NCLEX-RN Musculoskeletal Pharmacology
Practice Questions |
20 Original NGN-Style MCQs with Rationales
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?
Options
A. "I will take this medication with a small glass of orange juice to help
it absorb better."
B. "I will 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 at bedtime as long as I do not eat
anything after dinner."
D. "I will take this medication with my daily calcium supplement to
maximize bone building."
,Correct Answer
Correct Answer: B. "I will 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 and is highly irritating to the esophageal
mucosa. Therefore, it must be taken first thing in the morning, on an
empty stomach, with a full glass of plain water (not orange juice,
coffee, or mineral water, as calcium and other ions bind to the drug and
prevent absorption). The client must remain upright (sitting or
standing) for at least 30 minutes to prevent esophageal reflux and
ulceration. Option A is incorrect because acidic or calcium-fortified
juices impair absorption. Option C is incorrect because taking it at
bedtime increases the risk of esophageal irritation if the client lies
down. Option D is incorrect because calcium supplements directly bind
to alendronate in the GI tract, drastically reducing its absorption;
calcium should be taken at a different time of day (e.g., lunch or
dinner).
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize drug-food interactions that impair bisphosphonate
absorption.
• Educate patients on measures to prevent esophageal irritation from
alendronate.
Medication Safety Focus
Medication administration
,Question 2
Clinical Scenario
A 45-year-old male client with rheumatoid arthritis (RA) has been
taking methotrexate 15 mg orally once weekly for the past 3 months.
The nurse is reviewing the client’s recent laboratory results prior to the
next dose.
Question Stem
Which laboratory finding requires immediate notification of the
provider?
Options
A. White blood cell count of 7,200/mm³
B. Aspartate aminotransferase (AST) of 85 U/L
C. Serum creatinine of 0.9 mg/dL
D. Hemoglobin of 13.5 g/dL
Correct Answer
Correct Answer: B. Aspartate aminotransferase (AST) of 85 U/L
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
acts as a folic acid antagonist, inhibiting DNA synthesis and reducing
inflammation. It is hepatotoxic, myelosuppressive, and nephrotoxic.
Normal AST levels typically range from 10 to 40 U/L. An AST of 85 U/L
indicates hepatotoxicity, a known adverse effect of methotrexate, and
requires immediate provider notification to evaluate the need for dose
reduction, discontinuation, or further hepatic workup. Option A is
incorrect because a WBC of 7,200/mm³ is within the normal range
(4,500–11,000/mm³), indicating no current myelosuppression. Option C
is incorrect because a serum creatinine of 0.9 mg/dL is normal, showing
adequate renal function. Option D is incorrect because a hemoglobin of
, 13.5 g/dL is normal for an adult male, ruling out anemia secondary to
bone marrow suppression. Regular monitoring of CBC, liver function
tests (LFTs), and renal function is a critical nursing responsibility for
clients on methotrexate.
Learning Objective
• Interpret laboratory values associated with methotrexate therapy.
• Recognize early signs of methotrexate-induced hepatotoxicity.
• Prioritize nursing actions based on abnormal laboratory findings.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 52-year-old female client with severe, active rheumatoid arthritis is
prescribed adalimumab, a tumor necrosis factor (TNF) blocker. The
nurse is preparing to administer the first dose.
Question Stem
Which action is the priority before initiating this therapy?
Options
A. Administer a prophylactic dose of diphenhydramine.
B. Verify the client has had a recent tuberculin skin test or interferon-
gamma release assay.
C. Ensure the client has fasted for 8 hours prior to administration.
D. Check the client’s serum uric acid level.
Correct Answer
Correct Answer: B. Verify the client has had a recent tuberculin skin test
or interferon-gamma release assay.
Practice Questions |
20 Original NGN-Style MCQs with Rationales
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?
Options
A. "I will take this medication with a small glass of orange juice to help
it absorb better."
B. "I will 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 at bedtime as long as I do not eat
anything after dinner."
D. "I will take this medication with my daily calcium supplement to
maximize bone building."
,Correct Answer
Correct Answer: B. "I will 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 and is highly irritating to the esophageal
mucosa. Therefore, it must be taken first thing in the morning, on an
empty stomach, with a full glass of plain water (not orange juice,
coffee, or mineral water, as calcium and other ions bind to the drug and
prevent absorption). The client must remain upright (sitting or
standing) for at least 30 minutes to prevent esophageal reflux and
ulceration. Option A is incorrect because acidic or calcium-fortified
juices impair absorption. Option C is incorrect because taking it at
bedtime increases the risk of esophageal irritation if the client lies
down. Option D is incorrect because calcium supplements directly bind
to alendronate in the GI tract, drastically reducing its absorption;
calcium should be taken at a different time of day (e.g., lunch or
dinner).
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize drug-food interactions that impair bisphosphonate
absorption.
• Educate patients on measures to prevent esophageal irritation from
alendronate.
Medication Safety Focus
Medication administration
,Question 2
Clinical Scenario
A 45-year-old male client with rheumatoid arthritis (RA) has been
taking methotrexate 15 mg orally once weekly for the past 3 months.
The nurse is reviewing the client’s recent laboratory results prior to the
next dose.
Question Stem
Which laboratory finding requires immediate notification of the
provider?
Options
A. White blood cell count of 7,200/mm³
B. Aspartate aminotransferase (AST) of 85 U/L
C. Serum creatinine of 0.9 mg/dL
D. Hemoglobin of 13.5 g/dL
Correct Answer
Correct Answer: B. Aspartate aminotransferase (AST) of 85 U/L
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that
acts as a folic acid antagonist, inhibiting DNA synthesis and reducing
inflammation. It is hepatotoxic, myelosuppressive, and nephrotoxic.
Normal AST levels typically range from 10 to 40 U/L. An AST of 85 U/L
indicates hepatotoxicity, a known adverse effect of methotrexate, and
requires immediate provider notification to evaluate the need for dose
reduction, discontinuation, or further hepatic workup. Option A is
incorrect because a WBC of 7,200/mm³ is within the normal range
(4,500–11,000/mm³), indicating no current myelosuppression. Option C
is incorrect because a serum creatinine of 0.9 mg/dL is normal, showing
adequate renal function. Option D is incorrect because a hemoglobin of
, 13.5 g/dL is normal for an adult male, ruling out anemia secondary to
bone marrow suppression. Regular monitoring of CBC, liver function
tests (LFTs), and renal function is a critical nursing responsibility for
clients on methotrexate.
Learning Objective
• Interpret laboratory values associated with methotrexate therapy.
• Recognize early signs of methotrexate-induced hepatotoxicity.
• Prioritize nursing actions based on abnormal laboratory findings.
Medication Safety Focus
Monitoring
Question 3
Clinical Scenario
A 52-year-old female client with severe, active rheumatoid arthritis is
prescribed adalimumab, a tumor necrosis factor (TNF) blocker. The
nurse is preparing to administer the first dose.
Question Stem
Which action is the priority before initiating this therapy?
Options
A. Administer a prophylactic dose of diphenhydramine.
B. Verify the client has had a recent tuberculin skin test or interferon-
gamma release assay.
C. Ensure the client has fasted for 8 hours prior to administration.
D. Check the client’s serum uric acid level.
Correct Answer
Correct Answer: B. Verify the client has had a recent tuberculin skin test
or interferon-gamma release assay.
