NCLEX-RN Pharmacology Practice
Questions
| Pain and Inflammation |
20 Original NCLEX Next Generation
(NGN) MCQs with Detailed Rationales |
ATI Pharmacology Made Easy Review |
Nursing Exam Prep PDF
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of the knees reports
worsening joint pain despite taking acetaminophen regularly.
Her provider prescribes ibuprofen 400 mg orally three times
daily as needed. Her history includes hypertension, chronic
kidney disease (stage 3), and gastroesophageal reflux disease.
Current medications include lisinopril, hydrochlorothiazide, and
omeprazole. Vital signs are stable. Laboratory results include
serum creatinine 1.8 mg/dL (baseline 1.7 mg/dL), BUN 32
mg/dL, and potassium 4.8 mEq/L.
,Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
A. Administer the medication with food.
B. Review the patient's renal function and notify the provider of
impaired kidney function.
C. Teach the patient to avoid alcohol while taking ibuprofen.
D. Encourage increased dietary calcium intake.
Correct Answer
Correct Answer: B. Review the patient's renal function and
notify the provider of impaired kidney function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
especially in patients with chronic kidney disease or decreased
renal perfusion. In this patient, stage 3 chronic kidney disease
and elevated creatinine significantly increase the risk of NSAID-
induced acute kidney injury. The nurse should evaluate renal
function and communicate concerns to the provider before
administration rather than simply administering the medication.
,Option A is appropriate teaching because food may reduce
gastrointestinal irritation, but it does not address the greatest
safety concern. Option C is also appropriate education because
alcohol increases the risk of gastrointestinal bleeding; however,
this is not the immediate priority before the first dose. Option D
has no direct relationship to ibuprofen therapy or immediate
medication safety.
The nurse should also monitor urine output, blood pressure,
serum creatinine, and signs of fluid retention during NSAID
therapy. Older adults are particularly susceptible to renal
impairment and gastrointestinal complications associated with
NSAIDs.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing assessment before administering NSAIDs.
• Recognize appropriate monitoring parameters during
NSAID therapy.
Medication Safety Focus: Contraindication and renal
monitoring.
, Question 2
Clinical Scenario
A 42-year-old man underwent arthroscopic shoulder surgery
earlier in the day. The provider prescribes morphine IV every 3
hours as needed for severe pain. Thirty minutes after
administration, the nurse assesses the patient. Respiratory rate
is 8 breaths/min, oxygen saturation is 90% on room air, blood
pressure is 98/60 mm Hg, heart rate is 62 beats/min, and the
patient is difficult to arouse.
Question Stem
Which nursing action should the nurse perform first?
A. Administer naloxone as prescribed.
B. Reassess the patient's pain score.
C. Encourage the patient to take deep breaths.
D. Offer oral fluids.
Correct Answer
Correct Answer: A. Administer naloxone as prescribed.
Detailed Rationale
Morphine is a potent opioid analgesic that depresses the
central nervous system, including the respiratory center. A
respiratory rate below 10 breaths/min accompanied by
Questions
| Pain and Inflammation |
20 Original NCLEX Next Generation
(NGN) MCQs with Detailed Rationales |
ATI Pharmacology Made Easy Review |
Nursing Exam Prep PDF
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of the knees reports
worsening joint pain despite taking acetaminophen regularly.
Her provider prescribes ibuprofen 400 mg orally three times
daily as needed. Her history includes hypertension, chronic
kidney disease (stage 3), and gastroesophageal reflux disease.
Current medications include lisinopril, hydrochlorothiazide, and
omeprazole. Vital signs are stable. Laboratory results include
serum creatinine 1.8 mg/dL (baseline 1.7 mg/dL), BUN 32
mg/dL, and potassium 4.8 mEq/L.
,Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
A. Administer the medication with food.
B. Review the patient's renal function and notify the provider of
impaired kidney function.
C. Teach the patient to avoid alcohol while taking ibuprofen.
D. Encourage increased dietary calcium intake.
Correct Answer
Correct Answer: B. Review the patient's renal function and
notify the provider of impaired kidney function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
especially in patients with chronic kidney disease or decreased
renal perfusion. In this patient, stage 3 chronic kidney disease
and elevated creatinine significantly increase the risk of NSAID-
induced acute kidney injury. The nurse should evaluate renal
function and communicate concerns to the provider before
administration rather than simply administering the medication.
,Option A is appropriate teaching because food may reduce
gastrointestinal irritation, but it does not address the greatest
safety concern. Option C is also appropriate education because
alcohol increases the risk of gastrointestinal bleeding; however,
this is not the immediate priority before the first dose. Option D
has no direct relationship to ibuprofen therapy or immediate
medication safety.
The nurse should also monitor urine output, blood pressure,
serum creatinine, and signs of fluid retention during NSAID
therapy. Older adults are particularly susceptible to renal
impairment and gastrointestinal complications associated with
NSAIDs.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing assessment before administering NSAIDs.
• Recognize appropriate monitoring parameters during
NSAID therapy.
Medication Safety Focus: Contraindication and renal
monitoring.
, Question 2
Clinical Scenario
A 42-year-old man underwent arthroscopic shoulder surgery
earlier in the day. The provider prescribes morphine IV every 3
hours as needed for severe pain. Thirty minutes after
administration, the nurse assesses the patient. Respiratory rate
is 8 breaths/min, oxygen saturation is 90% on room air, blood
pressure is 98/60 mm Hg, heart rate is 62 beats/min, and the
patient is difficult to arouse.
Question Stem
Which nursing action should the nurse perform first?
A. Administer naloxone as prescribed.
B. Reassess the patient's pain score.
C. Encourage the patient to take deep breaths.
D. Offer oral fluids.
Correct Answer
Correct Answer: A. Administer naloxone as prescribed.
Detailed Rationale
Morphine is a potent opioid analgesic that depresses the
central nervous system, including the respiratory center. A
respiratory rate below 10 breaths/min accompanied by
