NCLEX-RN Pharmacology Musculoskeletal
System Exam Questions & Answers |
20 ATI-Style Practice Questions with
Rationales |
Nursing Pharmacology Study Guide
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 decreased appetite.
Laboratory results show WBC 2,800/mm³, platelets 95,000/mm³, and
ALT 88 U/L.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled methotrexate dose
B. Encourage increased dietary protein intake
C. Hold methotrexate and notify the provider
D. Reassure the client that these effects are expected
Correct Answer
,Correct Answer: C. Hold methotrexate and notify the provider
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
suppresses immune activity by inhibiting folate metabolism. Bone
marrow suppression, hepatotoxicity, and mucositis are serious adverse
effects. This client demonstrates all three: oral ulcers, leukopenia,
thrombocytopenia, and elevated liver enzymes. The nurse should
immediately withhold the medication and notify the provider because
continuing therapy could worsen toxicity and increase the risk for
severe infection or bleeding.
Option A is unsafe because administering methotrexate despite
evidence of toxicity could cause life-threatening complications.
Option B does not address the immediate concern. Nutritional support
may be beneficial later but does not resolve drug toxicity.
Option D is incorrect because mild nausea may be expected, but
significant cytopenias and liver dysfunction require prompt
intervention.
Nurses should monitor CBC, platelet count, liver function tests, and
assess for infection, bruising, and oral ulcerations. Patient teaching
should emphasize weekly dosing, avoiding alcohol, and reporting signs
of toxicity promptly.
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 actions when serious adverse effects occur.
• Identify required monitoring for DMARD therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 55-year-old man with acute gout receives a prescription for
colchicine. He asks how the medication helps relieve symptoms.
Question Stem
Which explanation by the nurse is most accurate?
A. It dissolves existing uric acid crystals in joints.
B. It reduces inflammation caused by neutrophil activity.
C. It increases renal excretion of uric acid.
D. It blocks uric acid production in the liver.
Correct Answer
Correct Answer: B. It reduces inflammation caused by neutrophil
activity.
Detailed Rationale
Colchicine is used for acute gout flares because it decreases
inflammatory responses associated with urate crystal deposition.
Specifically, it inhibits neutrophil migration and activity, reducing
inflammation and pain. It does not lower serum uric acid levels and
therefore is not considered a urate-lowering medication.
System Exam Questions & Answers |
20 ATI-Style Practice Questions with
Rationales |
Nursing Pharmacology Study Guide
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 decreased appetite.
Laboratory results show WBC 2,800/mm³, platelets 95,000/mm³, and
ALT 88 U/L.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled methotrexate dose
B. Encourage increased dietary protein intake
C. Hold methotrexate and notify the provider
D. Reassure the client that these effects are expected
Correct Answer
,Correct Answer: C. Hold methotrexate and notify the provider
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
suppresses immune activity by inhibiting folate metabolism. Bone
marrow suppression, hepatotoxicity, and mucositis are serious adverse
effects. This client demonstrates all three: oral ulcers, leukopenia,
thrombocytopenia, and elevated liver enzymes. The nurse should
immediately withhold the medication and notify the provider because
continuing therapy could worsen toxicity and increase the risk for
severe infection or bleeding.
Option A is unsafe because administering methotrexate despite
evidence of toxicity could cause life-threatening complications.
Option B does not address the immediate concern. Nutritional support
may be beneficial later but does not resolve drug toxicity.
Option D is incorrect because mild nausea may be expected, but
significant cytopenias and liver dysfunction require prompt
intervention.
Nurses should monitor CBC, platelet count, liver function tests, and
assess for infection, bruising, and oral ulcerations. Patient teaching
should emphasize weekly dosing, avoiding alcohol, and reporting signs
of toxicity promptly.
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 actions when serious adverse effects occur.
• Identify required monitoring for DMARD therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 55-year-old man with acute gout receives a prescription for
colchicine. He asks how the medication helps relieve symptoms.
Question Stem
Which explanation by the nurse is most accurate?
A. It dissolves existing uric acid crystals in joints.
B. It reduces inflammation caused by neutrophil activity.
C. It increases renal excretion of uric acid.
D. It blocks uric acid production in the liver.
Correct Answer
Correct Answer: B. It reduces inflammation caused by neutrophil
activity.
Detailed Rationale
Colchicine is used for acute gout flares because it decreases
inflammatory responses associated with urate crystal deposition.
Specifically, it inhibits neutrophil migration and activity, reducing
inflammation and pain. It does not lower serum uric acid levels and
therefore is not considered a urate-lowering medication.
