NCLEX-RN Pharmacology Practice Exam
Questions & Rationales
Pain and Inflammation
20 ATI & NGN-Style MCQs with Detailed
Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 67-year-old woman is admitted with severe osteoarthritis of
both knees. Her medical history includes hypertension, stage 3
chronic kidney disease (estimated GFR 42 mL/min/1.73 m²),
and gastroesophageal reflux disease (GERD). She reports knee
pain rated 8/10 despite taking acetaminophen as directed at
home. Current vital signs are BP 146/82 mm Hg, HR 78/min, RR
18/min, and temperature 36.8°C (98.2°F). The provider
prescribes several medications for pain management.
Question Stem
,Which prescribed medication should the nurse question before
administration?
A. Ibuprofen 600 mg orally every 6 hours as needed
B. Acetaminophen 650 mg orally every 6 hours as needed
C. Topical diclofenac gel applied to both knees four times daily
D. Lidocaine 5% patch applied for 12 hours daily
Correct Answer
Correct Answer: A. Ibuprofen 600 mg orally every 6 hours as
needed
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
especially in patients with chronic kidney disease. In this patient
with stage 3 CKD, systemic NSAIDs can worsen renal function,
promote sodium and water retention, increase blood pressure,
and increase the risk of gastrointestinal bleeding. The nurse
should question this prescription and collaborate with the
provider regarding safer alternatives.
Option B: Acetaminophen is generally considered the preferred
first-line analgesic for mild to moderate osteoarthritis pain in
,patients with chronic kidney disease when used within
recommended daily limits. Liver function and total daily dose
should still be monitored.
Option C: Topical diclofenac produces much lower systemic
absorption than oral NSAIDs, making it a safer option for
localized osteoarthritis pain, although caution is still
appropriate.
Option D: Lidocaine patches provide localized analgesia with
minimal systemic effects and do not significantly affect renal
function.
The nurse should assess renal function, monitor serum
creatinine, review concurrent nephrotoxic medications, educate
the patient to avoid over-the-counter NSAIDs unless approved,
and emphasize adequate hydration when appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize contraindications for systemic NSAID therapy.
• Prioritize safer analgesic options for patients with chronic
kidney disease.
, • Educate patients about avoiding unnecessary over-the-
counter NSAID use.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 42-year-old man underwent laparoscopic cholecystectomy
earlier today. He reports incisional pain rated 9/10. The
provider prescribes morphine IV every 3 hours as needed.
Before administering the first dose, the nurse obtains the
following assessment findings:
• BP 118/70 mm Hg
• HR 76/min
• RR 10/min
• SpO₂ 92% on room air
• Patient is difficult to arouse and falls asleep during
conversation.
Question Stem
Which nursing action is the priority?
A. Administer the prescribed morphine dose.
Questions & Rationales
Pain and Inflammation
20 ATI & NGN-Style MCQs with Detailed
Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 67-year-old woman is admitted with severe osteoarthritis of
both knees. Her medical history includes hypertension, stage 3
chronic kidney disease (estimated GFR 42 mL/min/1.73 m²),
and gastroesophageal reflux disease (GERD). She reports knee
pain rated 8/10 despite taking acetaminophen as directed at
home. Current vital signs are BP 146/82 mm Hg, HR 78/min, RR
18/min, and temperature 36.8°C (98.2°F). The provider
prescribes several medications for pain management.
Question Stem
,Which prescribed medication should the nurse question before
administration?
A. Ibuprofen 600 mg orally every 6 hours as needed
B. Acetaminophen 650 mg orally every 6 hours as needed
C. Topical diclofenac gel applied to both knees four times daily
D. Lidocaine 5% patch applied for 12 hours daily
Correct Answer
Correct Answer: A. Ibuprofen 600 mg orally every 6 hours as
needed
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
especially in patients with chronic kidney disease. In this patient
with stage 3 CKD, systemic NSAIDs can worsen renal function,
promote sodium and water retention, increase blood pressure,
and increase the risk of gastrointestinal bleeding. The nurse
should question this prescription and collaborate with the
provider regarding safer alternatives.
Option B: Acetaminophen is generally considered the preferred
first-line analgesic for mild to moderate osteoarthritis pain in
,patients with chronic kidney disease when used within
recommended daily limits. Liver function and total daily dose
should still be monitored.
Option C: Topical diclofenac produces much lower systemic
absorption than oral NSAIDs, making it a safer option for
localized osteoarthritis pain, although caution is still
appropriate.
Option D: Lidocaine patches provide localized analgesia with
minimal systemic effects and do not significantly affect renal
function.
The nurse should assess renal function, monitor serum
creatinine, review concurrent nephrotoxic medications, educate
the patient to avoid over-the-counter NSAIDs unless approved,
and emphasize adequate hydration when appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize contraindications for systemic NSAID therapy.
• Prioritize safer analgesic options for patients with chronic
kidney disease.
, • Educate patients about avoiding unnecessary over-the-
counter NSAID use.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 42-year-old man underwent laparoscopic cholecystectomy
earlier today. He reports incisional pain rated 9/10. The
provider prescribes morphine IV every 3 hours as needed.
Before administering the first dose, the nurse obtains the
following assessment findings:
• BP 118/70 mm Hg
• HR 76/min
• RR 10/min
• SpO₂ 92% on room air
• Patient is difficult to arouse and falls asleep during
conversation.
Question Stem
Which nursing action is the priority?
A. Administer the prescribed morphine dose.
