NCLEX-RN Pharmacology Pain &
Inflammation Exam |
20 NCLEX-Style Questions with
Rationales |
NSAIDs, Opioids, Corticosteroids,
Acetaminophen |
ATI & NGN Review Guide
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports worsening
bilateral knee pain that limits her ability to walk. Her medical
history includes hypertension, stage 3 chronic kidney disease
(eGFR 42 mL/min/1.73 m²), and gastroesophageal reflux
disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. The provider prescribes
ibuprofen 600 mg orally every 8 hours as needed for pain.
Before administering the first dose, the nurse reviews the
,client's laboratory results: serum creatinine 1.8 mg/dL,
potassium 5.2 mEq/L, blood pressure 138/82 mm Hg, and urine
output 35 mL/hr.
Question Stem
Which nursing action is the priority?
A. Administer the ibuprofen as prescribed and reassess pain in 1
hour.
B. Withhold the ibuprofen and notify the provider about the
client's renal function.
C. Encourage the client to increase dietary potassium while
taking ibuprofen.
D. Administer ibuprofen with milk to prevent gastric irritation.
Correct Answer
B. Withhold the ibuprofen and notify the provider about the
client's renal function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While this reduces pain and
inflammation, prostaglandins also help maintain renal blood
flow, particularly in patients with chronic kidney disease or
reduced renal perfusion. In this client, elevated serum
,creatinine, reduced eGFR, and concurrent ACE inhibitor therapy
increase the risk for NSAID-induced acute kidney injury and
worsening hyperkalemia. The safest nursing action is to
withhold the medication and contact the provider before
administration.
Option A is incorrect because administering ibuprofen without
evaluating the renal risk may worsen kidney function. Option C
is incorrect because the client's potassium is already elevated;
increasing potassium intake could further increase the risk of
cardiac dysrhythmias. Option D is partially appropriate for
reducing gastrointestinal irritation but does not address the
immediate safety concern of renal impairment. Although
NSAIDs should generally be taken with food or milk, preventing
kidney injury takes priority over minimizing gastrointestinal
discomfort.
Nurses should evaluate renal function, urine output, electrolyte
levels, and concurrent nephrotoxic medications before
administering NSAIDs to older adults or patients with chronic
kidney disease.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize contraindications to NSAID therapy in renal
impairment.
, • Prioritize nursing interventions when nephrotoxicity is a
concern.
• Identify laboratory values requiring provider notification
before medication administration.
Medication Safety Focus
Monitoring—Assess renal function before administering
NSAIDs in clients with impaired kidney function.
Question 2
Clinical Scenario
A 55-year-old man is admitted with acute gout affecting the first
metatarsophalangeal joint. The provider prescribes colchicine.
Before administering the medication, the nurse reviews the
client's history, which includes chronic kidney disease and
atorvastatin therapy.
Question Stem
Which assessment finding requires the nurse to notify the
provider before administering colchicine?
A. Mild redness and swelling of the affected toe
B. Serum creatinine of 2.1 mg/dL
C. Pain rating of 8 on a 0–10 scale
Inflammation Exam |
20 NCLEX-Style Questions with
Rationales |
NSAIDs, Opioids, Corticosteroids,
Acetaminophen |
ATI & NGN Review Guide
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports worsening
bilateral knee pain that limits her ability to walk. Her medical
history includes hypertension, stage 3 chronic kidney disease
(eGFR 42 mL/min/1.73 m²), and gastroesophageal reflux
disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. The provider prescribes
ibuprofen 600 mg orally every 8 hours as needed for pain.
Before administering the first dose, the nurse reviews the
,client's laboratory results: serum creatinine 1.8 mg/dL,
potassium 5.2 mEq/L, blood pressure 138/82 mm Hg, and urine
output 35 mL/hr.
Question Stem
Which nursing action is the priority?
A. Administer the ibuprofen as prescribed and reassess pain in 1
hour.
B. Withhold the ibuprofen and notify the provider about the
client's renal function.
C. Encourage the client to increase dietary potassium while
taking ibuprofen.
D. Administer ibuprofen with milk to prevent gastric irritation.
Correct Answer
B. Withhold the ibuprofen and notify the provider about the
client's renal function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While this reduces pain and
inflammation, prostaglandins also help maintain renal blood
flow, particularly in patients with chronic kidney disease or
reduced renal perfusion. In this client, elevated serum
,creatinine, reduced eGFR, and concurrent ACE inhibitor therapy
increase the risk for NSAID-induced acute kidney injury and
worsening hyperkalemia. The safest nursing action is to
withhold the medication and contact the provider before
administration.
Option A is incorrect because administering ibuprofen without
evaluating the renal risk may worsen kidney function. Option C
is incorrect because the client's potassium is already elevated;
increasing potassium intake could further increase the risk of
cardiac dysrhythmias. Option D is partially appropriate for
reducing gastrointestinal irritation but does not address the
immediate safety concern of renal impairment. Although
NSAIDs should generally be taken with food or milk, preventing
kidney injury takes priority over minimizing gastrointestinal
discomfort.
Nurses should evaluate renal function, urine output, electrolyte
levels, and concurrent nephrotoxic medications before
administering NSAIDs to older adults or patients with chronic
kidney disease.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize contraindications to NSAID therapy in renal
impairment.
, • Prioritize nursing interventions when nephrotoxicity is a
concern.
• Identify laboratory values requiring provider notification
before medication administration.
Medication Safety Focus
Monitoring—Assess renal function before administering
NSAIDs in clients with impaired kidney function.
Question 2
Clinical Scenario
A 55-year-old man is admitted with acute gout affecting the first
metatarsophalangeal joint. The provider prescribes colchicine.
Before administering the medication, the nurse reviews the
client's history, which includes chronic kidney disease and
atorvastatin therapy.
Question Stem
Which assessment finding requires the nurse to notify the
provider before administering colchicine?
A. Mild redness and swelling of the affected toe
B. Serum creatinine of 2.1 mg/dL
C. Pain rating of 8 on a 0–10 scale
