NCLEX-RN Pharmacology Practice Exam
Questions & Answers
Pain and Inflammation
20 NGN-Style NCLEX Nursing MCQs with
Rationales
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain rated 7/10 despite using nonpharmacologic
measures. Her provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. Her medical history includes
hypertension, stage 3 chronic kidney disease (eGFR 48
mL/min/1.73 m²), and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. Vital signs are stable. Serum creatinine has
increased from 1.0 mg/dL to 1.4 mg/dL over the past 6 months.
,Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Encourage the client to increase dietary potassium intake.
B. Assess the client's renal function and notify the provider of
impaired kidney function.
C. Administer the medication with milk to reduce gastric
irritation.
D. Instruct the client to avoid strenuous exercise while taking
ibuprofen.
Correct Answer
Correct Answer: B. Assess the client's renal function and notify
the provider of impaired kidney function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis and reducing pain and inflammation.
However, prostaglandins help maintain renal blood flow,
particularly in patients with chronic kidney disease or reduced
renal perfusion. This client has stage 3 CKD and a rising serum
creatinine, placing her at increased risk for NSAID-induced
acute kidney injury. The nurse's priority is to recognize this
,safety concern, review renal function, and notify the provider
before administering the medication. Early identification of
nephrotoxicity prevents further renal impairment.
Option A is incorrect because increasing potassium intake is
inappropriate. Ibuprofen used with an ACE inhibitor (lisinopril)
may actually contribute to hyperkalemia, making additional
potassium potentially harmful.
Option C is appropriate patient teaching because taking NSAIDs
with food or milk may decrease gastrointestinal irritation;
however, it does not address the immediate priority of
preventing kidney injury.
Option D may be reasonable lifestyle advice but is unrelated to
the highest-priority safety concern.
Nurses should monitor renal function, blood pressure, urine
output, and signs of gastrointestinal bleeding during NSAID
therapy, especially in older adults and clients with chronic
kidney disease.
Learning Objective
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced
nephrotoxicity.
• Prioritize nursing assessment before administering NSAIDs.
, • Recognize important drug-disease interactions involving
renal impairment.
Medication Safety Focus
Monitoring—Renal Function
Question 2
Clinical Scenario
A 42-year-old man is admitted with severe postoperative pain
following abdominal surgery. The provider prescribes morphine
4 mg IV every 3 hours as needed for severe pain. Before
administration, the nurse assesses the client and obtains the
following findings:
• Pain: 8/10
• Respiratory rate: 10 breaths/min
• Oxygen saturation: 92% on room air
• Blood pressure: 116/72 mm Hg
• Heart rate: 82/min
• Awake but difficult to arouse
Question Stem
What is the nurse's priority action?
Questions & Answers
Pain and Inflammation
20 NGN-Style NCLEX Nursing MCQs with
Rationales
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain rated 7/10 despite using nonpharmacologic
measures. Her provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. Her medical history includes
hypertension, stage 3 chronic kidney disease (eGFR 48
mL/min/1.73 m²), and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. Vital signs are stable. Serum creatinine has
increased from 1.0 mg/dL to 1.4 mg/dL over the past 6 months.
,Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Encourage the client to increase dietary potassium intake.
B. Assess the client's renal function and notify the provider of
impaired kidney function.
C. Administer the medication with milk to reduce gastric
irritation.
D. Instruct the client to avoid strenuous exercise while taking
ibuprofen.
Correct Answer
Correct Answer: B. Assess the client's renal function and notify
the provider of impaired kidney function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis and reducing pain and inflammation.
However, prostaglandins help maintain renal blood flow,
particularly in patients with chronic kidney disease or reduced
renal perfusion. This client has stage 3 CKD and a rising serum
creatinine, placing her at increased risk for NSAID-induced
acute kidney injury. The nurse's priority is to recognize this
,safety concern, review renal function, and notify the provider
before administering the medication. Early identification of
nephrotoxicity prevents further renal impairment.
Option A is incorrect because increasing potassium intake is
inappropriate. Ibuprofen used with an ACE inhibitor (lisinopril)
may actually contribute to hyperkalemia, making additional
potassium potentially harmful.
Option C is appropriate patient teaching because taking NSAIDs
with food or milk may decrease gastrointestinal irritation;
however, it does not address the immediate priority of
preventing kidney injury.
Option D may be reasonable lifestyle advice but is unrelated to
the highest-priority safety concern.
Nurses should monitor renal function, blood pressure, urine
output, and signs of gastrointestinal bleeding during NSAID
therapy, especially in older adults and clients with chronic
kidney disease.
Learning Objective
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced
nephrotoxicity.
• Prioritize nursing assessment before administering NSAIDs.
, • Recognize important drug-disease interactions involving
renal impairment.
Medication Safety Focus
Monitoring—Renal Function
Question 2
Clinical Scenario
A 42-year-old man is admitted with severe postoperative pain
following abdominal surgery. The provider prescribes morphine
4 mg IV every 3 hours as needed for severe pain. Before
administration, the nurse assesses the client and obtains the
following findings:
• Pain: 8/10
• Respiratory rate: 10 breaths/min
• Oxygen saturation: 92% on room air
• Blood pressure: 116/72 mm Hg
• Heart rate: 82/min
• Awake but difficult to arouse
Question Stem
What is the nurse's priority action?
