NCLEX Practice Exam for Pharmacology: Musculoskeletal Medications

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1. A nurse is providing instructions to a client receiving Baclofen (Lioresal). Which of the following would be included in the teaching plan?

  1. Limit fluid intake.
  2. Hold the medication if diarrhea occurs.
  3. Restrict alcohol intake.
  4. Notify the physician if weakness occurs.

2. A nurse is analyzing the laboratory studies on a client receiving Dantrolene Sodium (Dantrium). Which of the following laboratory test would identify an adverse effect associated with the use of the medication?

  1. Blood urea nitrogen.
  2. Creatinine.
  3. Liver function test.
  4. Triglyceride.

3. A nurse is caring for a client who is receiving Cyclobenzaprine hydrochloride (Flexeril) for the treatment of muscle spasm. Which of the following medical condition is contraindicated with the use of the medication?

  1. Diabetes Mellitus.
  2. Angle-closure glaucoma.
  3. Emphysema.
  4. Urinary tract infection.

4. A client is receiving Methocarbamol (Robaxin) as an adjunct to physical therapy for the relief of painful muscle discomfort. Which of the following is not true regarding with the use of the medication?

  1. The parenteral form causes hypotension and bradycardia when given rapidly.
  2. The medicine can cause the urine to turn into brown, black or green.
  3. The use of a cold or allergy medicine will lessen the side effects of the medication.
  4. The parenteral form is contraindicated in clients with liver damage.

5. Allopurinol (Zyloprim) is prescribed for a client for the treatment of gout. And the nurse is providing medication instructions. The nurse tells the client to?

  1. Take the medication on an empty stomach.
  2. To limit the use of vitamin C.
  3. A rash is a normal side effect of the medication.
  4. The effect of the medication will happen immediately.

6. A client is prescribed Colchicine. After taking three doses, the client complaints of nausea, vomiting, and loose bowel stools. Which of the following should the client do?

  1. Skip the next dose, and take the another dose.
  2. Withhold the medication and the physician is notified.
  3. Continue taking the medication as these symptoms will go away.
  4. Cut in half the next dosage.

7. Colchicine is prescribed for a client with gout. The nurse reviews the client’s record, knowing that this medication would be used in caution in which of the following medical condition?

  1. Behcet disease.
  2. Aplastic Anemia.
  3. Amyloidosis.
  4. Familial Mediterranean fever (FMF).

8. A client taking probenecid is complaining of gout pain. Which of the following medication should the nurse expect to be administered?

  1. Acetaminophen (Tylenol).
  2. Aspirin (Ecotrin).
  3. Orphenadrine (Norflex).
  4. Tizanidine (Zanaflex).

9. Gold sodium thiomalate is prescribed to a client with rheumatoid arthritis. Which of the following side effects indicates an overdosage of the medication?

  1. Flushing.
  2. Dizziness.
  3. Joint pain.
  4. Metallic taste.

10. Gold salt toxicity can be reversed using which medication?

  1. Acetaminophen.
  2. Dimercaprol.
  3. Calcium salts.
  4. Hydroxycobalamin.

11. Adalimumab (Humira) is given to a client for the treatment of rheumatoid arthritis. Which of the following side effect is associated with the medication?

  1. Numbness.
  2. Diarrhea.
  3. Urinary retention.
  4. Weight gain.

12. A client receiving Azathioprine (Imuran) complains of hair loss. The nurse tells the client that?

  1. Hair loss is irreversible.
  2. Hair loss is uncommon.
  3. Hair loss is temporary.
  4. Hair loss is a sign of toxicity.

13. The client is about to start the treatment for juvenile rheumatoid arthritis. Before the administration of etanercept (Enbrel), it is important for the nurse to:

  1. Ask for an allergy to latex.
  2. Ask the client to postpone vacation trip abroad.
  3. Tell the client to not miss due vaccination while on treatment.
  4. To avoid people with a recent injection of etanercept.

14. A nurse is giving medicinal instructions to a female client receiving Leflunomide(Arava). Which of the following is an appropriate instruction with the use of the medication?

  1. To use an effective form of birth control while on the treatment.
  2. Breastfeeding does not have to be stopped during the treatment.
  3. To use cholestyramine to lessen the side effects.
  4. It may take 3-5 days to notice any improvement while taking leflunomide.

15. A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months. The nurse tells the client to visit which of the following while on the treatment?

  1. Dentist.
  2. Ophthalmologist.
  3. Pulmonologist.
  4. Endocrinologist.

16. A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to?

  1. Clay-colored stool is a normal response of the treatment.
  2. Pregnancy is not contraindicated with the use of the medication.
  3. Strict hand washing.
  4. Get a daily source of sunlight during the day.

17. A client who is taking Methotrexate (Trexall) ask the nurse on what is the appropriate activity while taking the medication. The nurse advise the client to play which activity?

  1. Basketball.
  2. Ice hockey.
  3. Football.
  4. Tennis.

18. The nurse is reviewing the client’s history who is about to take Methotrexate. Which of the following drugs can be safely administered together with methotrexate?

  1. Tetracycline.
  2. Folic Acid.
  3. Sulfamethoxazole.
  4. Phenytoin.

19. Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to?

  1. Take the medication in the morning with meals.
  2. Take the medication 2 hours before bedtime.
  3. Take the medication with a glass of water after rising in the morning.
  4. Take the medication during lunch.

20. A client with osteoporosis is asking the nurse regarding the use of Salmon calcitonin (Miacalcin) nasal spray. The nurse tells the client to do the following, except?

  1. Delivery system contains enough medication for at least 30 doses. Discard any unused solution after 30 doses.
  2. If you do not feel the spray while using it, repeat the dose on the other nostrils.
  3. Miacalcin is usually given as one spray per day into only one of your nostrils.
  4. Take extra vitamin D while you are using Miacalcin.
Answers and Rationale:

1. Answer: C. Restrict alcohol intake. Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents.

  • Option A: Limiting fluid intake is not necessary, but the client should be warned that urinary retention occurs.
  • Option B: Constipation rather than diarrhea is a side effect.
  • Option D: Weakness is related to a CNS effect that is prevalent during the early phase of the treatment and diminishes with continued medication use.

2. Answer: C. Liver function test.

Liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function test should be performed before and during the duration of the treatment.

  • Options A and B assesses the kidney function.
  • Option D is not related to the use of the medication.

3. Answer: B. Angle-closure glaucoma.

Cyclobenzaprine hydrochloride (Flexeril) has an anticholinergic effect, so it is used in caution with patients with angle-closure glaucoma, urinary retention, and increased intraocular pressure.

4. Answer: C. The use of a cold or allergy medicine will lessen the side effects of the medication.

Methocarbamol is a muscle relaxant. Medicines such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety add to the sleepiness caused by methocarbamol.

5. Answer: B. To limit the use of vitamin C.

Instruct the client not to take larger doses of Vitamin C while taking allopurinol because kidney stones may occur.

  • Option A: Allopurinol is taken with a meal or with a milk.
  • Option C: This is a sign of hypersensitivity so the physician should be notified immediately.
  • Option D: A full therapeutic effect usually takes 1 week or longer.

6. Answer: B. Withhold the medication and the physician is notified.

If gastrointestinal symptoms occur (nausea, vomiting, diarrhea and abdominal pain), the medication is withheld and the physician is notified.

  • Options A and D: Cutting in half and skipping the next dose will not give the assurance of avoiding these symptoms.
  • Option C: These side effects are signs of overdosage that can be fatal.

7. Answer: B. Aplastic Anemia.

Colchicine is contraindicated in patients with a known hypersensitivity to the drug, in those with serious gastrointestinal, renal, hepatic, or cardiac disorders, and in those with blood dyscrasias such as aplastic anemia.

  • Options A, C, and D all have joint pain as one of the symptoms, so the use of colchicine helps in reducing the inflammation of the joint.

8. Answer: A. Acetaminophen (Tylenol).

The concurrent use of antigout medications and aspirin causes an increase in the uric acid level in the body; The client should be instructed to use acetaminophen (Tylenol) if prescribed rather than aspirin.

  • Options C and D are skeletal muscle relaxant medications.

9. Answer: D. Metallic taste.

Gold sodium thiomalate toxicity signs are pruritus, diarrhea, dermatitis, stomatitis, and metallic taste.

  • Options A and B: Flushing and dizziness are the side effects that may occur soon after the injection.
  • Option C: Increased joint pain may occur 1-2 days after the injection.

10. Answer: B. Dimercaprol.

Dimercaprol is used to treat arsenic, gold, or mercury poisoning.

  • Option A is an analgesic/antipyretic.
  • Option C is the antidote for fluoride ingestion.
  • Option D is the antidote for cyanide poisoning.

11. Answer: A. Numbness.

Adalimumab (Humira) has been associated with neurological side effects such as numbness, tingling, dizziness, visual disturbances, and weakness in the legs).

  • Options B, C, and D are not associated with the use of medication.

12. Answer: C. Hair loss is temporary.

Temporary hair loss may occur. Normal hair growth will return after treatment has ended.

13. Answer: A. Ask for an allergy to latex.

Before using etanercept, tell the physician or the nurse for any allergy to latex or natural dry rubber that can be found in the prefilled syringes or autoinjectors form of the medication.

14. Answer: A. To use an effective form of birth control while on the treatment.

Use an effective form of birth control to avoid pregnancy while taking leflunomide because of its teratogenic effect.

  • Option B: The medicine can be excreted in the human milk.
  • Option C: Cholestyramine decreases leflunomide’s effectiveness.
  • Option D: It may take 4 weeks or more to notice any improvement while taking leflunomide.

15. Answer: B. Ophthalmologist.

Plaquenil can adversely affect the eyes such as retinal damage. Clients taking this medicine should be seen by an ophthalmologist at least once a year.

16. Answer: C. Strict hand washing.

Clients taking Methotrexate are more likely to get infections or may worsen any current infections. Therefore, hand washing will help to prevent the spread of infection.

  • Option A is a sign of a liver toxicity and the physician should be notified of it.
  • Option B: Pregnancy is not allowed during the treatment.
  • Option D: Photosensitivity may happen during the treatment so the client is advised to wear sunscreen or any protective gear against the sunlight.

17. Answer: D. Tennis.

Avoid contact sports or other situations where bruising or injury could occur because the medication can lower the number of platelets, which are necessary for proper blood clotting.

  • Options A, B, and C are all contact sports.

18. Answer: B. Folic Acid

Clients who take folic acid supplements lowered the risk of GI problems and mouth sores brought about by the use of methotrexate.

  • Option A may decrease intestinal absorption of methotrexate.
  • Options C and D: Methotrexate is partially bound to serum albumin, and toxicity may be increased because of displacement by certain drugs, such as salicylates, phenylbutazone, phenytoin, and sulfonamides.

19. Answer: C. Take the medication with a glass of water after rising in the morning.

Alendronate needs to be taken with a glass of water after rising in the morning in order to prevent gastrointestinal effects.

20. Answer: B. If you do not feel the spray while using it, repeat the dose on the other nostrils.

Miacalcin spray delivers a fine mist into the nose. Even if the client does not feel the spray while using it, the medication is still being absorbed by the nasal passages.

  • Option A: Discard any unused solution after 30 doses because spray may not deliver correct dose.
  • Option C: Use the other nostril the next day and continue alternating back and forth for each daily dose.
  • Option D: Vitamin D helps in treating osteoporosis by helping in maintaining healthy bones.

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