NCLEX-RN Pharmacology Musculoskeletal System Exam
Questions with Detailed Rationales |
20 Original Practice MCQs |
NSAIDs, Corticosteroids, DMARDs, Osteoporosis & Gout
Medications |
Next Generation NCLEX (NGN) Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The healthcare provider prescribes alendronate
70 mg orally once weekly. The client asks the nurse how to take
this medication to ensure it works properly and avoids side
effects.
Question Stem
Which statement by the nurse provides the correct patient
teaching regarding the administration of alendronate?
A. "Take this medication with a small glass of orange juice to
help with absorption."
B. "Take the pill at bedtime and lie down immediately to
prevent stomach upset."
,C. "Take the medication with a full glass of plain water and
remain upright for at least 30 minutes."
D. "Take this medication at the same time as your daily calcium
and vitamin D supplements."
Correct Answer
C. "Take the medication 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 by inhibiting osteoclast-mediated bone
resorption. Due to its high potential for causing severe
esophageal irritation, ulceration, and esophagitis, strict
administration guidelines must be followed. The correct action
is to take the medication with a full glass (6-8 oz) of plain water
only, first thing in the morning, at least 30 minutes before the
first food, beverage, or other medication of the day. The client
must remain fully upright (sitting or standing) for at least 30
minutes to prevent gastroesophageal reflux. Option A is
incorrect because taking it with food or juice (especially those
high in calcium, like orange juice) drastically reduces its
absorption. Option B is incorrect because lying down increases
the risk of esophageal ulceration. Option D is incorrect because
while calcium and vitamin D are essential for osteoporosis
management, they must be taken at a different time of day
(e.g., lunch or dinner) to avoid binding with alendronate and
preventing its absorption. Nursing considerations include
,assessing the client's ability to sit upright for 30 minutes; if they
cannot, an alternative medication should be discussed.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize risk factors and prevention strategies for
medication-induced esophageal irritation.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 45-year-old male client with severe rheumatoid arthritis is
scheduled to receive his weekly dose of methotrexate. Morning
laboratory results reveal: WBC 2,800/mm³, AST 85 U/L, ALT 92
U/L, and platelets 130,000/mm³. The client reports feeling
slightly more fatigued than usual but has no acute complaints.
Question Stem
Which action should the nurse take first?
A. Hold the medication and notify the healthcare provider.
B. Administer the scheduled methotrexate dose with a glass of
water.
C. Administer the methotrexate and provide a folic acid
supplement.
, D. Encourage increased oral fluid intake before administering
the medication.
Correct Answer
A. Hold the medication and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and folate antagonist used for severe rheumatoid
arthritis. It is a high-alert medication with a narrow therapeutic
index and significant potential for hepatotoxicity,
myelosuppression, and pulmonary toxicity. The client’s
laboratory results show elevated liver transaminases (AST and
ALT) and leukopenia (low WBC), which are classic signs of
methotrexate-induced hepatotoxicity and bone marrow
suppression. The priority nursing action is to hold the
medication and immediately notify the healthcare provider, as
continuing the drug could lead to life-threatening infection,
bleeding, or liver failure. Option B is incorrect because
administering the scheduled dose would exacerbate the
toxicity. Option C is incorrect; while folic acid supplementation
is standard to reduce methotrexate side effects, it does not
reverse acute, significant myelosuppression or hepatotoxicity,
and the provider must be notified first. Option D is incorrect
because increasing fluids does not resolve established bone
marrow suppression or elevated liver enzymes. Clinical
reasoning dictates that abnormal critical labs for a high-alert
medication require holding the dose and provider notification.
Questions with Detailed Rationales |
20 Original Practice MCQs |
NSAIDs, Corticosteroids, DMARDs, Osteoporosis & Gout
Medications |
Next Generation NCLEX (NGN) Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The healthcare provider prescribes alendronate
70 mg orally once weekly. The client asks the nurse how to take
this medication to ensure it works properly and avoids side
effects.
Question Stem
Which statement by the nurse provides the correct patient
teaching regarding the administration of alendronate?
A. "Take this medication with a small glass of orange juice to
help with absorption."
B. "Take the pill at bedtime and lie down immediately to
prevent stomach upset."
,C. "Take the medication with a full glass of plain water and
remain upright for at least 30 minutes."
D. "Take this medication at the same time as your daily calcium
and vitamin D supplements."
Correct Answer
C. "Take the medication 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 by inhibiting osteoclast-mediated bone
resorption. Due to its high potential for causing severe
esophageal irritation, ulceration, and esophagitis, strict
administration guidelines must be followed. The correct action
is to take the medication with a full glass (6-8 oz) of plain water
only, first thing in the morning, at least 30 minutes before the
first food, beverage, or other medication of the day. The client
must remain fully upright (sitting or standing) for at least 30
minutes to prevent gastroesophageal reflux. Option A is
incorrect because taking it with food or juice (especially those
high in calcium, like orange juice) drastically reduces its
absorption. Option B is incorrect because lying down increases
the risk of esophageal ulceration. Option D is incorrect because
while calcium and vitamin D are essential for osteoporosis
management, they must be taken at a different time of day
(e.g., lunch or dinner) to avoid binding with alendronate and
preventing its absorption. Nursing considerations include
,assessing the client's ability to sit upright for 30 minutes; if they
cannot, an alternative medication should be discussed.
Learning Objective
• Identify proper administration techniques for oral
bisphosphonates.
• Recognize risk factors and prevention strategies for
medication-induced esophageal irritation.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 45-year-old male client with severe rheumatoid arthritis is
scheduled to receive his weekly dose of methotrexate. Morning
laboratory results reveal: WBC 2,800/mm³, AST 85 U/L, ALT 92
U/L, and platelets 130,000/mm³. The client reports feeling
slightly more fatigued than usual but has no acute complaints.
Question Stem
Which action should the nurse take first?
A. Hold the medication and notify the healthcare provider.
B. Administer the scheduled methotrexate dose with a glass of
water.
C. Administer the methotrexate and provide a folic acid
supplement.
, D. Encourage increased oral fluid intake before administering
the medication.
Correct Answer
A. Hold the medication and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and folate antagonist used for severe rheumatoid
arthritis. It is a high-alert medication with a narrow therapeutic
index and significant potential for hepatotoxicity,
myelosuppression, and pulmonary toxicity. The client’s
laboratory results show elevated liver transaminases (AST and
ALT) and leukopenia (low WBC), which are classic signs of
methotrexate-induced hepatotoxicity and bone marrow
suppression. The priority nursing action is to hold the
medication and immediately notify the healthcare provider, as
continuing the drug could lead to life-threatening infection,
bleeding, or liver failure. Option B is incorrect because
administering the scheduled dose would exacerbate the
toxicity. Option C is incorrect; while folic acid supplementation
is standard to reduce methotrexate side effects, it does not
reverse acute, significant myelosuppression or hepatotoxicity,
and the provider must be notified first. Option D is incorrect
because increasing fluids does not resolve established bone
marrow suppression or elevated liver enzymes. Clinical
reasoning dictates that abnormal critical labs for a high-alert
medication require holding the dose and provider notification.
