NCLEX-RN Pharmacology Made Easy Exam
Questions |
Introduction to Pharmacology |
20 Original NCLEX Practice Questions with
Detailed Rationales |
ATI & NGN Style Study Guide
Question 1
Clinical Scenario
A 72-year-old female with a history of chronic kidney disease
(CKD Stage 4) and chronic pain is being discharged from an
orthopedic unit after a total hip arthroplasty. During medication
reconciliation, the nurse notes that the provider has prescribed
a nonsteroidal anti-inflammatory drug (NSAID) for post-
operative pain management. The patient's baseline serum
creatinine is $2.4\text{ mg/dL}$ (normal range: $0.5 - 1.1\text{
mg/dL}$).
Question Stem
Which action should the nurse take first?
A. Teach the client to take the NSAID with food to prevent
gastrointestinal upset.
,B. Hold the medication and contact the healthcare provider to
discuss the prescription.
C. Administer the first dose of the NSAID as scheduled to ensure
adequate pain control.
D. Review the client's liver function panel before administering
the medication.
Correct Answer
Correct Answer: B. Hold the medication and contact the
healthcare provider to discuss the prescription.
Detailed Rationale
This question highlights clinical judgment, medication safety,
and the impact of renal impairment on pharmacokinetics.
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit
cyclooxygenase (COX) enzymes, which decreases prostaglandin
synthesis. Prostaglandins are responsible for maintaining renal
blood flow and perfusion by dilating the afferent arteriole,
especially in patients with pre-existing renal compromise.
In a client with Stage 4 chronic kidney disease (indicated by a
severely elevated serum creatinine of $2.4\text{ mg/dL}$), the
administration of an NSAID can precipitate acute kidney injury
(AKI) on chronic kidney disease by causing profound afferent
arteriolar vasoconstriction and decreased glomerular filtration
rate (GFR). Therefore, NSAIDs are contraindicated in patients
,with severe renal impairment. Holding the medication and
clarifying the prescription with the healthcare provider is the
priority nursing action to prevent a serious adverse event.
• Option A is incorrect because, while taking NSAIDs with
food is an appropriate general teaching point to minimize
gastric irritation, it does not address the acute
physiological danger of worsening renal failure in this
compromised patient.
• Option C is incorrect because administering the drug is
unsafe and violates the nurse’s duty to protect the patient
from predictable harm.
• Option D is incorrect because, although liver function is
important, the patient's acute risk is related to her known
severe renal impairment, and reviewing liver function does
not resolve the contraindication.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the contraindications of NSAIDs in patients with
renal impairment.
• Analyze the pathophysiological effect of prostaglandin
inhibition on renal blood flow.
• Prioritize patient safety by initiating appropriate
medication reconciliation interventions.
, Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A nurse is preparing to administer generic hydromorphone to a
client via intravenous (IV) push. The medication is supplied in a
prefilled syringe labeled "Hydromorphone 2 mg/mL." The
prescription is for "Hydromorphone 0.5 mg IV push every 4
hours as needed for severe pain."
Question Stem
Which action by the nurse is essential to ensure safe medication
administration?
A. Administer the entire contents of the prefilled syringe to
avoid wasting medication.
B. Confirm the prescription with a second licensed nurse prior
to preparing the syringe.
C. Expel the excess 1.5 mL of medication in the presence of
another licensed nurse prior to administration.
D. Store the unused portion of the syringe in the automated
dispensing cabinet for the patient's next dose.
Correct Answer
Questions |
Introduction to Pharmacology |
20 Original NCLEX Practice Questions with
Detailed Rationales |
ATI & NGN Style Study Guide
Question 1
Clinical Scenario
A 72-year-old female with a history of chronic kidney disease
(CKD Stage 4) and chronic pain is being discharged from an
orthopedic unit after a total hip arthroplasty. During medication
reconciliation, the nurse notes that the provider has prescribed
a nonsteroidal anti-inflammatory drug (NSAID) for post-
operative pain management. The patient's baseline serum
creatinine is $2.4\text{ mg/dL}$ (normal range: $0.5 - 1.1\text{
mg/dL}$).
Question Stem
Which action should the nurse take first?
A. Teach the client to take the NSAID with food to prevent
gastrointestinal upset.
,B. Hold the medication and contact the healthcare provider to
discuss the prescription.
C. Administer the first dose of the NSAID as scheduled to ensure
adequate pain control.
D. Review the client's liver function panel before administering
the medication.
Correct Answer
Correct Answer: B. Hold the medication and contact the
healthcare provider to discuss the prescription.
Detailed Rationale
This question highlights clinical judgment, medication safety,
and the impact of renal impairment on pharmacokinetics.
Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit
cyclooxygenase (COX) enzymes, which decreases prostaglandin
synthesis. Prostaglandins are responsible for maintaining renal
blood flow and perfusion by dilating the afferent arteriole,
especially in patients with pre-existing renal compromise.
In a client with Stage 4 chronic kidney disease (indicated by a
severely elevated serum creatinine of $2.4\text{ mg/dL}$), the
administration of an NSAID can precipitate acute kidney injury
(AKI) on chronic kidney disease by causing profound afferent
arteriolar vasoconstriction and decreased glomerular filtration
rate (GFR). Therefore, NSAIDs are contraindicated in patients
,with severe renal impairment. Holding the medication and
clarifying the prescription with the healthcare provider is the
priority nursing action to prevent a serious adverse event.
• Option A is incorrect because, while taking NSAIDs with
food is an appropriate general teaching point to minimize
gastric irritation, it does not address the acute
physiological danger of worsening renal failure in this
compromised patient.
• Option C is incorrect because administering the drug is
unsafe and violates the nurse’s duty to protect the patient
from predictable harm.
• Option D is incorrect because, although liver function is
important, the patient's acute risk is related to her known
severe renal impairment, and reviewing liver function does
not resolve the contraindication.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the contraindications of NSAIDs in patients with
renal impairment.
• Analyze the pathophysiological effect of prostaglandin
inhibition on renal blood flow.
• Prioritize patient safety by initiating appropriate
medication reconciliation interventions.
, Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A nurse is preparing to administer generic hydromorphone to a
client via intravenous (IV) push. The medication is supplied in a
prefilled syringe labeled "Hydromorphone 2 mg/mL." The
prescription is for "Hydromorphone 0.5 mg IV push every 4
hours as needed for severe pain."
Question Stem
Which action by the nurse is essential to ensure safe medication
administration?
A. Administer the entire contents of the prefilled syringe to
avoid wasting medication.
B. Confirm the prescription with a second licensed nurse prior
to preparing the syringe.
C. Expel the excess 1.5 mL of medication in the presence of
another licensed nurse prior to administration.
D. Store the unused portion of the syringe in the automated
dispensing cabinet for the patient's next dose.
Correct Answer
