NCLEX-RN Pharmacology Practice Exam:
Pain and Inflammation |
Next Gen NCLEX (NGN) Questions with
Detailed Rationales
NSAIDs, Opioids, Corticosteroids,
Acetaminophen, DMARDs & Gout
Medications
| ATI Pharmacology Made Easy Study
Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with osteoarthritis of both knees.
His medical history includes hypertension, chronic kidney
disease (stage 3), and gastroesophageal reflux disease. Home
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
,every 8 hours as needed for pain. Baseline laboratory results
include serum creatinine 2.0 mg/dL and BUN 34 mg/dL. The
client reports knee pain rated 8/10.
Question Stem
Which action should the nurse take before administering the
first dose of ibuprofen?
Options
A. Administer the medication with food as prescribed.
B. Contact the provider to discuss the client's impaired renal
function.
C. Encourage increased fluid intake before giving the
medication.
D. Administer the medication and reassess pain in 30 minutes.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
impaired renal function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
,synthesis responsible for pain and inflammation. However,
prostaglandins also help maintain renal blood flow, especially in
patients with compromised kidney function. In clients with
chronic kidney disease, NSAIDs can significantly decrease renal
perfusion, worsening kidney injury and increasing serum
creatinine.
Because this client already has stage 3 chronic kidney disease
with elevated BUN and creatinine, administering ibuprofen
could further impair renal function. The nurse should clarify the
prescription with the provider before administration and
advocate for a safer analgesic alternative.
Option A is incorrect because taking NSAIDs with food reduces
gastrointestinal irritation but does not address the client's renal
risk.
Option C is incorrect because hydration alone does not
eliminate NSAID-induced nephrotoxicity.
Option D is unsafe because the medication should not be
administered until its appropriateness is verified.
The nurse should assess renal function before administering
nephrotoxic medications, review concurrent medications that
may increase kidney injury (such as ACE inhibitors and
diuretics), and monitor urine output and laboratory values
during therapy.
, Learning Objective
After completing this question, the learner should be able to:
• Identify contraindications to NSAID therapy.
• Recognize patients at increased risk for NSAID-induced
kidney injury.
• Prioritize safe medication administration based on
laboratory findings.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 24-year-old woman is discharged after arthroscopic knee
surgery. She receives a prescription for oxycodone 5 mg orally
every 6 hours as needed for severe pain. During discharge
teaching, the nurse reviews medication safety.
Question Stem
Which statement by the client indicates correct understanding
of oxycodone therapy?
Options
Pain and Inflammation |
Next Gen NCLEX (NGN) Questions with
Detailed Rationales
NSAIDs, Opioids, Corticosteroids,
Acetaminophen, DMARDs & Gout
Medications
| ATI Pharmacology Made Easy Study
Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with osteoarthritis of both knees.
His medical history includes hypertension, chronic kidney
disease (stage 3), and gastroesophageal reflux disease. Home
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
,every 8 hours as needed for pain. Baseline laboratory results
include serum creatinine 2.0 mg/dL and BUN 34 mg/dL. The
client reports knee pain rated 8/10.
Question Stem
Which action should the nurse take before administering the
first dose of ibuprofen?
Options
A. Administer the medication with food as prescribed.
B. Contact the provider to discuss the client's impaired renal
function.
C. Encourage increased fluid intake before giving the
medication.
D. Administer the medication and reassess pain in 30 minutes.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
impaired renal function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
,synthesis responsible for pain and inflammation. However,
prostaglandins also help maintain renal blood flow, especially in
patients with compromised kidney function. In clients with
chronic kidney disease, NSAIDs can significantly decrease renal
perfusion, worsening kidney injury and increasing serum
creatinine.
Because this client already has stage 3 chronic kidney disease
with elevated BUN and creatinine, administering ibuprofen
could further impair renal function. The nurse should clarify the
prescription with the provider before administration and
advocate for a safer analgesic alternative.
Option A is incorrect because taking NSAIDs with food reduces
gastrointestinal irritation but does not address the client's renal
risk.
Option C is incorrect because hydration alone does not
eliminate NSAID-induced nephrotoxicity.
Option D is unsafe because the medication should not be
administered until its appropriateness is verified.
The nurse should assess renal function before administering
nephrotoxic medications, review concurrent medications that
may increase kidney injury (such as ACE inhibitors and
diuretics), and monitor urine output and laboratory values
during therapy.
, Learning Objective
After completing this question, the learner should be able to:
• Identify contraindications to NSAID therapy.
• Recognize patients at increased risk for NSAID-induced
kidney injury.
• Prioritize safe medication administration based on
laboratory findings.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 24-year-old woman is discharged after arthroscopic knee
surgery. She receives a prescription for oxycodone 5 mg orally
every 6 hours as needed for severe pain. During discharge
teaching, the nurse reviews medication safety.
Question Stem
Which statement by the client indicates correct understanding
of oxycodone therapy?
Options
