NCLEX-RN Pharmacology Practice Exam
|
Pain & Inflammation |
20 Original NGN-Style Questions with
Detailed Rationales | NSAIDs, Opioids,
Corticosteroids, Gout & Analgesics
| ATI-Inspired Nursing Exam Review PDF
Question 1
Clinical Scenario
A 67-year-old man with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite using acetaminophen. His
provider prescribes ibuprofen 400 mg orally every 6 hours as
needed. His history includes hypertension, stage 3 chronic
kidney disease, and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. Assessment findings include BP 148/86 mm Hg, HR
78/min, serum creatinine 1.8 mg/dL, BUN 34 mg/dL, and
potassium 4.6 mEq/L.
,Question Stem
Which assessment finding should cause the nurse to question
administering the prescribed ibuprofen?
A. History of gastroesophageal reflux disease
B. Elevated serum creatinine level
C. Blood pressure of 148/86 mm Hg
D. Pain rating of 7/10
Correct Answer
Correct Answer: B. Elevated serum creatinine level
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although this action decreases pain and
inflammation, prostaglandins also help maintain renal blood
flow, especially in patients with chronic kidney disease or
decreased renal perfusion. A serum creatinine of 1.8 mg/dL
indicates impaired renal function, making additional
nephrotoxic effects from NSAIDs a significant concern. The
nurse should question the prescription and notify the provider
before administration because further reduction in renal
perfusion may worsen kidney injury. Older adults and
,individuals receiving ACE inhibitors, such as lisinopril, are
particularly vulnerable to NSAID-induced renal impairment.
Option A is incorrect because GERD increases the risk for
gastrointestinal irritation but does not automatically preclude
NSAID therapy, particularly when gastroprotective therapy such
as omeprazole is prescribed. Option C is incorrect because
mildly elevated blood pressure warrants monitoring but is not
the most immediate contraindication. Option D is incorrect
because the pain severity supports the need for analgesia but
does not determine medication safety.
The nurse should monitor renal function, urine output, blood
pressure, and signs of gastrointestinal bleeding. Patients should
also be instructed to avoid dehydration and the concurrent use
of additional OTC NSAIDs.
Learning Objectives
After completing this question, the learner should be able to:
• Identify renal contraindications to NSAID therapy.
• Recognize patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment findings before administering
analgesics.
Medication Safety Focus
, Monitoring—Renal function before NSAID administration
Question 2
Clinical Scenario
A 58-year-old woman is recovering from abdominal surgery and
is prescribed morphine 2 mg IV every 2 hours as needed for
severe pain. Before administration, the nurse assesses the
client. Findings include pain rated 8/10, respiratory rate
10/min, oxygen saturation 91% on room air, BP 110/70 mm Hg,
and the client is difficult to awaken.
Question Stem
What is the nurse's priority action?
A. Administer the prescribed morphine.
B. Encourage the client to use relaxation techniques.
C. Withhold morphine and notify the provider immediately.
D. Administer an antiemetic before giving morphine.
Correct Answer
Correct Answer: C. Withhold morphine and notify the provider
immediately.
Detailed Rationale
|
Pain & Inflammation |
20 Original NGN-Style Questions with
Detailed Rationales | NSAIDs, Opioids,
Corticosteroids, Gout & Analgesics
| ATI-Inspired Nursing Exam Review PDF
Question 1
Clinical Scenario
A 67-year-old man with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite using acetaminophen. His
provider prescribes ibuprofen 400 mg orally every 6 hours as
needed. His history includes hypertension, stage 3 chronic
kidney disease, and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. Assessment findings include BP 148/86 mm Hg, HR
78/min, serum creatinine 1.8 mg/dL, BUN 34 mg/dL, and
potassium 4.6 mEq/L.
,Question Stem
Which assessment finding should cause the nurse to question
administering the prescribed ibuprofen?
A. History of gastroesophageal reflux disease
B. Elevated serum creatinine level
C. Blood pressure of 148/86 mm Hg
D. Pain rating of 7/10
Correct Answer
Correct Answer: B. Elevated serum creatinine level
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although this action decreases pain and
inflammation, prostaglandins also help maintain renal blood
flow, especially in patients with chronic kidney disease or
decreased renal perfusion. A serum creatinine of 1.8 mg/dL
indicates impaired renal function, making additional
nephrotoxic effects from NSAIDs a significant concern. The
nurse should question the prescription and notify the provider
before administration because further reduction in renal
perfusion may worsen kidney injury. Older adults and
,individuals receiving ACE inhibitors, such as lisinopril, are
particularly vulnerable to NSAID-induced renal impairment.
Option A is incorrect because GERD increases the risk for
gastrointestinal irritation but does not automatically preclude
NSAID therapy, particularly when gastroprotective therapy such
as omeprazole is prescribed. Option C is incorrect because
mildly elevated blood pressure warrants monitoring but is not
the most immediate contraindication. Option D is incorrect
because the pain severity supports the need for analgesia but
does not determine medication safety.
The nurse should monitor renal function, urine output, blood
pressure, and signs of gastrointestinal bleeding. Patients should
also be instructed to avoid dehydration and the concurrent use
of additional OTC NSAIDs.
Learning Objectives
After completing this question, the learner should be able to:
• Identify renal contraindications to NSAID therapy.
• Recognize patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment findings before administering
analgesics.
Medication Safety Focus
, Monitoring—Renal function before NSAID administration
Question 2
Clinical Scenario
A 58-year-old woman is recovering from abdominal surgery and
is prescribed morphine 2 mg IV every 2 hours as needed for
severe pain. Before administration, the nurse assesses the
client. Findings include pain rated 8/10, respiratory rate
10/min, oxygen saturation 91% on room air, BP 110/70 mm Hg,
and the client is difficult to awaken.
Question Stem
What is the nurse's priority action?
A. Administer the prescribed morphine.
B. Encourage the client to use relaxation techniques.
C. Withhold morphine and notify the provider immediately.
D. Administer an antiemetic before giving morphine.
Correct Answer
Correct Answer: C. Withhold morphine and notify the provider
immediately.
Detailed Rationale
