NCLEX-RN Pharmacology Exam
Questions & Rationales |
Pain and Inflammation |
20 Original ATI & NGN-Style
Practice Questions with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old client with osteoarthritis reports chronic knee
pain rated 7/10. The provider prescribes ibuprofen 400 mg
orally every 6 hours as needed. The client's history includes
chronic kidney disease stage 3, hypertension, and
gastroesophageal reflux disease. Laboratory results show a
serum creatinine of 2.0 mg/dL.
Question Stem
,Which assessment finding should cause the nurse to question
the prescription before administration?
A. Blood pressure 138/82 mm Hg
B. Serum creatinine 2.0 mg/dL
C. Heart rate 78/min
D. Pain rating 7/10
Correct Answer
Correct Answer: B. Serum creatinine 2.0 mg/dL
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes and decreases
prostaglandin synthesis. Although effective for pain and
inflammation, NSAIDs can reduce renal blood flow and worsen
kidney function. A serum creatinine of 2.0 mg/dL indicates
significant renal impairment, making NSAID therapy potentially
harmful. The nurse should clarify the prescription with the
provider before administration.
Option A is incorrect because a blood pressure of 138/82 mm
Hg does not independently contraindicate ibuprofen use,
although NSAIDs may contribute to hypertension. Option C is
incorrect because a heart rate of 78/min is within normal limits.
Option D is incorrect because the pain level supports the need
for analgesia but does not address medication safety concerns.
,Nurses should assess renal function before administering
NSAIDs, especially in older adults and clients with chronic
kidney disease. Monitoring urine output, serum creatinine, and
signs of fluid retention is essential.
Learning Objective
After completing this question, the learner should be able to:
• Identify renal contraindications to NSAID therapy.
• Evaluate laboratory data before medication administration.
• Recognize medication-related risks in older adults.
• Prioritize client safety when reviewing prescriptions.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 45-year-old client is receiving morphine IV following
abdominal surgery. Thirty minutes after administration, the
nurse notes the client is difficult to arouse.
Vital signs:
• Respiratory rate: 8/min
, • Oxygen saturation: 88%
• Blood pressure: 104/64 mm Hg
Question Stem
Which action should the nurse take first?
A. Notify the provider
B. Administer naloxone as prescribed
C. Reassess pain level
D. Place the client in high-Fowler's position
Correct Answer
Correct Answer: B. Administer naloxone as prescribed
Detailed Rationale
Morphine is an opioid agonist that depresses the central
nervous system and respiratory drive. A respiratory rate of
8/min and oxygen saturation of 88% indicate significant opioid-
induced respiratory depression. Immediate administration of
naloxone, an opioid antagonist, is the priority because it can
rapidly reverse life-threatening respiratory depression.
Option A is important but should occur after initiating
emergency treatment. Option C delays intervention and places
the client at risk. Option D may help ventilation but does not
address the underlying cause.
Questions & Rationales |
Pain and Inflammation |
20 Original ATI & NGN-Style
Practice Questions with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old client with osteoarthritis reports chronic knee
pain rated 7/10. The provider prescribes ibuprofen 400 mg
orally every 6 hours as needed. The client's history includes
chronic kidney disease stage 3, hypertension, and
gastroesophageal reflux disease. Laboratory results show a
serum creatinine of 2.0 mg/dL.
Question Stem
,Which assessment finding should cause the nurse to question
the prescription before administration?
A. Blood pressure 138/82 mm Hg
B. Serum creatinine 2.0 mg/dL
C. Heart rate 78/min
D. Pain rating 7/10
Correct Answer
Correct Answer: B. Serum creatinine 2.0 mg/dL
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes and decreases
prostaglandin synthesis. Although effective for pain and
inflammation, NSAIDs can reduce renal blood flow and worsen
kidney function. A serum creatinine of 2.0 mg/dL indicates
significant renal impairment, making NSAID therapy potentially
harmful. The nurse should clarify the prescription with the
provider before administration.
Option A is incorrect because a blood pressure of 138/82 mm
Hg does not independently contraindicate ibuprofen use,
although NSAIDs may contribute to hypertension. Option C is
incorrect because a heart rate of 78/min is within normal limits.
Option D is incorrect because the pain level supports the need
for analgesia but does not address medication safety concerns.
,Nurses should assess renal function before administering
NSAIDs, especially in older adults and clients with chronic
kidney disease. Monitoring urine output, serum creatinine, and
signs of fluid retention is essential.
Learning Objective
After completing this question, the learner should be able to:
• Identify renal contraindications to NSAID therapy.
• Evaluate laboratory data before medication administration.
• Recognize medication-related risks in older adults.
• Prioritize client safety when reviewing prescriptions.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 45-year-old client is receiving morphine IV following
abdominal surgery. Thirty minutes after administration, the
nurse notes the client is difficult to arouse.
Vital signs:
• Respiratory rate: 8/min
, • Oxygen saturation: 88%
• Blood pressure: 104/64 mm Hg
Question Stem
Which action should the nurse take first?
A. Notify the provider
B. Administer naloxone as prescribed
C. Reassess pain level
D. Place the client in high-Fowler's position
Correct Answer
Correct Answer: B. Administer naloxone as prescribed
Detailed Rationale
Morphine is an opioid agonist that depresses the central
nervous system and respiratory drive. A respiratory rate of
8/min and oxygen saturation of 88% indicate significant opioid-
induced respiratory depression. Immediate administration of
naloxone, an opioid antagonist, is the priority because it can
rapidly reverse life-threatening respiratory depression.
Option A is important but should occur after initiating
emergency treatment. Option C delays intervention and places
the client at risk. Option D may help ventilation but does not
address the underlying cause.
