NCLEX-RN Pharmacology Musculoskeletal System Exam
Questions & Answers |
20 Original NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Inspired |
Nursing Exam Prep 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 regarding alendronate administration?
A. "I will take this medication with a full glass of milk right
before going to bed."
B. "I should take this medication first thing in the morning on an
empty stomach and remain upright for at least 30 minutes."
C. "I can take this medication with my morning coffee to help
,me remember it."
D. "If I miss a weekly dose, I will take two tablets the next
morning to catch up."
Correct Answer
Correct Answer: B. "I should take this medication first thing in
the morning on an empty stomach and remain upright for at
least 30 minutes."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. It has very poor oral bioavailability, which is further
decreased by food, beverages (other than plain water), and
medications containing calcium, magnesium, or aluminum.
Therefore, it must be taken first thing in the morning on an
empty stomach with a full glass of plain water. The client must
remain upright (sitting or standing) for at least 30 minutes after
ingestion to prevent esophageal irritation, ulceration, or reflux.
Option A is incorrect because milk contains calcium, which
binds to alendronate and prevents absorption, and lying down
increases esophageal risk. Option C is incorrect because coffee
interferes with absorption. Option D is incorrect because
doubling the dose increases the risk of severe esophageal
adverse effects and hypocalcemia; a missed weekly dose should
be taken the next morning, and the regular schedule resumed,
without doubling up.
Learning Objective
, • Identify the proper administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
alendronate.
• Educate patients on measures to prevent esophageal
irritation from bisphosphonates.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 55-year-old male client with a history of gout is prescribed
allopurinol 300 mg daily. During a follow-up visit, the client
reports developing a new, widespread, pruritic maculopapular
rash on his trunk and extremities. His vital signs are stable, and
he denies difficulty breathing.
Question Stem
Which action should the nurse take first?
A. Apply a topical corticosteroid cream to the affected areas.
B. Instruct the client to take an over-the-counter antihistamine.
C. Withhold the allopurinol and notify the health care provider
immediately.
D. Reassure the client that a mild rash is an expected side effect
of allopurinol.
, Correct Answer
Correct Answer: C. Withhold the allopurinol and notify the
health care provider immediately.
Detailed Rationale
Allopurinol is a xanthine oxidase inhibitor used to lower serum
uric acid levels in clients with chronic gout. A widespread,
pruritic rash can be an early manifestation of allopurinol
hypersensitivity syndrome (AHS) or severe cutaneous adverse
reactions (SCARs), such as Stevens-Johnson syndrome (SJS) or
toxic epidermal necrolysis (TEN), which carry a Black Box
Warning. The priority nursing action is to withhold the
medication immediately to prevent progression of the reaction
and notify the health care provider for further evaluation and
alternative therapy. Option A and B are incorrect because they
only treat the symptoms and do not address the potentially life-
threatening underlying cause. Option D is incorrect and
dangerous; a rash is never an "expected" or benign side effect
of allopurinol and requires immediate medical evaluation.
Learning Objective
• Recognize early signs of severe hypersensitivity reactions
to allopurinol.
• Prioritize nursing interventions for suspected adverse drug
reactions.
• Understand the Black Box Warning associated with
allopurinol hypersensitivity.
Questions & Answers |
20 Original NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Inspired |
Nursing Exam Prep 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 regarding alendronate administration?
A. "I will take this medication with a full glass of milk right
before going to bed."
B. "I should take this medication first thing in the morning on an
empty stomach and remain upright for at least 30 minutes."
C. "I can take this medication with my morning coffee to help
,me remember it."
D. "If I miss a weekly dose, I will take two tablets the next
morning to catch up."
Correct Answer
Correct Answer: B. "I should take this medication first thing in
the morning on an empty stomach and remain upright for at
least 30 minutes."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. It has very poor oral bioavailability, which is further
decreased by food, beverages (other than plain water), and
medications containing calcium, magnesium, or aluminum.
Therefore, it must be taken first thing in the morning on an
empty stomach with a full glass of plain water. The client must
remain upright (sitting or standing) for at least 30 minutes after
ingestion to prevent esophageal irritation, ulceration, or reflux.
Option A is incorrect because milk contains calcium, which
binds to alendronate and prevents absorption, and lying down
increases esophageal risk. Option C is incorrect because coffee
interferes with absorption. Option D is incorrect because
doubling the dose increases the risk of severe esophageal
adverse effects and hypocalcemia; a missed weekly dose should
be taken the next morning, and the regular schedule resumed,
without doubling up.
Learning Objective
, • Identify the proper administration technique for oral
bisphosphonates.
• Recognize factors that decrease the absorption of
alendronate.
• Educate patients on measures to prevent esophageal
irritation from bisphosphonates.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 55-year-old male client with a history of gout is prescribed
allopurinol 300 mg daily. During a follow-up visit, the client
reports developing a new, widespread, pruritic maculopapular
rash on his trunk and extremities. His vital signs are stable, and
he denies difficulty breathing.
Question Stem
Which action should the nurse take first?
A. Apply a topical corticosteroid cream to the affected areas.
B. Instruct the client to take an over-the-counter antihistamine.
C. Withhold the allopurinol and notify the health care provider
immediately.
D. Reassure the client that a mild rash is an expected side effect
of allopurinol.
, Correct Answer
Correct Answer: C. Withhold the allopurinol and notify the
health care provider immediately.
Detailed Rationale
Allopurinol is a xanthine oxidase inhibitor used to lower serum
uric acid levels in clients with chronic gout. A widespread,
pruritic rash can be an early manifestation of allopurinol
hypersensitivity syndrome (AHS) or severe cutaneous adverse
reactions (SCARs), such as Stevens-Johnson syndrome (SJS) or
toxic epidermal necrolysis (TEN), which carry a Black Box
Warning. The priority nursing action is to withhold the
medication immediately to prevent progression of the reaction
and notify the health care provider for further evaluation and
alternative therapy. Option A and B are incorrect because they
only treat the symptoms and do not address the potentially life-
threatening underlying cause. Option D is incorrect and
dangerous; a rash is never an "expected" or benign side effect
of allopurinol and requires immediate medical evaluation.
Learning Objective
• Recognize early signs of severe hypersensitivity reactions
to allopurinol.
• Prioritize nursing interventions for suspected adverse drug
reactions.
• Understand the Black Box Warning associated with
allopurinol hypersensitivity.
