NCLEX-RN Pharmacology Practice
Questions
Pain & Inflammation | 20 Original
NCLEX-Style MCQs with Detailed
Rationales
ATI & NGN Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of both knees reports
worsening joint pain over the past several months. She rates
her pain as 7/10 despite taking acetaminophen as directed. The
provider prescribes ibuprofen 400 mg orally three times daily.
Her medical history includes hypertension, stage 3 chronic
kidney disease, and gastroesophageal reflux disease (GERD).
Current medications include lisinopril, hydrochlorothiazide, and
,omeprazole. Baseline laboratory results reveal a serum
creatinine of 1.8 mg/dL and an estimated glomerular filtration
rate (eGFR) of 42 mL/min/1.73 m².
Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
A. Assess the client's bowel elimination pattern.
B. Review the client's renal function and notify the provider if
kidney impairment is significant.
C. Encourage the client to increase dietary potassium intake.
D. Administer the medication with orange juice.
Correct Answer
B. Review the client's renal function and notify the provider if
kidney impairment is significant.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While this mechanism decreases pain
and inflammation, prostaglandins also help maintain renal
blood flow, particularly in older adults and individuals with
impaired kidney function. This client already has stage 3 chronic
kidney disease and is taking an ACE inhibitor (lisinopril) and a
,diuretic (hydrochlorothiazide). This combination significantly
increases the risk of acute kidney injury when an NSAID is
added. Therefore, evaluating renal function and collaborating
with the provider before initiating therapy is the priority nursing
action.
Option A is incorrect because bowel assessment is not the
primary concern before NSAID administration.
Option C is incorrect because NSAIDs do not require increased
potassium intake. In fact, NSAIDs combined with ACE inhibitors
may contribute to hyperkalemia.
Option D is incorrect because ibuprofen should be administered
with food or milk—not acidic beverages—to reduce
gastrointestinal irritation.
Nurses should monitor serum creatinine, urine output, blood
pressure, and signs of gastrointestinal bleeding throughout
therapy. Older adults are particularly vulnerable to NSAID-
induced renal impairment and gastrointestinal complications.
Learning Objectives
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced kidney
injury.
• Prioritize nursing assessment before initiating NSAID
therapy.
, • Recognize important drug interactions involving NSAIDs.
• Monitor renal function during anti-inflammatory
treatment.
Medication Safety Focus
Monitoring Parameters (Renal Function)
Question 2
Clinical Scenario
A 45-year-old man is admitted with severe postoperative pain
following abdominal surgery. The provider prescribes morphine
sulfate 2 mg IV every 2 hours as needed. Before administering
the medication, the nurse assesses the client and obtains the
following findings:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 92% on room air
• Blood pressure: 118/74 mm Hg
• Heart rate: 72/min
• Pain rating: 8/10
Question Stem
What is the nurse's priority action?
Questions
Pain & Inflammation | 20 Original
NCLEX-Style MCQs with Detailed
Rationales
ATI & NGN Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of both knees reports
worsening joint pain over the past several months. She rates
her pain as 7/10 despite taking acetaminophen as directed. The
provider prescribes ibuprofen 400 mg orally three times daily.
Her medical history includes hypertension, stage 3 chronic
kidney disease, and gastroesophageal reflux disease (GERD).
Current medications include lisinopril, hydrochlorothiazide, and
,omeprazole. Baseline laboratory results reveal a serum
creatinine of 1.8 mg/dL and an estimated glomerular filtration
rate (eGFR) of 42 mL/min/1.73 m².
Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
A. Assess the client's bowel elimination pattern.
B. Review the client's renal function and notify the provider if
kidney impairment is significant.
C. Encourage the client to increase dietary potassium intake.
D. Administer the medication with orange juice.
Correct Answer
B. Review the client's renal function and notify the provider if
kidney impairment is significant.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While this mechanism decreases pain
and inflammation, prostaglandins also help maintain renal
blood flow, particularly in older adults and individuals with
impaired kidney function. This client already has stage 3 chronic
kidney disease and is taking an ACE inhibitor (lisinopril) and a
,diuretic (hydrochlorothiazide). This combination significantly
increases the risk of acute kidney injury when an NSAID is
added. Therefore, evaluating renal function and collaborating
with the provider before initiating therapy is the priority nursing
action.
Option A is incorrect because bowel assessment is not the
primary concern before NSAID administration.
Option C is incorrect because NSAIDs do not require increased
potassium intake. In fact, NSAIDs combined with ACE inhibitors
may contribute to hyperkalemia.
Option D is incorrect because ibuprofen should be administered
with food or milk—not acidic beverages—to reduce
gastrointestinal irritation.
Nurses should monitor serum creatinine, urine output, blood
pressure, and signs of gastrointestinal bleeding throughout
therapy. Older adults are particularly vulnerable to NSAID-
induced renal impairment and gastrointestinal complications.
Learning Objectives
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced kidney
injury.
• Prioritize nursing assessment before initiating NSAID
therapy.
, • Recognize important drug interactions involving NSAIDs.
• Monitor renal function during anti-inflammatory
treatment.
Medication Safety Focus
Monitoring Parameters (Renal Function)
Question 2
Clinical Scenario
A 45-year-old man is admitted with severe postoperative pain
following abdominal surgery. The provider prescribes morphine
sulfate 2 mg IV every 2 hours as needed. Before administering
the medication, the nurse assesses the client and obtains the
following findings:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 92% on room air
• Blood pressure: 118/74 mm Hg
• Heart rate: 72/min
• Pain rating: 8/10
Question Stem
What is the nurse's priority action?
