NCLEX Pharmacology Practice Test
Pain & Inflammation
| 20 Original Nursing Questions with
Detailed Rationales
| ATI-Style Medication Safety Exam Prep
Question 1
Clinical Scenario
A 72-year-old woman is admitted with osteoarthritis of the
knees. She rates her pain as 7/10 and requests medication
before participating in physical therapy. Her medical history
includes hypertension, chronic kidney disease stage 3, and
peptic ulcer disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. Laboratory results show:
• Serum creatinine: 2.0 mg/dL
• BUN: 42 mg/dL
• Hemoglobin: 11.2 g/dL
• Platelets: 250,000/mm³
,The provider prescribes pain medication as needed.
Question Stem
Which prescribed medication should the nurse question before
administration?
A. Acetaminophen
B. Celecoxib
C. Ketorolac
D. Tramadol
Correct Answer
Correct Answer: C. Ketorolac
Detailed Rationale
Ketorolac is a potent nonsteroidal anti-inflammatory drug
(NSAID) intended only for short-term management of moderate
to severe pain. It significantly inhibits prostaglandin synthesis,
reducing renal blood flow and increasing the risk of acute
kidney injury. This patient already has chronic kidney disease,
evidenced by an elevated serum creatinine and BUN, making
ketorolac an unsafe choice. Additionally, ketorolac increases the
risk of gastrointestinal bleeding and peptic ulcer complications,
another important concern because of the patient's history of
peptic ulcer disease. The nurse should clarify the prescription
,with the provider before administration to prevent serious
harm.
Option A: Acetaminophen is generally considered the preferred
first-line analgesic for osteoarthritis pain in patients with renal
impairment when used within recommended daily dosing
limits. Liver function should still be considered, but no hepatic
disease is described.
Option B: Celecoxib may reduce gastrointestinal irritation
compared with nonselective NSAIDs but still carries risks of
renal impairment and cardiovascular events. Although caution
is warranted, ketorolac presents the greatest immediate safety
concern.
Option D: Tramadol may require dosage adjustment in renal
impairment but is not absolutely contraindicated in this
scenario. Monitoring for dizziness, sedation, and respiratory
depression is appropriate.
Medication safety requires nurses to evaluate comorbidities
and laboratory values before administering analgesics.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to ketorolac therapy.
• Recognize the effects of NSAIDs on renal function.
, • Prioritize medication safety using patient history and
laboratory values.
• Select safer analgesic alternatives in older adults.
Medication Safety Focus
Contraindication—Avoid ketorolac in patients with significant
renal impairment or active peptic ulcer disease.
Question 2
Clinical Scenario
A 45-year-old man underwent abdominal surgery this morning.
He is receiving intravenous morphine through a patient-
controlled analgesia (PCA) pump. Four hours later, the nurse
finds him difficult to arouse. Assessment findings include:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 88% on room air
• Blood pressure: 102/60 mmHg
• Heart rate: 58 beats/min
• Pupils: pinpoint
Question Stem
Which action should the nurse take first?
Pain & Inflammation
| 20 Original Nursing Questions with
Detailed Rationales
| ATI-Style Medication Safety Exam Prep
Question 1
Clinical Scenario
A 72-year-old woman is admitted with osteoarthritis of the
knees. She rates her pain as 7/10 and requests medication
before participating in physical therapy. Her medical history
includes hypertension, chronic kidney disease stage 3, and
peptic ulcer disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. Laboratory results show:
• Serum creatinine: 2.0 mg/dL
• BUN: 42 mg/dL
• Hemoglobin: 11.2 g/dL
• Platelets: 250,000/mm³
,The provider prescribes pain medication as needed.
Question Stem
Which prescribed medication should the nurse question before
administration?
A. Acetaminophen
B. Celecoxib
C. Ketorolac
D. Tramadol
Correct Answer
Correct Answer: C. Ketorolac
Detailed Rationale
Ketorolac is a potent nonsteroidal anti-inflammatory drug
(NSAID) intended only for short-term management of moderate
to severe pain. It significantly inhibits prostaglandin synthesis,
reducing renal blood flow and increasing the risk of acute
kidney injury. This patient already has chronic kidney disease,
evidenced by an elevated serum creatinine and BUN, making
ketorolac an unsafe choice. Additionally, ketorolac increases the
risk of gastrointestinal bleeding and peptic ulcer complications,
another important concern because of the patient's history of
peptic ulcer disease. The nurse should clarify the prescription
,with the provider before administration to prevent serious
harm.
Option A: Acetaminophen is generally considered the preferred
first-line analgesic for osteoarthritis pain in patients with renal
impairment when used within recommended daily dosing
limits. Liver function should still be considered, but no hepatic
disease is described.
Option B: Celecoxib may reduce gastrointestinal irritation
compared with nonselective NSAIDs but still carries risks of
renal impairment and cardiovascular events. Although caution
is warranted, ketorolac presents the greatest immediate safety
concern.
Option D: Tramadol may require dosage adjustment in renal
impairment but is not absolutely contraindicated in this
scenario. Monitoring for dizziness, sedation, and respiratory
depression is appropriate.
Medication safety requires nurses to evaluate comorbidities
and laboratory values before administering analgesics.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to ketorolac therapy.
• Recognize the effects of NSAIDs on renal function.
, • Prioritize medication safety using patient history and
laboratory values.
• Select safer analgesic alternatives in older adults.
Medication Safety Focus
Contraindication—Avoid ketorolac in patients with significant
renal impairment or active peptic ulcer disease.
Question 2
Clinical Scenario
A 45-year-old man underwent abdominal surgery this morning.
He is receiving intravenous morphine through a patient-
controlled analgesia (PCA) pump. Four hours later, the nurse
finds him difficult to arouse. Assessment findings include:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 88% on room air
• Blood pressure: 102/60 mmHg
• Heart rate: 58 beats/min
• Pupils: pinpoint
Question Stem
Which action should the nurse take first?
