NCLEX-RN Pharmacology
Practice Exam |
20 NGN-Style Pain &
Inflammation Questions with
Rationales
ATI Pharmacology Review |
Nursing Test Bank
Question 1
Clinical Scenario
A 45-year-old client is admitted with postoperative pain
following abdominal surgery. The provider prescribes morphine
4 mg IV every 4 hours as needed. Before administration, the
nurse assesses the client and notes a respiratory rate of 10/min,
,oxygen saturation of 92% on room air, blood pressure of 118/72
mm Hg, and reports of severe pain rated 8/10.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed morphine dose
B. Encourage deep-breathing exercises and reassess later
C. Withhold morphine and notify the provider of the respiratory
findings
D. Administer acetaminophen instead of morphine
Correct Answer
Correct Answer: C. Withhold morphine and notify the provider
of the respiratory findings
Detailed Rationale
Morphine is an opioid agonist that depresses the central
nervous system and respiratory drive. A respiratory rate of
10/min indicates respiratory depression risk. Administering
morphine could worsen hypoventilation and potentially lead to
life-threatening respiratory compromise. The nurse should
withhold the medication and notify the provider for further
instructions or alternative pain management.
Option A is unsafe because administering morphine despite
respiratory depression violates medication safety principles.
,Option B may be helpful later but does not address the
immediate safety concern. Option D is inappropriate because
the nurse cannot independently substitute medications without
a provider's order.
Before opioid administration, nurses should assess respiratory
status, sedation level, oxygen saturation, pain severity, and
previous response to opioids. Monitoring is especially
important in postoperative clients, older adults, and those with
sleep apnea. Naloxone should be readily available when opioid-
induced respiratory depression occurs.
Learning Objective
After completing this question, the learner should be able to:
• Assess respiratory safety before opioid administration.
• Identify signs of opioid-induced respiratory depression.
• Prioritize nursing interventions when administering
opioids.
• Recognize when to withhold a prescribed medication.
Medication Safety Focus
Monitoring
Question 2
, Clinical Scenario
A 68-year-old client with osteoarthritis takes ibuprofen 800 mg
three times daily. The client reports black, tarry stools and
increasing fatigue over the past week. Vital signs are stable.
Question Stem
Which adverse effect is the nurse most concerned about?
A. Gastrointestinal bleeding
B. Hepatotoxicity
C. Hyperglycemia
D. Urinary retention
Correct Answer
Correct Answer: A. Gastrointestinal bleeding
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Prostaglandins help protect the gastric mucosa. Long-
term NSAID use increases the risk of gastric ulceration and
gastrointestinal bleeding.
Black, tarry stools (melena) strongly suggest upper
gastrointestinal bleeding. Fatigue may indicate anemia from
blood loss. This finding requires prompt evaluation.
Practice Exam |
20 NGN-Style Pain &
Inflammation Questions with
Rationales
ATI Pharmacology Review |
Nursing Test Bank
Question 1
Clinical Scenario
A 45-year-old client is admitted with postoperative pain
following abdominal surgery. The provider prescribes morphine
4 mg IV every 4 hours as needed. Before administration, the
nurse assesses the client and notes a respiratory rate of 10/min,
,oxygen saturation of 92% on room air, blood pressure of 118/72
mm Hg, and reports of severe pain rated 8/10.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed morphine dose
B. Encourage deep-breathing exercises and reassess later
C. Withhold morphine and notify the provider of the respiratory
findings
D. Administer acetaminophen instead of morphine
Correct Answer
Correct Answer: C. Withhold morphine and notify the provider
of the respiratory findings
Detailed Rationale
Morphine is an opioid agonist that depresses the central
nervous system and respiratory drive. A respiratory rate of
10/min indicates respiratory depression risk. Administering
morphine could worsen hypoventilation and potentially lead to
life-threatening respiratory compromise. The nurse should
withhold the medication and notify the provider for further
instructions or alternative pain management.
Option A is unsafe because administering morphine despite
respiratory depression violates medication safety principles.
,Option B may be helpful later but does not address the
immediate safety concern. Option D is inappropriate because
the nurse cannot independently substitute medications without
a provider's order.
Before opioid administration, nurses should assess respiratory
status, sedation level, oxygen saturation, pain severity, and
previous response to opioids. Monitoring is especially
important in postoperative clients, older adults, and those with
sleep apnea. Naloxone should be readily available when opioid-
induced respiratory depression occurs.
Learning Objective
After completing this question, the learner should be able to:
• Assess respiratory safety before opioid administration.
• Identify signs of opioid-induced respiratory depression.
• Prioritize nursing interventions when administering
opioids.
• Recognize when to withhold a prescribed medication.
Medication Safety Focus
Monitoring
Question 2
, Clinical Scenario
A 68-year-old client with osteoarthritis takes ibuprofen 800 mg
three times daily. The client reports black, tarry stools and
increasing fatigue over the past week. Vital signs are stable.
Question Stem
Which adverse effect is the nurse most concerned about?
A. Gastrointestinal bleeding
B. Hepatotoxicity
C. Hyperglycemia
D. Urinary retention
Correct Answer
Correct Answer: A. Gastrointestinal bleeding
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Prostaglandins help protect the gastric mucosa. Long-
term NSAID use increases the risk of gastric ulceration and
gastrointestinal bleeding.
Black, tarry stools (melena) strongly suggest upper
gastrointestinal bleeding. Fatigue may indicate anemia from
blood loss. This finding requires prompt evaluation.
