NCLEX-RN Pharmacology Musculoskeletal
System Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales & Nursing Exam Review
Question 1
[Difficulty: Easy]
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 for alendronate?
Options
A. "I will take this medication with a full glass of milk to protect
my stomach."
B. "I can take this medication right before going to bed to help
me remember it."
C. "I will remain upright for at least 30 minutes after taking the
,pill."
D. "I will chew the tablet to ensure it dissolves quickly in my
stomach."
Correct Answer
Correct Answer: C. "I will remain upright for at least 30 minutes
after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. Due to its poor oral bioavailability and high
potential for causing severe esophageal irritation, ulceration, or
esophagitis, specific administration guidelines must be strictly
followed. 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. The client must remain fully upright (sitting or
standing) for at least 30 minutes after ingestion and until after
their first food of the day to prevent gastroesophageal reflux of
the medication. Taking alendronate with milk, coffee, juice, or
food significantly decreases its absorption, making Option A
incorrect. Taking it right before bed (Option B) increases the
risk of esophageal injury due to recumbency. Chewing or
sucking the tablet (Option D) can cause oropharyngeal
ulceration and is strictly contraindicated; the tablet must be
swallowed whole. Nursing considerations include assessing the
client's ability to sit or stand upright for 30 minutes and
,evaluating for pre-existing esophageal abnormalities (e.g.,
achalasia, strictures), which are absolute contraindications.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the importance of remaining upright
after medication administration.
Medication Safety Focus
Medication administration / Patient education
Question 2
[Difficulty: Moderate]
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis has been
taking methotrexate 15 mg orally once weekly for the past
three months. The client presents to the clinic for routine
follow-up and laboratory evaluation.
Question Stem
Which laboratory finding requires immediate notification of the
health care 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. Serum creatinine 0.9 mg/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, suppressing the
immune system and inflammatory response. A major adverse
effect of methotrexate is bone marrow suppression, which can
manifest as leukopenia, anemia, or thrombocytopenia. A WBC
count of 3,200/mm³ indicates leukopenia (normal range is
typically 4,500–11,000/mm³), placing the client at a significantly
increased risk for severe, life-threatening infections. This
finding requires immediate provider notification to evaluate the
need for dose reduction, discontinuation, or administration of
colony-stimulating factors. Option B is incorrect because a
platelet count of 160,000/mm³ is within the normal range
(150,000–400,000/mm³). Option C is incorrect because an AST
of 25 U/L is within the normal range (10–40 U/L); while
methotrexate can cause hepatotoxicity, this value does not
indicate liver injury. Option D is incorrect because a serum
creatinine of 0.9 mg/dL is normal, indicating adequate renal
System Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales & Nursing Exam Review
Question 1
[Difficulty: Easy]
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 for alendronate?
Options
A. "I will take this medication with a full glass of milk to protect
my stomach."
B. "I can take this medication right before going to bed to help
me remember it."
C. "I will remain upright for at least 30 minutes after taking the
,pill."
D. "I will chew the tablet to ensure it dissolves quickly in my
stomach."
Correct Answer
Correct Answer: C. "I will remain upright for at least 30 minutes
after taking the pill."
Detailed Rationale
Alendronate is a bisphosphonate used to treat and prevent
osteoporosis by inhibiting osteoclast-mediated bone
resorption. Due to its poor oral bioavailability and high
potential for causing severe esophageal irritation, ulceration, or
esophagitis, specific administration guidelines must be strictly
followed. 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. The client must remain fully upright (sitting or
standing) for at least 30 minutes after ingestion and until after
their first food of the day to prevent gastroesophageal reflux of
the medication. Taking alendronate with milk, coffee, juice, or
food significantly decreases its absorption, making Option A
incorrect. Taking it right before bed (Option B) increases the
risk of esophageal injury due to recumbency. Chewing or
sucking the tablet (Option D) can cause oropharyngeal
ulceration and is strictly contraindicated; the tablet must be
swallowed whole. Nursing considerations include assessing the
client's ability to sit or stand upright for 30 minutes and
,evaluating for pre-existing esophageal abnormalities (e.g.,
achalasia, strictures), which are absolute contraindications.
Learning Objective
• Identify the correct administration technique for oral
bisphosphonates.
• Recognize the risk of esophageal irritation associated with
alendronate.
• Educate patients on the importance of remaining upright
after medication administration.
Medication Safety Focus
Medication administration / Patient education
Question 2
[Difficulty: Moderate]
Clinical Scenario
A 54-year-old male client with rheumatoid arthritis has been
taking methotrexate 15 mg orally once weekly for the past
three months. The client presents to the clinic for routine
follow-up and laboratory evaluation.
Question Stem
Which laboratory finding requires immediate notification of the
health care 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. Serum creatinine 0.9 mg/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, suppressing the
immune system and inflammatory response. A major adverse
effect of methotrexate is bone marrow suppression, which can
manifest as leukopenia, anemia, or thrombocytopenia. A WBC
count of 3,200/mm³ indicates leukopenia (normal range is
typically 4,500–11,000/mm³), placing the client at a significantly
increased risk for severe, life-threatening infections. This
finding requires immediate provider notification to evaluate the
need for dose reduction, discontinuation, or administration of
colony-stimulating factors. Option B is incorrect because a
platelet count of 160,000/mm³ is within the normal range
(150,000–400,000/mm³). Option C is incorrect because an AST
of 25 U/L is within the normal range (10–40 U/L); while
methotrexate can cause hepatotoxicity, this value does not
indicate liver injury. Option D is incorrect because a serum
creatinine of 0.9 mg/dL is normal, indicating adequate renal
