NCLEX-RN Pharmacology Practice Exam
Pain and Inflammation
(20 Questions with Detailed Rationales,
Medication Safety, Clinical Judgment &
ATI/NGN-Style Review)
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain despite nonpharmacologic interventions.
Her history includes hypertension, stage 3 chronic kidney
disease, and gastroesophageal reflux disease (GERD). Current
medications include lisinopril and omeprazole. The provider
prescribes ibuprofen 600 mg orally three times daily.
Question Stem
Which nursing action is the priority before administering the
first dose?
,A. Assess the client's renal function and serum creatinine.
B. Encourage the client to take the medication with orange
juice.
C. Teach the client to limit daily calcium intake.
D. Administer the medication on an empty stomach.
Correct Answer
A. Assess the client's renal function and serum creatinine.
Detailed Rationale
NSAIDs inhibit prostaglandin synthesis, reducing renal blood
flow and increasing the risk of acute kidney injury, particularly
in older adults and clients with chronic kidney disease.
Assessing renal function before initiating therapy promotes safe
medication administration. Option B is incorrect because
NSAIDs should be taken with food or milk to reduce
gastrointestinal irritation. Option C has no therapeutic
relevance. Option D increases the risk of gastric irritation and
ulcer formation. The nurse should also monitor blood pressure
and signs of gastrointestinal bleeding during therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced kidney
injury.
• Prioritize assessments before administering NSAIDs.
, • Recognize appropriate monitoring during NSAID therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 30-year-old woman is admitted with severe postoperative
pain following abdominal surgery. She receives morphine
intravenously every 4 hours as needed. Thirty minutes after
administration, the nurse notes that the client is difficult to
arouse. Respiratory rate is 8 breaths/min, oxygen saturation is
88% on room air, and pupils are pinpoint.
Question Stem
Which action should the nurse take first?
A. Encourage deep-breathing exercises.
B. Administer naloxone as prescribed.
C. Document the expected opioid effects.
D. Administer the next scheduled pain medication.
Correct Answer
B. Administer naloxone as prescribed.
Detailed Rationale
, The client demonstrates opioid-induced respiratory depression,
a life-threatening complication requiring immediate
intervention. Naloxone rapidly reverses opioid effects by
competitively blocking opioid receptors. Airway support and
close monitoring should accompany administration because
naloxone's duration of action may be shorter than morphine's,
requiring repeat doses. Option A is inappropriate because the
client cannot adequately participate. Option C delays
treatment. Option D would worsen respiratory depression.
Continuous reassessment of respiratory status and pain is
essential after reversal.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize opioid overdose manifestations.
• Prioritize emergency interventions for respiratory
depression.
• Monitor clients after naloxone administration.
Medication Safety Focus
Adverse Effect
Question 3
Clinical Scenario
Pain and Inflammation
(20 Questions with Detailed Rationales,
Medication Safety, Clinical Judgment &
ATI/NGN-Style Review)
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain despite nonpharmacologic interventions.
Her history includes hypertension, stage 3 chronic kidney
disease, and gastroesophageal reflux disease (GERD). Current
medications include lisinopril and omeprazole. The provider
prescribes ibuprofen 600 mg orally three times daily.
Question Stem
Which nursing action is the priority before administering the
first dose?
,A. Assess the client's renal function and serum creatinine.
B. Encourage the client to take the medication with orange
juice.
C. Teach the client to limit daily calcium intake.
D. Administer the medication on an empty stomach.
Correct Answer
A. Assess the client's renal function and serum creatinine.
Detailed Rationale
NSAIDs inhibit prostaglandin synthesis, reducing renal blood
flow and increasing the risk of acute kidney injury, particularly
in older adults and clients with chronic kidney disease.
Assessing renal function before initiating therapy promotes safe
medication administration. Option B is incorrect because
NSAIDs should be taken with food or milk to reduce
gastrointestinal irritation. Option C has no therapeutic
relevance. Option D increases the risk of gastric irritation and
ulcer formation. The nurse should also monitor blood pressure
and signs of gastrointestinal bleeding during therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify clients at increased risk for NSAID-induced kidney
injury.
• Prioritize assessments before administering NSAIDs.
, • Recognize appropriate monitoring during NSAID therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 30-year-old woman is admitted with severe postoperative
pain following abdominal surgery. She receives morphine
intravenously every 4 hours as needed. Thirty minutes after
administration, the nurse notes that the client is difficult to
arouse. Respiratory rate is 8 breaths/min, oxygen saturation is
88% on room air, and pupils are pinpoint.
Question Stem
Which action should the nurse take first?
A. Encourage deep-breathing exercises.
B. Administer naloxone as prescribed.
C. Document the expected opioid effects.
D. Administer the next scheduled pain medication.
Correct Answer
B. Administer naloxone as prescribed.
Detailed Rationale
, The client demonstrates opioid-induced respiratory depression,
a life-threatening complication requiring immediate
intervention. Naloxone rapidly reverses opioid effects by
competitively blocking opioid receptors. Airway support and
close monitoring should accompany administration because
naloxone's duration of action may be shorter than morphine's,
requiring repeat doses. Option A is inappropriate because the
client cannot adequately participate. Option C delays
treatment. Option D would worsen respiratory depression.
Continuous reassessment of respiratory status and pain is
essential after reversal.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize opioid overdose manifestations.
• Prioritize emergency interventions for respiratory
depression.
• Monitor clients after naloxone administration.
Medication Safety Focus
Adverse Effect
Question 3
Clinical Scenario
