
laboratory abnormalities and symptoms indicate significant toxicity
requiring immediate provider notification and likely medication
withholding.
Option A is unsafe because continuing methotrexate could worsen
marrow suppression. Option B does not address the immediate safety
concern. Option D is incorrect because these findings are not expected
therapeutic effects and require urgent evaluation.
Nurses should monitor CBC, liver function tests, and renal function
during methotrexate therapy. Patients should be instructed to report
signs of infection, bleeding, or mouth ulcers promptly. Folic acid
supplementation may reduce some adverse effects but does not
eliminate the risk of severe toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Recognize methotrexate toxicity.
• Interpret laboratory findings associated with bone marrow
suppression.
• Prioritize nursing interventions for severe adverse drug reactions.
• Identify monitoring requirements for DMARD therapy.
Medication Safety Focus
Monitoring
, Question 2
Clinical Scenario
A 24-year-old woman with systemic lupus erythematosus is prescribed
prednisone 40 mg daily. She asks the nurse how long she will need to
take the medication.
Question Stem
Which statement by the nurse is most appropriate?
A. "You may stop the medication whenever your symptoms improve."
B. "Prednisone should be discontinued abruptly if side effects occur."
C. "Your provider will gradually reduce the dose when appropriate."
D. "You should take the medication only during lupus flare-ups."
Correct Answer
Correct Answer: C. "Your provider will gradually reduce the dose
when appropriate."
Detailed Rationale
Prednisone suppresses adrenal cortisol production. Abrupt
discontinuation after prolonged use can result in adrenal insufficiency,
characterized by hypotension, weakness, fatigue, and potential
cardiovascular collapse. Therefore, tapering is required when
discontinuing therapy.
Option A is unsafe because stopping corticosteroids suddenly may
cause serious complications. Option B is incorrect because abrupt
cessation increases risk of adrenal crisis. Option D may be appropriate
for some short courses but does not accurately address long-term
corticosteroid management.
Questions & Answers |
20 NGN-Style Practice Tests with Rationales |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for 6 months. During a clinic
visit, she reports mouth sores, fatigue, and easy bruising. Laboratory
results show WBC 2,800/mm³, hemoglobin 9.8 g/dL, and platelet count
85,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled methotrexate dose
B. Encourage increased dietary protein intake
C. Notify the provider about possible bone marrow suppression
D. Reassure the client that these findings are expected
Correct Answer
Correct Answer: C. Notify the provider about possible bone marrow
suppression
Detailed Rationale
,Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
inhibits folate metabolism and suppresses immune activity. A serious
adverse effect is bone marrow suppression, evidenced by leukopenia,
anemia, thrombocytopenia, oral ulcers, and fatigue. The client's
laboratory abnormalities and symptoms indicate significant toxicity
requiring immediate provider notification and likely medication
withholding.
Option A is unsafe because continuing methotrexate could worsen
marrow suppression. Option B does not address the immediate safety
concern. Option D is incorrect because these findings are not expected
therapeutic effects and require urgent evaluation.
Nurses should monitor CBC, liver function tests, and renal function
during methotrexate therapy. Patients should be instructed to report
signs of infection, bleeding, or mouth ulcers promptly. Folic acid
supplementation may reduce some adverse effects but does not
eliminate the risk of severe toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Recognize methotrexate toxicity.
• Interpret laboratory findings associated with bone marrow
suppression.
• Prioritize nursing interventions for severe adverse drug reactions.
• Identify monitoring requirements for DMARD therapy.
Medication Safety Focus
Monitoring
, Question 2
Clinical Scenario
A 24-year-old woman with systemic lupus erythematosus is prescribed
prednisone 40 mg daily. She asks the nurse how long she will need to
take the medication.
Question Stem
Which statement by the nurse is most appropriate?
A. "You may stop the medication whenever your symptoms improve."
B. "Prednisone should be discontinued abruptly if side effects occur."
C. "Your provider will gradually reduce the dose when appropriate."
D. "You should take the medication only during lupus flare-ups."
Correct Answer
Correct Answer: C. "Your provider will gradually reduce the dose
when appropriate."
Detailed Rationale
Prednisone suppresses adrenal cortisol production. Abrupt
discontinuation after prolonged use can result in adrenal insufficiency,
characterized by hypotension, weakness, fatigue, and potential
cardiovascular collapse. Therefore, tapering is required when
discontinuing therapy.
Option A is unsafe because stopping corticosteroids suddenly may
cause serious complications. Option B is incorrect because abrupt
cessation increases risk of adrenal crisis. Option D may be appropriate
for some short courses but does not accurately address long-term
corticosteroid management.
