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 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 an understanding of
the teaching?
A. "I will take this medication with a full glass of orange juice to
help with absorption."
B. "I will chew the tablet thoroughly before swallowing to
ensure it dissolves quickly."
C. "I will remain fully upright in a chair or standing for at least
,30 minutes after taking it."
D. "I will take this medication at bedtime to avoid experiencing
daytime heartburn."
Correct Answer
Correct Answer: C. "I will remain fully 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 by inhibiting osteoclast-mediated bone
resorption. It is notoriously irritating to the esophageal mucosa
and can cause esophagitis, esophageal ulcers, and strictures if
not administered correctly. To minimize this risk, the client
must take the medication first thing in the morning on an
empty stomach with a full glass (6-8 oz) of plain water only.
Beverages like orange juice, coffee, or mineral water contain
calcium or other ions that bind to the drug and severely impair
its absorption. Furthermore, the client must remain fully
upright (sitting or standing) for at least 30 minutes after
ingestion to prevent gastroesophageal reflux of the pill.
Chewing or sucking the tablet is contraindicated as it increases
oral and esophageal irritation. This strict administration
protocol is essential for both drug efficacy and the prevention
of severe esophageal complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
,bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on dietary and positional restrictions
following bisphosphonate administration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis is scheduled
to receive his weekly dose of methotrexate. His recent
laboratory results show a white blood cell (WBC) count of
2,800/mm³, aspartate aminotransferase (AST) of 65 U/L, and
alanine aminotransferase (ALT) of 70 U/L.
Question Stem
Which action should the nurse take first?
A. Notify the healthcare provider of the laboratory results and
hold the dose.
B. Administer the scheduled dose of methotrexate as
prescribed.
C. Instruct the client to increase fluid intake to 3 liters per day
before the dose.
D. Assess the client’s current level of joint pain and morning
stiffness.
, Correct Answer
Correct Answer: A. Notify the healthcare provider of the
laboratory results and hold the dose.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist. While highly
effective for rheumatoid arthritis, it carries significant risks of
hepatotoxicity and bone marrow suppression. The client’s
laboratory results reveal leukopenia (WBC 2,800/mm³) and
elevated liver transaminases, which are early indicators of
methotrexate-induced toxicity. The nurse’s priority action is to
withhold the scheduled dose and immediately notify the
healthcare provider for further evaluation and potential dose
adjustment or discontinuation. Administering the medication
would exacerbate the toxicity, potentially leading to life-
threatening infection or liver failure. While increasing fluid
intake is a general supportive measure for clients on
methotrexate to promote renal excretion, it does not address
the immediate danger posed by the abnormal laboratory
values. Assessing joint pain is a lower priority than addressing
potential systemic toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of methotrexate
toxicity.
• Prioritize nursing actions when abnormal labs are identified
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 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 an understanding of
the teaching?
A. "I will take this medication with a full glass of orange juice to
help with absorption."
B. "I will chew the tablet thoroughly before swallowing to
ensure it dissolves quickly."
C. "I will remain fully upright in a chair or standing for at least
,30 minutes after taking it."
D. "I will take this medication at bedtime to avoid experiencing
daytime heartburn."
Correct Answer
Correct Answer: C. "I will remain fully 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 by inhibiting osteoclast-mediated bone
resorption. It is notoriously irritating to the esophageal mucosa
and can cause esophagitis, esophageal ulcers, and strictures if
not administered correctly. To minimize this risk, the client
must take the medication first thing in the morning on an
empty stomach with a full glass (6-8 oz) of plain water only.
Beverages like orange juice, coffee, or mineral water contain
calcium or other ions that bind to the drug and severely impair
its absorption. Furthermore, the client must remain fully
upright (sitting or standing) for at least 30 minutes after
ingestion to prevent gastroesophageal reflux of the pill.
Chewing or sucking the tablet is contraindicated as it increases
oral and esophageal irritation. This strict administration
protocol is essential for both drug efficacy and the prevention
of severe esophageal complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct administration technique for oral
,bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on dietary and positional restrictions
following bisphosphonate administration.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis is scheduled
to receive his weekly dose of methotrexate. His recent
laboratory results show a white blood cell (WBC) count of
2,800/mm³, aspartate aminotransferase (AST) of 65 U/L, and
alanine aminotransferase (ALT) of 70 U/L.
Question Stem
Which action should the nurse take first?
A. Notify the healthcare provider of the laboratory results and
hold the dose.
B. Administer the scheduled dose of methotrexate as
prescribed.
C. Instruct the client to increase fluid intake to 3 liters per day
before the dose.
D. Assess the client’s current level of joint pain and morning
stiffness.
, Correct Answer
Correct Answer: A. Notify the healthcare provider of the
laboratory results and hold the dose.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist. While highly
effective for rheumatoid arthritis, it carries significant risks of
hepatotoxicity and bone marrow suppression. The client’s
laboratory results reveal leukopenia (WBC 2,800/mm³) and
elevated liver transaminases, which are early indicators of
methotrexate-induced toxicity. The nurse’s priority action is to
withhold the scheduled dose and immediately notify the
healthcare provider for further evaluation and potential dose
adjustment or discontinuation. Administering the medication
would exacerbate the toxicity, potentially leading to life-
threatening infection or liver failure. While increasing fluid
intake is a general supportive measure for clients on
methotrexate to promote renal excretion, it does not address
the immediate danger posed by the abnormal laboratory
values. Assessing joint pain is a lower priority than addressing
potential systemic toxicity.
Learning Objective
After completing this question, the learner should be able to:
• Interpret laboratory values indicative of methotrexate
toxicity.
• Prioritize nursing actions when abnormal labs are identified
