NCLEX-RN Pharmacology Practice
Questions:
Pain & Inflammation |
20 ATI & NGN-Style MCQs with
Detailed Rationales |
NSAIDs, Opioids, Corticosteroids,
DMARDs, Gout Medications &
Medication Safety
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports chronic
bilateral knee pain rated 7/10. Her medical history includes
hypertension, chronic kidney disease (CKD stage 3), and
gastroesophageal reflux disease (GERD). Current medications
include lisinopril, hydrochlorothiazide, and omeprazole. The
provider prescribes ibuprofen 600 mg orally every 8 hours as
needed for pain. Baseline laboratory results reveal serum
,creatinine 1.8 mg/dL (159 µmol/L), BUN 34 mg/dL (12.1
mmol/L), and potassium 4.7 mEq/L. The nurse reviews the
prescription before administration.
Question Stem
Which action should the nurse take first?
A. Administer the first dose because the medication is
prescribed as needed.
B. Contact the provider to discuss the client's renal function
before administering the medication.
C. Encourage the client to increase oral fluid intake while taking
ibuprofen.
D. Administer the medication with food to reduce
gastrointestinal irritation.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
renal function before administering the medication.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While this decreases pain and
inflammation, prostaglandins are essential for maintaining renal
blood flow, particularly in older adults and those with chronic
,kidney disease. This client already has impaired renal function
and is taking an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide). The combination of an NSAID, ACE
inhibitor, and diuretic significantly increases the risk of acute
kidney injury by reducing renal perfusion and glomerular
filtration. Therefore, the priority nursing action is to verify the
safety of the prescription before administering the medication.
Option A is unsafe because the nurse must evaluate
contraindications before medication administration. Option C
may help prevent dehydration but does not eliminate the
increased nephrotoxic risk. Option D is appropriate patient
teaching because taking NSAIDs with food can reduce
gastrointestinal irritation; however, it does not address the
immediate safety concern regarding renal function. Nurses
should assess renal laboratory values, review concurrent
medications, monitor urine output, and report worsening renal
function promptly. Medication reconciliation and individualized
assessment are essential before administering NSAIDs to
vulnerable populations.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize drug combinations that increase nephrotoxicity.
, • Prioritize nursing assessment before administering NSAIDs.
• Apply clinical judgment when evaluating medication safety.
Medication Safety Focus
Contraindication and Renal Function Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed naproxen for treatment of
acute ankle sprain pain following a recreational sports injury.
During discharge teaching, she asks how to take the medication
safely at home. She has no chronic illnesses and reports no
medication allergies.
Question Stem
Which statement by the client indicates correct understanding
of the teaching?
A. "I'll stop taking the medication if I notice black or tarry
stools."
B. "I'll take this medication on an empty stomach so it works
faster."
C. "I can safely take another NSAID if my pain becomes worse."
Questions:
Pain & Inflammation |
20 ATI & NGN-Style MCQs with
Detailed Rationales |
NSAIDs, Opioids, Corticosteroids,
DMARDs, Gout Medications &
Medication Safety
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports chronic
bilateral knee pain rated 7/10. Her medical history includes
hypertension, chronic kidney disease (CKD stage 3), and
gastroesophageal reflux disease (GERD). Current medications
include lisinopril, hydrochlorothiazide, and omeprazole. The
provider prescribes ibuprofen 600 mg orally every 8 hours as
needed for pain. Baseline laboratory results reveal serum
,creatinine 1.8 mg/dL (159 µmol/L), BUN 34 mg/dL (12.1
mmol/L), and potassium 4.7 mEq/L. The nurse reviews the
prescription before administration.
Question Stem
Which action should the nurse take first?
A. Administer the first dose because the medication is
prescribed as needed.
B. Contact the provider to discuss the client's renal function
before administering the medication.
C. Encourage the client to increase oral fluid intake while taking
ibuprofen.
D. Administer the medication with food to reduce
gastrointestinal irritation.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
renal function before administering the medication.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. While this decreases pain and
inflammation, prostaglandins are essential for maintaining renal
blood flow, particularly in older adults and those with chronic
,kidney disease. This client already has impaired renal function
and is taking an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide). The combination of an NSAID, ACE
inhibitor, and diuretic significantly increases the risk of acute
kidney injury by reducing renal perfusion and glomerular
filtration. Therefore, the priority nursing action is to verify the
safety of the prescription before administering the medication.
Option A is unsafe because the nurse must evaluate
contraindications before medication administration. Option C
may help prevent dehydration but does not eliminate the
increased nephrotoxic risk. Option D is appropriate patient
teaching because taking NSAIDs with food can reduce
gastrointestinal irritation; however, it does not address the
immediate safety concern regarding renal function. Nurses
should assess renal laboratory values, review concurrent
medications, monitor urine output, and report worsening renal
function promptly. Medication reconciliation and individualized
assessment are essential before administering NSAIDs to
vulnerable populations.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize drug combinations that increase nephrotoxicity.
, • Prioritize nursing assessment before administering NSAIDs.
• Apply clinical judgment when evaluating medication safety.
Medication Safety Focus
Contraindication and Renal Function Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed naproxen for treatment of
acute ankle sprain pain following a recreational sports injury.
During discharge teaching, she asks how to take the medication
safely at home. She has no chronic illnesses and reports no
medication allergies.
Question Stem
Which statement by the client indicates correct understanding
of the teaching?
A. "I'll stop taking the medication if I notice black or tarry
stools."
B. "I'll take this medication on an empty stomach so it works
faster."
C. "I can safely take another NSAID if my pain becomes worse."
