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NSG 2504 MUSCULOSKELETAL DISORDERS
EXAM## 150+ NCLEX-STYLE QUESTIONS &
RATIONALES### BASED ON SAUNDERS NCLEX
REVIEW (2025-2026 EDITION)
### Topic 1: Osteoporosis & Metabolic Bone Disorders (Questions 1-
15)
**1. The nurse is conducting health screening for osteoporosis. Which
client is at greatest risk of developing this disorder?**
A) A 25-year-old woman who runs 5 miles daily
B) A 36-year-old man who has asthma and uses an inhaler
C) A 70-year-old man who consumes excess alcohol
D) A sedentary 65-year-old woman who smokes cigarettes
**Answer: D**
*Rationale:* Risk factors for osteoporosis include female gender, being
postmenopausal, advanced age, a low-calcium diet, excessive alcohol
intake, being sedentary, and smoking cigarettes. Long-term use of
corticosteroids (asthma inhalers) also increases risk, but the combination
of factors in option D presents the greatest overall risk. The 25-year-old
runner has protective factors .
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**2. A client asks the nurse about calcium supplementation to prevent
osteoporosis. Which response is most accurate?**
A) "Calcium supplements are only effective if taken with vitamin D."
B) "You should take calcium supplements on an empty stomach for best
absorption."
C) "The recommended daily intake of calcium for an adult is 600-800
mg."
D) "Calcium from dietary sources is better absorbed than from
supplements."
**Answer: A**
*Rationale:* Vitamin D is essential for calcium absorption. Adults aged
51-70 need 1000-1200 mg daily, increasing to 1200 mg after age 70.
Calcium is best absorbed when taken with food (acidic environment).
Dietary and supplemental calcium have comparable absorption when
taken correctly.
**3. Which statement by a client indicates understanding of osteoporosis
prevention teaching?**
A) "I will stop smoking and limit alcohol to one drink daily."
B) "I will increase my intake of red meat for protein."
C) "I will avoid weight-bearing exercises to protect my bones."
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D) "I only need to take calcium if I have symptoms."
**Answer: A**
*Rationale:* Smoking cessation and moderate alcohol intake are
important preventive measures. Weight-bearing exercises (walking,
jogging, weight training) are recommended to maintain bone density.
Calcium and vitamin D supplementation should be continuous, not
symptom-based. High protein intake can increase calcium excretion.
**4. A client has a new diagnosis of osteoporosis. Which medication
does the nurse expect to be prescribed as first-line therapy?**
A) Raloxifene (Evista)
B) Alendronate (Fosamax)
C) Calcitonin (Miacalcin)
D) Teriparatide (Forteo)
**Answer: B**
*Rationale:* Bisphosphonates (alendronate, risedronate, ibandronate,
zoledronic acid) are first-line therapy for osteoporosis. Raloxifene is a
selective estrogen receptor modulator (SERM) used in postmenopausal
women. Calcitonin is second-line. Teriparatide is a parathyroid hormone
analog reserved for severe cases.
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**5. The nurse is teaching a client about alendronate (Fosamax). Which
instruction is most important?**
A) "Take this medication with a full glass of water, on an empty
stomach, first thing in the morning."
B) "Take this medication with food to prevent stomach upset."
C) "Remain supine for 30 minutes after taking this medication."
D) "You may take this medication with any other daily medications."
**Answer: A**
*Rationale:* Alendronate must be taken on an empty stomach with a full
glass of water, then the client must remain upright for 30-60 minutes to
prevent esophageal irritation. It should not be taken with other
medications, food, or beverages (including coffee, juice).
**6. Which client is at highest risk for developing osteoporosis?**
A) A 45-year-old premenopausal woman with normal BMI
B) A 70-year-old man with normal testosterone levels
C) A 68-year-old postmenopausal woman with a family history of hip
fracture
D) A 55-year-old man who walks daily
**Answer: C**
NSG 2504 MUSCULOSKELETAL DISORDERS
EXAM## 150+ NCLEX-STYLE QUESTIONS &
RATIONALES### BASED ON SAUNDERS NCLEX
REVIEW (2025-2026 EDITION)
### Topic 1: Osteoporosis & Metabolic Bone Disorders (Questions 1-
15)
**1. The nurse is conducting health screening for osteoporosis. Which
client is at greatest risk of developing this disorder?**
A) A 25-year-old woman who runs 5 miles daily
B) A 36-year-old man who has asthma and uses an inhaler
C) A 70-year-old man who consumes excess alcohol
D) A sedentary 65-year-old woman who smokes cigarettes
**Answer: D**
*Rationale:* Risk factors for osteoporosis include female gender, being
postmenopausal, advanced age, a low-calcium diet, excessive alcohol
intake, being sedentary, and smoking cigarettes. Long-term use of
corticosteroids (asthma inhalers) also increases risk, but the combination
of factors in option D presents the greatest overall risk. The 25-year-old
runner has protective factors .
,2|Page
**2. A client asks the nurse about calcium supplementation to prevent
osteoporosis. Which response is most accurate?**
A) "Calcium supplements are only effective if taken with vitamin D."
B) "You should take calcium supplements on an empty stomach for best
absorption."
C) "The recommended daily intake of calcium for an adult is 600-800
mg."
D) "Calcium from dietary sources is better absorbed than from
supplements."
**Answer: A**
*Rationale:* Vitamin D is essential for calcium absorption. Adults aged
51-70 need 1000-1200 mg daily, increasing to 1200 mg after age 70.
Calcium is best absorbed when taken with food (acidic environment).
Dietary and supplemental calcium have comparable absorption when
taken correctly.
**3. Which statement by a client indicates understanding of osteoporosis
prevention teaching?**
A) "I will stop smoking and limit alcohol to one drink daily."
B) "I will increase my intake of red meat for protein."
C) "I will avoid weight-bearing exercises to protect my bones."
,3|Page
D) "I only need to take calcium if I have symptoms."
**Answer: A**
*Rationale:* Smoking cessation and moderate alcohol intake are
important preventive measures. Weight-bearing exercises (walking,
jogging, weight training) are recommended to maintain bone density.
Calcium and vitamin D supplementation should be continuous, not
symptom-based. High protein intake can increase calcium excretion.
**4. A client has a new diagnosis of osteoporosis. Which medication
does the nurse expect to be prescribed as first-line therapy?**
A) Raloxifene (Evista)
B) Alendronate (Fosamax)
C) Calcitonin (Miacalcin)
D) Teriparatide (Forteo)
**Answer: B**
*Rationale:* Bisphosphonates (alendronate, risedronate, ibandronate,
zoledronic acid) are first-line therapy for osteoporosis. Raloxifene is a
selective estrogen receptor modulator (SERM) used in postmenopausal
women. Calcitonin is second-line. Teriparatide is a parathyroid hormone
analog reserved for severe cases.
, 4|Page
**5. The nurse is teaching a client about alendronate (Fosamax). Which
instruction is most important?**
A) "Take this medication with a full glass of water, on an empty
stomach, first thing in the morning."
B) "Take this medication with food to prevent stomach upset."
C) "Remain supine for 30 minutes after taking this medication."
D) "You may take this medication with any other daily medications."
**Answer: A**
*Rationale:* Alendronate must be taken on an empty stomach with a full
glass of water, then the client must remain upright for 30-60 minutes to
prevent esophageal irritation. It should not be taken with other
medications, food, or beverages (including coffee, juice).
**6. Which client is at highest risk for developing osteoporosis?**
A) A 45-year-old premenopausal woman with normal BMI
B) A 70-year-old man with normal testosterone levels
C) A 68-year-old postmenopausal woman with a family history of hip
fracture
D) A 55-year-old man who walks daily
**Answer: C**
