NCLEX-RN Pharmacology Pain &
Inflammation Exam Questions with
Rationales
Opioids, NSAIDs, Corticosteroids,
Acetaminophen
ATI & NGN Style Review
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports chronic knee pain
rated 7/10. His medical history includes hypertension, chronic
kidney disease stage 3, and heart failure. Current medications
include lisinopril, furosemide, and low-dose aspirin. The
provider prescribes ibuprofen 600 mg orally every 6 hours as
needed for pain.
Question Stem
Which action should the nurse take before administering the
first dose?
,A. Administer the medication as prescribed because it is
commonly used for osteoarthritis.
B. Assess the client's renal function and notify the provider
about the history of kidney disease.
C. Instruct the client to take the medication on an empty
stomach.
D. Hold the medication until the client's blood pressure is below
140/90 mm Hg.
Correct Answer
Correct Answer: B. Assess the client's renal function and notify
the provider about the history of kidney disease.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen can reduce renal blood flow by inhibiting
prostaglandin synthesis. In clients with chronic kidney disease,
heart failure, or those taking diuretics and ACE inhibitors,
NSAIDs can significantly worsen renal function and increase the
risk of acute kidney injury. Therefore, the nurse should assess
renal function and communicate concerns to the provider
before administration.
Option A is incorrect because the medication's appropriateness
must be evaluated in the context of the client's comorbidities.
Option C is incorrect because NSAIDs should generally be taken
,with food or milk to minimize gastrointestinal irritation. Option
D is incorrect because blood pressure alone is not the primary
concern; renal impairment and fluid retention represent greater
risks in this situation.
The nurse should review serum creatinine, BUN, and estimated
glomerular filtration rate (eGFR). Ongoing monitoring should
include blood pressure, edema, urine output, and signs of
gastrointestinal bleeding. Patient education should emphasize
avoiding additional over-the-counter NSAIDs unless approved
by the healthcare provider.
Learning Objective
After completing this question, the learner should be able to:
• Identify renal risks associated with NSAID therapy.
• Recognize high-risk patients who require additional
assessment before NSAID administration.
• Evaluate medication safety in clients with multiple
comorbidities.
Medication Safety Focus
Contraindication and Monitoring
Question 2
Clinical Scenario
, A 26-year-old woman is prescribed celecoxib for management
of rheumatoid arthritis. During a teaching session, she states
she has a severe allergy to sulfonamide antibiotics.
Question Stem
Which nursing action is most appropriate?
A. Administer the medication and observe for mild
gastrointestinal upset.
B. Administer the medication with food to prevent allergic
reactions.
C. Notify the provider before administration because celecoxib
may be contraindicated.
D. Reduce the dose by half and monitor for rash.
Correct Answer
Correct Answer: C. Notify the provider before administration
because celecoxib may be contraindicated.
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor that contains a
sulfonamide structure. Clients with a history of severe
sulfonamide allergy may be at increased risk for hypersensitivity
reactions. The nurse should verify the allergy history and
consult the provider before administering the medication.
Inflammation Exam Questions with
Rationales
Opioids, NSAIDs, Corticosteroids,
Acetaminophen
ATI & NGN Style Review
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports chronic knee pain
rated 7/10. His medical history includes hypertension, chronic
kidney disease stage 3, and heart failure. Current medications
include lisinopril, furosemide, and low-dose aspirin. The
provider prescribes ibuprofen 600 mg orally every 6 hours as
needed for pain.
Question Stem
Which action should the nurse take before administering the
first dose?
,A. Administer the medication as prescribed because it is
commonly used for osteoarthritis.
B. Assess the client's renal function and notify the provider
about the history of kidney disease.
C. Instruct the client to take the medication on an empty
stomach.
D. Hold the medication until the client's blood pressure is below
140/90 mm Hg.
Correct Answer
Correct Answer: B. Assess the client's renal function and notify
the provider about the history of kidney disease.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen can reduce renal blood flow by inhibiting
prostaglandin synthesis. In clients with chronic kidney disease,
heart failure, or those taking diuretics and ACE inhibitors,
NSAIDs can significantly worsen renal function and increase the
risk of acute kidney injury. Therefore, the nurse should assess
renal function and communicate concerns to the provider
before administration.
Option A is incorrect because the medication's appropriateness
must be evaluated in the context of the client's comorbidities.
Option C is incorrect because NSAIDs should generally be taken
,with food or milk to minimize gastrointestinal irritation. Option
D is incorrect because blood pressure alone is not the primary
concern; renal impairment and fluid retention represent greater
risks in this situation.
The nurse should review serum creatinine, BUN, and estimated
glomerular filtration rate (eGFR). Ongoing monitoring should
include blood pressure, edema, urine output, and signs of
gastrointestinal bleeding. Patient education should emphasize
avoiding additional over-the-counter NSAIDs unless approved
by the healthcare provider.
Learning Objective
After completing this question, the learner should be able to:
• Identify renal risks associated with NSAID therapy.
• Recognize high-risk patients who require additional
assessment before NSAID administration.
• Evaluate medication safety in clients with multiple
comorbidities.
Medication Safety Focus
Contraindication and Monitoring
Question 2
Clinical Scenario
, A 26-year-old woman is prescribed celecoxib for management
of rheumatoid arthritis. During a teaching session, she states
she has a severe allergy to sulfonamide antibiotics.
Question Stem
Which nursing action is most appropriate?
A. Administer the medication and observe for mild
gastrointestinal upset.
B. Administer the medication with food to prevent allergic
reactions.
C. Notify the provider before administration because celecoxib
may be contraindicated.
D. Reduce the dose by half and monitor for rash.
Correct Answer
Correct Answer: C. Notify the provider before administration
because celecoxib may be contraindicated.
Detailed Rationale
Celecoxib is a selective COX-2 inhibitor that contains a
sulfonamide structure. Clients with a history of severe
sulfonamide allergy may be at increased risk for hypersensitivity
reactions. The nurse should verify the allergy history and
consult the provider before administering the medication.
