NCLEX-RN Pharmacology Pain
& Inflammation Exam |
20 NGN Practice Questions
with Rationales |
ATI-Style Nursing Test Bank
PDF
Question 1
Clinical Scenario
A 72-year-old woman with osteoarthritis is admitted for
worsening knee pain. Her medical history includes chronic
kidney disease (stage 3), hypertension, and heart failure.
Current medications include lisinopril, furosemide, and aspirin
81 mg daily. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Assessment findings include
BP 148/84 mm Hg, HR 76/min, RR 18/min, temperature 36.8°C
,(98.2°F), and mild bilateral ankle edema. Serum creatinine is 1.8
mg/dL (baseline 1.6 mg/dL).
Question Stem
Which action should the nurse take first?
A. Administer the ibuprofen as prescribed because the dose is
therapeutic.
B. Contact the provider to discuss an alternative analgesic
before administering the medication.
C. Administer the medication with food to reduce
gastrointestinal irritation.
D. Encourage increased oral fluid intake before giving the
medication.
Correct Answer
Correct Answer: B. Contact the provider to discuss an
alternative analgesic before administering the medication.
Detailed Rationale
This patient has multiple risk factors that increase the likelihood
of NSAID-related complications. Ibuprofen inhibits
cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although this decreases pain and inflammation,
prostaglandins also maintain renal blood flow, particularly in
patients with chronic kidney disease, heart failure, or those
,taking ACE inhibitors and diuretics. The combination of an
NSAID, an ACE inhibitor (lisinopril), and a diuretic (furosemide)
is commonly associated with increased risk for acute kidney
injury. NSAIDs may also promote sodium and water retention,
worsening edema and heart failure.
Option A is incorrect because therapeutic dosing does not
eliminate significant contraindications or patient-specific risks.
Option C is incorrect because administering NSAIDs with food
reduces gastric irritation but does not prevent renal injury or
worsening heart failure.
Option D is incorrect because encouraging fluids does not
adequately protect against NSAID-induced decreases in renal
perfusion and may be inappropriate in patients with heart
failure.
The nurse's priority is to identify the medication safety concern
before administration and collaborate with the provider
regarding a safer alternative, such as acetaminophen if clinically
appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
, • Recognize medication combinations that increase renal
toxicity.
• Prioritize interventions before administering NSAIDs to
high-risk patients.
Medication Safety Focus
Contraindication and renal monitoring
Question 2
Clinical Scenario
A 45-year-old man underwent abdominal surgery yesterday. He
rates his incisional pain as 8/10 and is prescribed morphine 4
mg IV every 3 hours as needed. Before administration, the
nurse assesses the patient and obtains the following findings:
• BP: 118/72 mm Hg
• HR: 64/min
• RR: 8/min
• Oxygen saturation: 90% on room air
• Patient is difficult to arouse and falls asleep during
conversation.
Question Stem
Which action should the nurse take first?
& Inflammation Exam |
20 NGN Practice Questions
with Rationales |
ATI-Style Nursing Test Bank
Question 1
Clinical Scenario
A 72-year-old woman with osteoarthritis is admitted for
worsening knee pain. Her medical history includes chronic
kidney disease (stage 3), hypertension, and heart failure.
Current medications include lisinopril, furosemide, and aspirin
81 mg daily. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Assessment findings include
BP 148/84 mm Hg, HR 76/min, RR 18/min, temperature 36.8°C
,(98.2°F), and mild bilateral ankle edema. Serum creatinine is 1.8
mg/dL (baseline 1.6 mg/dL).
Question Stem
Which action should the nurse take first?
A. Administer the ibuprofen as prescribed because the dose is
therapeutic.
B. Contact the provider to discuss an alternative analgesic
before administering the medication.
C. Administer the medication with food to reduce
gastrointestinal irritation.
D. Encourage increased oral fluid intake before giving the
medication.
Correct Answer
Correct Answer: B. Contact the provider to discuss an
alternative analgesic before administering the medication.
Detailed Rationale
This patient has multiple risk factors that increase the likelihood
of NSAID-related complications. Ibuprofen inhibits
cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although this decreases pain and inflammation,
prostaglandins also maintain renal blood flow, particularly in
patients with chronic kidney disease, heart failure, or those
,taking ACE inhibitors and diuretics. The combination of an
NSAID, an ACE inhibitor (lisinopril), and a diuretic (furosemide)
is commonly associated with increased risk for acute kidney
injury. NSAIDs may also promote sodium and water retention,
worsening edema and heart failure.
Option A is incorrect because therapeutic dosing does not
eliminate significant contraindications or patient-specific risks.
Option C is incorrect because administering NSAIDs with food
reduces gastric irritation but does not prevent renal injury or
worsening heart failure.
Option D is incorrect because encouraging fluids does not
adequately protect against NSAID-induced decreases in renal
perfusion and may be inappropriate in patients with heart
failure.
The nurse's priority is to identify the medication safety concern
before administration and collaborate with the provider
regarding a safer alternative, such as acetaminophen if clinically
appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
, • Recognize medication combinations that increase renal
toxicity.
• Prioritize interventions before administering NSAIDs to
high-risk patients.
Medication Safety Focus
Contraindication and renal monitoring
Question 2
Clinical Scenario
A 45-year-old man underwent abdominal surgery yesterday. He
rates his incisional pain as 8/10 and is prescribed morphine 4
mg IV every 3 hours as needed. Before administration, the
nurse assesses the patient and obtains the following findings:
• BP: 118/72 mm Hg
• HR: 64/min
• RR: 8/min
• Oxygen saturation: 90% on room air
• Patient is difficult to arouse and falls asleep during
conversation.
Question Stem
Which action should the nurse take first?
