NCLEX-RN Pharmacology Musculoskeletal System
Exam |
20 Original NGN Practice Questions with Detailed
Rationales |
Nursing Test Bank & Study Guide
Question 1
Clinical Scenario
A 68-year-old male with a medical history of osteoarthritis,
hypertension, and chronic kidney disease (CKD) stage 3 is admitted for
worsening joint pain. His current home medications include lisinopril,
amlodipine, and ibuprofen 600 mg three times daily as needed for pain.
His vital signs are: temperature 37.1°C (98.8°F), heart rate 88 bpm,
respiratory rate 18 breaths/min, and blood pressure 142/88 mm Hg.
Question Stem
Which assessment finding requires the nurse's immediate intervention?
Options
A. Mild epigastric pain reported after taking medication
B. Blood pressure 138/88 mm Hg
C. Urine output of 20 mL/hr over the last 2 hours
D. Morning joint stiffness lasting approximately 15 minutes
Correct Answer
Correct Answer: C. Urine output of 20 mL/hr over the last 2 hours
,Detailed Rationale
The correct answer is C because a urine output of 20 mL/hr indicates
oliguria and potential acute kidney injury (AKI). NSAIDs like ibuprofen
inhibit prostaglandin synthesis, which can cause afferent arteriole
constriction in the kidneys. This effect is significantly amplified in clients
with pre-existing CKD and those taking ACE inhibitors (lisinopril),
creating a high risk for acute renal failure. Immediate intervention is
required to prevent permanent renal damage.
Option A is incorrect because while mild epigastric pain is a common
side effect of NSAIDs and should be monitored, it is not an immediate
life-threatening emergency compared to acute renal failure.
Option B is incorrect because a blood pressure of 138/88 mm Hg is
within an acceptable range for a client with hypertension and does not
require immediate intervention.
Option D is incorrect because morning stiffness lasting less than 30
minutes is a classic, expected finding in osteoarthritis, not a
complication of medication therapy.
Learning Objective
• Recognize the signs of acute kidney injury in clients taking NSAIDs.
• Identify the pharmacodynamic interaction between NSAIDs, ACE
inhibitors, and renal function.
• Prioritize nursing assessments based on the severity of potential
adverse effects.
Medication Safety Focus
Adverse effect monitoring and high-risk drug interactions in renal
impairment.
Question 2
,Clinical Scenario
A 45-year-old female with a history of rheumatoid arthritis (RA) is
experiencing a severe flare-up. The provider prescribes prednisone 40
mg orally daily for 3 weeks to reduce inflammation. The nurse is
providing discharge teaching regarding this new medication regimen.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will take this medication with food to prevent stomach upset."
B. "I will monitor my blood glucose levels daily while on this therapy."
C. "I will avoid crowds and people who are currently sick."
D. "I can stop taking this medication abruptly once my joint pain is
gone."
Correct Answer
Correct Answer: D. "I can stop taking this medication abruptly once my
joint pain is gone."
Detailed Rationale
The correct answer is D because abruptly discontinuing systemic
corticosteroids after more than a few weeks of therapy can precipitate
an acute adrenal crisis. The hypothalamic-pituitary-adrenal (HPA) axis
becomes suppressed, and the body cannot immediately resume
endogenous cortisol production. Corticosteroids must be tapered
gradually as directed by the provider.
Option A is a correct statement; taking prednisone with food or milk
minimizes gastrointestinal irritation and ulcer risk.
Option B is a correct statement; corticosteroids induce gluconeogenesis
and can cause hyperglycemia, requiring monitoring, especially in
predisposed individuals.
Option C is a correct statement; corticosteroids are
, immunosuppressive, increasing the client's susceptibility to infections.
Avoiding sick contacts is a crucial safety measure.
Learning Objective
• Explain the physiological rationale for tapering systemic
corticosteroids.
• Identify common adverse effects of corticosteroid therapy,
including hyperglycemia and immunosuppression.
• Evaluate patient understanding of safe medication administration
practices.
Medication Safety Focus
Medication administration (prevention of adrenal crisis via proper
tapering).
Question 3
Clinical Scenario
A 52-year-old male with newly diagnosed severe rheumatoid arthritis is
scheduled to begin methotrexate therapy. The nurse reviews the
client's baseline laboratory results prior to the first dose.
Question Stem
Which laboratory result should the nurse report to the provider before
administering the medication?
Options
A. White blood cell count 3,200/mm³
B. Fasting blood glucose 110 mg/dL
C. Serum potassium 4.2 mEq/L
D. Aspartate aminotransferase (AST) 25 U/L
Exam |
20 Original NGN Practice Questions with Detailed
Rationales |
Nursing Test Bank & Study Guide
Question 1
Clinical Scenario
A 68-year-old male with a medical history of osteoarthritis,
hypertension, and chronic kidney disease (CKD) stage 3 is admitted for
worsening joint pain. His current home medications include lisinopril,
amlodipine, and ibuprofen 600 mg three times daily as needed for pain.
His vital signs are: temperature 37.1°C (98.8°F), heart rate 88 bpm,
respiratory rate 18 breaths/min, and blood pressure 142/88 mm Hg.
Question Stem
Which assessment finding requires the nurse's immediate intervention?
Options
A. Mild epigastric pain reported after taking medication
B. Blood pressure 138/88 mm Hg
C. Urine output of 20 mL/hr over the last 2 hours
D. Morning joint stiffness lasting approximately 15 minutes
Correct Answer
Correct Answer: C. Urine output of 20 mL/hr over the last 2 hours
,Detailed Rationale
The correct answer is C because a urine output of 20 mL/hr indicates
oliguria and potential acute kidney injury (AKI). NSAIDs like ibuprofen
inhibit prostaglandin synthesis, which can cause afferent arteriole
constriction in the kidneys. This effect is significantly amplified in clients
with pre-existing CKD and those taking ACE inhibitors (lisinopril),
creating a high risk for acute renal failure. Immediate intervention is
required to prevent permanent renal damage.
Option A is incorrect because while mild epigastric pain is a common
side effect of NSAIDs and should be monitored, it is not an immediate
life-threatening emergency compared to acute renal failure.
Option B is incorrect because a blood pressure of 138/88 mm Hg is
within an acceptable range for a client with hypertension and does not
require immediate intervention.
Option D is incorrect because morning stiffness lasting less than 30
minutes is a classic, expected finding in osteoarthritis, not a
complication of medication therapy.
Learning Objective
• Recognize the signs of acute kidney injury in clients taking NSAIDs.
• Identify the pharmacodynamic interaction between NSAIDs, ACE
inhibitors, and renal function.
• Prioritize nursing assessments based on the severity of potential
adverse effects.
Medication Safety Focus
Adverse effect monitoring and high-risk drug interactions in renal
impairment.
Question 2
,Clinical Scenario
A 45-year-old female with a history of rheumatoid arthritis (RA) is
experiencing a severe flare-up. The provider prescribes prednisone 40
mg orally daily for 3 weeks to reduce inflammation. The nurse is
providing discharge teaching regarding this new medication regimen.
Question Stem
Which statement by the client indicates a need for further teaching?
Options
A. "I will take this medication with food to prevent stomach upset."
B. "I will monitor my blood glucose levels daily while on this therapy."
C. "I will avoid crowds and people who are currently sick."
D. "I can stop taking this medication abruptly once my joint pain is
gone."
Correct Answer
Correct Answer: D. "I can stop taking this medication abruptly once my
joint pain is gone."
Detailed Rationale
The correct answer is D because abruptly discontinuing systemic
corticosteroids after more than a few weeks of therapy can precipitate
an acute adrenal crisis. The hypothalamic-pituitary-adrenal (HPA) axis
becomes suppressed, and the body cannot immediately resume
endogenous cortisol production. Corticosteroids must be tapered
gradually as directed by the provider.
Option A is a correct statement; taking prednisone with food or milk
minimizes gastrointestinal irritation and ulcer risk.
Option B is a correct statement; corticosteroids induce gluconeogenesis
and can cause hyperglycemia, requiring monitoring, especially in
predisposed individuals.
Option C is a correct statement; corticosteroids are
, immunosuppressive, increasing the client's susceptibility to infections.
Avoiding sick contacts is a crucial safety measure.
Learning Objective
• Explain the physiological rationale for tapering systemic
corticosteroids.
• Identify common adverse effects of corticosteroid therapy,
including hyperglycemia and immunosuppression.
• Evaluate patient understanding of safe medication administration
practices.
Medication Safety Focus
Medication administration (prevention of adrenal crisis via proper
tapering).
Question 3
Clinical Scenario
A 52-year-old male with newly diagnosed severe rheumatoid arthritis is
scheduled to begin methotrexate therapy. The nurse reviews the
client's baseline laboratory results prior to the first dose.
Question Stem
Which laboratory result should the nurse report to the provider before
administering the medication?
Options
A. White blood cell count 3,200/mm³
B. Fasting blood glucose 110 mg/dL
C. Serum potassium 4.2 mEq/L
D. Aspartate aminotransferase (AST) 25 U/L
