NCLEX-RN Pharmacology Musculoskeletal System
Exam Questions & Answers |
20 Original ATI & NGN Style Practice MCQs with
Detailed Rationales |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female is diagnosed with osteoporosis and
receives a new prescription for oral alendronate. She has a
history of mild gastroesophageal reflux disease (GERD).
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of milk at
bedtime."
B. "I will remain fully upright for at least 30 minutes after taking
the pill."
C. "I will chew the tablet to ensure it dissolves faster in my
stomach."
,D. "I will take this medication immediately after eating my
breakfast."
Correct Answer
Correct Answer: B. "I will remain fully upright for at least 30
minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate used to treat osteoporosis by
inhibiting osteoclast-mediated bone resorption. A major
adverse effect of oral bisphosphonates is severe esophageal
irritation, which can lead to esophagitis, esophageal ulcers, or
strictures. To minimize this risk, the nurse must teach the client
to take the medication with a full glass of plain water (not
mineral water, coffee, or juice, which decrease absorption) on
an empty stomach, first thing in the morning. The client must
remain fully upright (sitting or standing) for at least 30 minutes
and until after their first food of the day to prevent
gastroesophageal reflux. Option A is incorrect because calcium
(in milk) binds to alendronate and severely impairs its
absorption, and taking it at bedtime increases reflux risk.
Option C is incorrect because bisphosphonate tablets must be
swallowed whole; chewing them causes oral and esophageal
irritation. Option D is incorrect because food drastically reduces
the medication's bioavailability.
Learning Objective
After completing this question, the learner should be able to:
• Describe the proper administration technique for oral
,bisphosphonates.
• Identify adverse effects associated with improper
bisphosphonate administration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male with rheumatoid arthritis is scheduled to
receive his weekly dose of methotrexate. His recent laboratory
results show: AST 65 U/L, ALT 70 U/L, WBC 3,200/mm³, and
Platelets 110,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled dose of methotrexate as
prescribed.
B. Request a prescription for an immediate liver biopsy.
C. Withhold the medication and notify the healthcare provider.
D. Administer folic acid and then proceed with the
methotrexate dose.
Correct Answer
Correct Answer: C. Withhold the medication and notify the
healthcare provider.
, Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and folate antimetabolite. It is highly hepatotoxic and
myelosuppressive. The client’s laboratory results indicate
hepatotoxicity (elevated AST and ALT) and bone marrow
suppression (leukopenia and thrombocytopenia). Administering
another dose could lead to life-threatening infection, bleeding,
or liver failure. The priority nursing action is to withhold the
medication and immediately notify the healthcare provider for
further evaluation and potential dose adjustment or
discontinuation. Option A is incorrect and unsafe, as it ignores
critical abnormal lab values. Option B is incorrect because a
liver biopsy is an invasive procedure that is not the first-line
action; the provider will first reassess the need for the
medication. Option D is incorrect because while folic acid is
often prescribed to mitigate methotrexate side effects, it does
not make it safe to administer the drug in the presence of
active, significant toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of methotrexate
toxicity.
• Prioritize nursing interventions for abnormal laboratory
findings.
Medication Safety Focus
Monitoring
Exam Questions & Answers |
20 Original ATI & NGN Style Practice MCQs with
Detailed Rationales |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female is diagnosed with osteoporosis and
receives a new prescription for oral alendronate. She has a
history of mild gastroesophageal reflux disease (GERD).
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I will take this medication with a full glass of milk at
bedtime."
B. "I will remain fully upright for at least 30 minutes after taking
the pill."
C. "I will chew the tablet to ensure it dissolves faster in my
stomach."
,D. "I will take this medication immediately after eating my
breakfast."
Correct Answer
Correct Answer: B. "I will remain fully upright for at least 30
minutes after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate used to treat osteoporosis by
inhibiting osteoclast-mediated bone resorption. A major
adverse effect of oral bisphosphonates is severe esophageal
irritation, which can lead to esophagitis, esophageal ulcers, or
strictures. To minimize this risk, the nurse must teach the client
to take the medication with a full glass of plain water (not
mineral water, coffee, or juice, which decrease absorption) on
an empty stomach, first thing in the morning. The client must
remain fully upright (sitting or standing) for at least 30 minutes
and until after their first food of the day to prevent
gastroesophageal reflux. Option A is incorrect because calcium
(in milk) binds to alendronate and severely impairs its
absorption, and taking it at bedtime increases reflux risk.
Option C is incorrect because bisphosphonate tablets must be
swallowed whole; chewing them causes oral and esophageal
irritation. Option D is incorrect because food drastically reduces
the medication's bioavailability.
Learning Objective
After completing this question, the learner should be able to:
• Describe the proper administration technique for oral
,bisphosphonates.
• Identify adverse effects associated with improper
bisphosphonate administration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male with rheumatoid arthritis is scheduled to
receive his weekly dose of methotrexate. His recent laboratory
results show: AST 65 U/L, ALT 70 U/L, WBC 3,200/mm³, and
Platelets 110,000/mm³.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled dose of methotrexate as
prescribed.
B. Request a prescription for an immediate liver biopsy.
C. Withhold the medication and notify the healthcare provider.
D. Administer folic acid and then proceed with the
methotrexate dose.
Correct Answer
Correct Answer: C. Withhold the medication and notify the
healthcare provider.
, Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) and folate antimetabolite. It is highly hepatotoxic and
myelosuppressive. The client’s laboratory results indicate
hepatotoxicity (elevated AST and ALT) and bone marrow
suppression (leukopenia and thrombocytopenia). Administering
another dose could lead to life-threatening infection, bleeding,
or liver failure. The priority nursing action is to withhold the
medication and immediately notify the healthcare provider for
further evaluation and potential dose adjustment or
discontinuation. Option A is incorrect and unsafe, as it ignores
critical abnormal lab values. Option B is incorrect because a
liver biopsy is an invasive procedure that is not the first-line
action; the provider will first reassess the need for the
medication. Option D is incorrect because while folic acid is
often prescribed to mitigate methotrexate side effects, it does
not make it safe to administer the drug in the presence of
active, significant toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of methotrexate
toxicity.
• Prioritize nursing interventions for abnormal laboratory
findings.
Medication Safety Focus
Monitoring
