ATI Pharmacology Made Easy Pain &
Inflammation Exam |
20 NCLEX-RN NGN Pharmacology
Practice Questions with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports worsening
bilateral knee pain rated 7/10 despite taking acetaminophen as
directed. The provider prescribes ibuprofen 400 mg orally three
times daily with food. Her history includes hypertension and
stage 3 chronic kidney disease. Current medications include
lisinopril and hydrochlorothiazide. Vital signs are stable. Serum
creatinine is 1.8 mg/dL (baseline 1.6 mg/dL).
Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
,A. Administer the medication with food to reduce gastric
irritation.
B. Contact the provider to discuss the client's declining renal
function before administering the medication.
C. Teach the client to avoid grapefruit juice while taking
ibuprofen.
D. Encourage increased intake of dairy products during therapy.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
declining renal function before administering the medication.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, especially in
older adults and patients with chronic kidney disease. This
client already has impaired renal function and is taking lisinopril
and hydrochlorothiazide, creating the well-known "triple
whammy" combination that significantly increases the risk for
acute kidney injury. The nurse should question the prescription
and notify the provider before administering the medication.
,Option A is appropriate teaching for routine NSAID
administration but does not address the immediate safety
concern.
Option C is incorrect because grapefruit juice has no clinically
significant interaction with ibuprofen.
Option D is unnecessary because NSAIDs do not require
increased dairy intake.
The nurse should review renal function, urine output, blood
pressure, and concurrent nephrotoxic medications before
initiating NSAID therapy in high-risk patients. Early recognition
of medication-related renal injury helps prevent irreversible
kidney damage.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
nephrotoxicity.
• Prioritize assessment findings before NSAID
administration.
• Recognize medication combinations that increase acute
kidney injury risk.
• Apply clinical judgment when questioning potentially
unsafe medication orders.
, Medication Safety Focus
Monitoring—Renal function before NSAID therapy
Question 2
Clinical Scenario
A 45-year-old man underwent arthroscopic shoulder surgery
earlier today. He receives morphine intravenously for
postoperative pain. Thirty minutes later, the nurse notes the
following:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 89% on room air
• Blood pressure: 102/60 mm Hg
• Heart rate: 64/min
• Client is difficult to arouse.
Question Stem
Which nursing action should the nurse take first?
A. Administer naloxone as prescribed while supporting the
client's airway.
B. Encourage the client to take deep breaths every 30 minutes.
C. Document the expected effects of opioid therapy.
Inflammation Exam |
20 NCLEX-RN NGN Pharmacology
Practice Questions with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports worsening
bilateral knee pain rated 7/10 despite taking acetaminophen as
directed. The provider prescribes ibuprofen 400 mg orally three
times daily with food. Her history includes hypertension and
stage 3 chronic kidney disease. Current medications include
lisinopril and hydrochlorothiazide. Vital signs are stable. Serum
creatinine is 1.8 mg/dL (baseline 1.6 mg/dL).
Question Stem
Which nursing action is the highest priority before
administering the first dose of ibuprofen?
,A. Administer the medication with food to reduce gastric
irritation.
B. Contact the provider to discuss the client's declining renal
function before administering the medication.
C. Teach the client to avoid grapefruit juice while taking
ibuprofen.
D. Encourage increased intake of dairy products during therapy.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
declining renal function before administering the medication.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, especially in
older adults and patients with chronic kidney disease. This
client already has impaired renal function and is taking lisinopril
and hydrochlorothiazide, creating the well-known "triple
whammy" combination that significantly increases the risk for
acute kidney injury. The nurse should question the prescription
and notify the provider before administering the medication.
,Option A is appropriate teaching for routine NSAID
administration but does not address the immediate safety
concern.
Option C is incorrect because grapefruit juice has no clinically
significant interaction with ibuprofen.
Option D is unnecessary because NSAIDs do not require
increased dairy intake.
The nurse should review renal function, urine output, blood
pressure, and concurrent nephrotoxic medications before
initiating NSAID therapy in high-risk patients. Early recognition
of medication-related renal injury helps prevent irreversible
kidney damage.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
nephrotoxicity.
• Prioritize assessment findings before NSAID
administration.
• Recognize medication combinations that increase acute
kidney injury risk.
• Apply clinical judgment when questioning potentially
unsafe medication orders.
, Medication Safety Focus
Monitoring—Renal function before NSAID therapy
Question 2
Clinical Scenario
A 45-year-old man underwent arthroscopic shoulder surgery
earlier today. He receives morphine intravenously for
postoperative pain. Thirty minutes later, the nurse notes the
following:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 89% on room air
• Blood pressure: 102/60 mm Hg
• Heart rate: 64/min
• Client is difficult to arouse.
Question Stem
Which nursing action should the nurse take first?
A. Administer naloxone as prescribed while supporting the
client's airway.
B. Encourage the client to take deep breaths every 30 minutes.
C. Document the expected effects of opioid therapy.
