NCLEX-RN Pharmacology Musculoskeletal
System Practice Questions with Detailed
Rationales |
20 Original NGN-Style MCQs |
Nursing Exam Review & Study Guide
Question 1
Clinical Scenario
A 68-year-old female client with a new diagnosis of
osteoporosis is being discharged with a new prescription for
alendronate 70 mg once weekly. She has no known drug
allergies and a history of mild gastroesophageal reflux disease
(GERD).
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a full glass of orange juice to
help it go down."
B. "I will remain upright in a chair or standing for at least 30
minutes after taking it."
,C. "I will take this medication at bedtime to avoid daytime
heartburn."
D. "I will chew the tablet thoroughly to ensure faster absorption
in my stomach."
Correct Answer
Correct Answer: B. "I will remain upright in a chair or standing
for at least 30 minutes after taking it."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis. It is poorly absorbed and highly irritating to the
esophageal mucosa. To maximize absorption and minimize the
risk of esophagitis or esophageal ulcers, the client must take
the medication first thing in the morning with a full glass of
plain water (at least 8 ounces) on an empty stomach. The client
must remain upright (sitting or standing) for at least 30 minutes
after administration and until after the first food of the day.
Option A is incorrect because calcium-fortified juices (like
orange juice) or mineral water significantly impair alendronate
absorption. Option C is incorrect because taking it at bedtime
increases the risk of esophageal reflux and ulceration, as the
client will likely lie down. Option D is incorrect because
alendronate tablets must be swallowed whole; chewing or
sucking on the tablet can cause oropharyngeal ulceration. This
question emphasizes the critical nursing role in patient
education to prevent severe gastrointestinal adverse effects.
Learning Objective
, • Identify the correct administration technique for oral
bisphosphonates.
• Recognize interventions to prevent esophageal irritation
from alendronate.
• Educate patients on factors that impair bisphosphonate
absorption.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis has been
taking methotrexate 15 mg weekly for the past 3 months.
Routine laboratory results are drawn: WBC 2,800/mm³,
Hemoglobin 10.5 g/dL, ALT 65 U/L, AST 70 U/L, and Platelets
140,000/mm³.
Question Stem
Which laboratory finding requires immediate intervention by
the nurse?
Options
A. Hemoglobin 10.5 g/dL
B. ALT 65 U/L
C. WBC 2,800/mm³
D. AST 70 U/L
, Correct Answer
Correct Answer: C. WBC 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and immunosuppressant that can cause dose-
dependent bone marrow suppression. A white blood cell (WBC)
count of 2,800/mm³ indicates leukopenia, placing the client at a
high, immediate risk for severe, life-threatening infections. The
nurse must hold the medication and notify the healthcare
provider immediately. While mild anemia (Hemoglobin 10.5
g/dL) and mild elevations in liver transaminases (ALT 65 U/L,
AST 70 U/L) are common, expected findings that require
ongoing monitoring, they do not represent an immediate, acute
threat compared to profound leukopenia. Platelets of
140,000/mm³ are at the lower limit of normal but do not
require immediate intervention. This scenario highlights the
necessity of vigilant laboratory monitoring when administering
high-alert immunosuppressive therapies.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing interventions for abnormal laboratory
findings in clients on DMARDs.
• Recognize the signs of immunosuppression and infection
risk.
System Practice Questions with Detailed
Rationales |
20 Original NGN-Style MCQs |
Nursing Exam Review & Study Guide
Question 1
Clinical Scenario
A 68-year-old female client with a new diagnosis of
osteoporosis is being discharged with a new prescription for
alendronate 70 mg once weekly. She has no known drug
allergies and a history of mild gastroesophageal reflux disease
(GERD).
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a full glass of orange juice to
help it go down."
B. "I will remain upright in a chair or standing for at least 30
minutes after taking it."
,C. "I will take this medication at bedtime to avoid daytime
heartburn."
D. "I will chew the tablet thoroughly to ensure faster absorption
in my stomach."
Correct Answer
Correct Answer: B. "I will remain upright in a chair or standing
for at least 30 minutes after taking it."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis. It is poorly absorbed and highly irritating to the
esophageal mucosa. To maximize absorption and minimize the
risk of esophagitis or esophageal ulcers, the client must take
the medication first thing in the morning with a full glass of
plain water (at least 8 ounces) on an empty stomach. The client
must remain upright (sitting or standing) for at least 30 minutes
after administration and until after the first food of the day.
Option A is incorrect because calcium-fortified juices (like
orange juice) or mineral water significantly impair alendronate
absorption. Option C is incorrect because taking it at bedtime
increases the risk of esophageal reflux and ulceration, as the
client will likely lie down. Option D is incorrect because
alendronate tablets must be swallowed whole; chewing or
sucking on the tablet can cause oropharyngeal ulceration. This
question emphasizes the critical nursing role in patient
education to prevent severe gastrointestinal adverse effects.
Learning Objective
, • Identify the correct administration technique for oral
bisphosphonates.
• Recognize interventions to prevent esophageal irritation
from alendronate.
• Educate patients on factors that impair bisphosphonate
absorption.
Medication Safety Focus
Medication administration / Patient education
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis has been
taking methotrexate 15 mg weekly for the past 3 months.
Routine laboratory results are drawn: WBC 2,800/mm³,
Hemoglobin 10.5 g/dL, ALT 65 U/L, AST 70 U/L, and Platelets
140,000/mm³.
Question Stem
Which laboratory finding requires immediate intervention by
the nurse?
Options
A. Hemoglobin 10.5 g/dL
B. ALT 65 U/L
C. WBC 2,800/mm³
D. AST 70 U/L
, Correct Answer
Correct Answer: C. WBC 2,800/mm³
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and immunosuppressant that can cause dose-
dependent bone marrow suppression. A white blood cell (WBC)
count of 2,800/mm³ indicates leukopenia, placing the client at a
high, immediate risk for severe, life-threatening infections. The
nurse must hold the medication and notify the healthcare
provider immediately. While mild anemia (Hemoglobin 10.5
g/dL) and mild elevations in liver transaminases (ALT 65 U/L,
AST 70 U/L) are common, expected findings that require
ongoing monitoring, they do not represent an immediate, acute
threat compared to profound leukopenia. Platelets of
140,000/mm³ are at the lower limit of normal but do not
require immediate intervention. This scenario highlights the
necessity of vigilant laboratory monitoring when administering
high-alert immunosuppressive therapies.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing interventions for abnormal laboratory
findings in clients on DMARDs.
• Recognize the signs of immunosuppression and infection
risk.
