NCLEX-RN Pharmacology Musculoskeletal System
Practice Questions |
20 NGN Clinical Judgment MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy |
Nursing Exam Review Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes 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?
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 any daytime
nausea."
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 inhibit bone
resorption in osteoporosis. It is highly irritating to the
esophageal mucosa and can cause severe esophagitis or
esophageal ulcers. To minimize this risk, the medication must
be taken with a full glass of plain water (not orange juice,
coffee, or mineral water, which can interfere with 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 the first food of the day to prevent
esophageal reflux. Chewing the tablet is contraindicated as it
can cause oral or esophageal ulceration. Taking it at bedtime
increases the risk of reflux and esophageal injury because the
client will likely be supine.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
, • Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the timing and positioning required
for safe bisphosphonate therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis (RA) has
been taking methotrexate 15 mg orally once weekly for the
past 3 months. He presents to the clinic for a routine follow-up
and laboratory evaluation.
Question Stem
Which laboratory finding requires immediate notification of the
provider?
Options
A. White blood cell (WBC) count 3,200/mm³
B. Platelet count 160,000/mm³
C. Aspartate aminotransferase (AST) 25 U/L
D. Hemoglobin 13 g/dL
Correct Answer
Correct Answer: A. White blood cell (WBC) count 3,200/mm³
, Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist. A major adverse
effect is bone marrow suppression, which can lead to
leukopenia, thrombocytopenia, and anemia. A WBC count of
3,200/mm³ indicates leukopenia (normal range is typically
4,500 to 11,000/mm³), placing the client at a significantly
increased risk for severe, life-threatening infections. This
requires immediate provider notification and likely a hold on
the medication. A platelet count of 160,000/mm³, AST of 25
U/L, and hemoglobin of 13 g/dL are all within normal adult
limits and do not indicate acute toxicity. Regular monitoring of
CBC and liver function tests is mandatory for clients on
methotrexate.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing actions for abnormal laboratory findings
in clients on DMARDs.
• Recognize the importance of routine CBC and hepatic
monitoring during methotrexate therapy.
Medication Safety Focus
Monitoring
Question 3
Practice Questions |
20 NGN Clinical Judgment MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy |
Nursing Exam Review Study Guide
Question 1
Clinical Scenario
A 68-year-old female client is newly diagnosed with
osteoporosis. The provider prescribes 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?
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 any daytime
nausea."
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 inhibit bone
resorption in osteoporosis. It is highly irritating to the
esophageal mucosa and can cause severe esophagitis or
esophageal ulcers. To minimize this risk, the medication must
be taken with a full glass of plain water (not orange juice,
coffee, or mineral water, which can interfere with 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 the first food of the day to prevent
esophageal reflux. Chewing the tablet is contraindicated as it
can cause oral or esophageal ulceration. Taking it at bedtime
increases the risk of reflux and esophageal injury because the
client will likely be supine.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
, • Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the timing and positioning required
for safe bisphosphonate therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis (RA) has
been taking methotrexate 15 mg orally once weekly for the
past 3 months. He presents to the clinic for a routine follow-up
and laboratory evaluation.
Question Stem
Which laboratory finding requires immediate notification of the
provider?
Options
A. White blood cell (WBC) count 3,200/mm³
B. Platelet count 160,000/mm³
C. Aspartate aminotransferase (AST) 25 U/L
D. Hemoglobin 13 g/dL
Correct Answer
Correct Answer: A. White blood cell (WBC) count 3,200/mm³
, Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that acts as a folic acid antagonist. A major adverse
effect is bone marrow suppression, which can lead to
leukopenia, thrombocytopenia, and anemia. A WBC count of
3,200/mm³ indicates leukopenia (normal range is typically
4,500 to 11,000/mm³), placing the client at a significantly
increased risk for severe, life-threatening infections. This
requires immediate provider notification and likely a hold on
the medication. A platelet count of 160,000/mm³, AST of 25
U/L, and hemoglobin of 13 g/dL are all within normal adult
limits and do not indicate acute toxicity. Regular monitoring of
CBC and liver function tests is mandatory for clients on
methotrexate.
Learning Objective
• Interpret laboratory values to identify methotrexate-
induced bone marrow suppression.
• Prioritize nursing actions for abnormal laboratory findings
in clients on DMARDs.
• Recognize the importance of routine CBC and hepatic
monitoring during methotrexate therapy.
Medication Safety Focus
Monitoring
Question 3
