NCLEX-RN Pharmacology Musculoskeletal System
Exam Questions with Rationales |
20 Original NGN-Style Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis and is prescribed alendronate 70 mg orally once
weekly. The nurse is providing discharge teaching regarding the
proper administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a glass of milk."
B. "I will remain upright for at least 30 minutes after taking it."
C. "I can take this medication at bedtime to avoid stomach
upset."
D. "I will take this medication with my morning coffee."
,Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes
after taking it."
Detailed Rationale
The correct answer is B. 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 on an empty stomach with a full glass of plain water
(not mineral water, coffee, tea, or milk). The client must also
remain fully upright (sitting or standing) for at least 30 minutes
after ingestion and until after the first food of the day. Option A
is incorrect because calcium in milk binds to alendronate,
drastically reducing its absorption. Option C is incorrect
because lying down at bedtime increases the risk of esophageal
reflux and irritation. Option D is incorrect because coffee and
other beverages interfere with the medication's absorption.
This question emphasizes the critical nursing role in patient
education to prevent severe gastrointestinal adverse effects
and ensure therapeutic efficacy.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
,alendronate.
• Educate patients on strategies to prevent esophageal
irritation.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 72-year-old male client with osteoarthritis has been taking
ibuprofen 800 mg three times daily for the past 3 months.
During a follow-up visit, he reports new-onset epigastric pain
and notes that his stools have been dark and tarry for the past
2 days. His vital signs are stable.
Question Stem
Which action should the nurse take first?
Options
A. Administer an over-the-counter antacid.
B. Instruct the client to increase his daily fluid intake.
C. Withhold the next dose of ibuprofen and notify the provider.
D. Schedule a routine follow-up appointment in 2 weeks.
Correct Answer
Correct Answer: C. Withhold the next dose of ibuprofen and
notify the provider.
, Detailed Rationale
The correct answer is C. Dark, tarry stools (melena) combined
with epigastric pain are classic signs of a gastrointestinal (GI)
bleed, a severe and potentially life-threatening adverse effect
of nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen. The priority nursing action is to withhold the
offending medication to prevent further mucosal damage and
bleeding, and immediately notify the healthcare provider for
further evaluation (e.g., stool guaiac, hemoglobin/hematocrit,
possible endoscopy). Option A is incorrect because while
antacids may temporarily mask mild dyspepsia, they do not
treat an active GI bleed and delaying provider notification is
unsafe. Option B is incorrect because increasing fluids does not
address the acute bleeding risk. Option D is incorrect because
this is an urgent situation requiring immediate intervention, not
routine follow-up.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs and symptoms of NSAID-induced
gastrointestinal bleeding.
• Prioritize nursing interventions when a severe adverse drug
reaction is suspected.
• Understand the contraindications and risks of long-term
NSAID therapy in older adults.
Medication Safety Focus
Adverse effect
Exam Questions with Rationales |
20 Original NGN-Style Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis and is prescribed alendronate 70 mg orally once
weekly. The nurse is providing discharge teaching regarding the
proper administration of this medication.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
Options
A. "I will take this medication with a glass of milk."
B. "I will remain upright for at least 30 minutes after taking it."
C. "I can take this medication at bedtime to avoid stomach
upset."
D. "I will take this medication with my morning coffee."
,Correct Answer
Correct Answer: B. "I will remain upright for at least 30 minutes
after taking it."
Detailed Rationale
The correct answer is B. 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 on an empty stomach with a full glass of plain water
(not mineral water, coffee, tea, or milk). The client must also
remain fully upright (sitting or standing) for at least 30 minutes
after ingestion and until after the first food of the day. Option A
is incorrect because calcium in milk binds to alendronate,
drastically reducing its absorption. Option C is incorrect
because lying down at bedtime increases the risk of esophageal
reflux and irritation. Option D is incorrect because coffee and
other beverages interfere with the medication's absorption.
This question emphasizes the critical nursing role in patient
education to prevent severe gastrointestinal adverse effects
and ensure therapeutic efficacy.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
,alendronate.
• Educate patients on strategies to prevent esophageal
irritation.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 72-year-old male client with osteoarthritis has been taking
ibuprofen 800 mg three times daily for the past 3 months.
During a follow-up visit, he reports new-onset epigastric pain
and notes that his stools have been dark and tarry for the past
2 days. His vital signs are stable.
Question Stem
Which action should the nurse take first?
Options
A. Administer an over-the-counter antacid.
B. Instruct the client to increase his daily fluid intake.
C. Withhold the next dose of ibuprofen and notify the provider.
D. Schedule a routine follow-up appointment in 2 weeks.
Correct Answer
Correct Answer: C. Withhold the next dose of ibuprofen and
notify the provider.
, Detailed Rationale
The correct answer is C. Dark, tarry stools (melena) combined
with epigastric pain are classic signs of a gastrointestinal (GI)
bleed, a severe and potentially life-threatening adverse effect
of nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen. The priority nursing action is to withhold the
offending medication to prevent further mucosal damage and
bleeding, and immediately notify the healthcare provider for
further evaluation (e.g., stool guaiac, hemoglobin/hematocrit,
possible endoscopy). Option A is incorrect because while
antacids may temporarily mask mild dyspepsia, they do not
treat an active GI bleed and delaying provider notification is
unsafe. Option B is incorrect because increasing fluids does not
address the acute bleeding risk. Option D is incorrect because
this is an urgent situation requiring immediate intervention, not
routine follow-up.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs and symptoms of NSAID-induced
gastrointestinal bleeding.
• Prioritize nursing interventions when a severe adverse drug
reaction is suspected.
• Understand the contraindications and risks of long-term
NSAID therapy in older adults.
Medication Safety Focus
Adverse effect
