NCLEX-RN Pharmacology Practice
Questions |
Pain & Inflammation |
20 ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman is admitted with severe osteoarthritis
pain involving both knees. Her medical history includes stage 3
chronic kidney disease (estimated GFR 42 mL/min/1.73 m²),
hypertension, and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Before administering the first
dose, the nurse reviews the client's laboratory results: serum
creatinine 1.8 mg/dL, BUN 34 mg/dL, potassium 5.1 mEq/L.
Question Stem
,Which nursing action is most appropriate?
A. Administer the ibuprofen as prescribed because the client is
receiving a proton pump inhibitor.
B. Hold the ibuprofen and notify the provider about the client's
renal function.
C. Administer the medication with food to reduce
gastrointestinal irritation.
D. Encourage the client to increase fluid intake after receiving
the medication.
Correct Answer
B. Hold the ibuprofen and notify the provider about the
client's renal function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX), decreasing
prostaglandin synthesis. Although this reduces pain and
inflammation, renal prostaglandins also help maintain renal
blood flow, especially in older adults and those with chronic
kidney disease. In this client, impaired renal function (elevated
creatinine, reduced eGFR, elevated BUN) places her at
increased risk for NSAID-induced acute kidney injury.
Concurrent use of an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide) further increases this risk through the
,well-known "triple whammy" effect that reduces renal
perfusion.
Option A is incorrect because a proton pump inhibitor reduces
gastrointestinal ulcer risk but does not protect kidney function.
Option C is appropriate for minimizing gastric irritation but does
not address the greater priority of preventing nephrotoxicity.
Option D may help maintain hydration but cannot eliminate the
renal risks associated with NSAID therapy in a patient with
significant kidney impairment.
The nurse should recognize contraindications before medication
administration and collaborate with the provider regarding
safer analgesic alternatives, such as appropriately dosed
acetaminophen or other individualized pain management
strategies.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment of renal function before
administering NSAIDs.
• Recognize clinically significant drug combinations that
increase nephrotoxicity risk.
Medication Safety Focus
, Contraindication and renal function monitoring
Question 2
Clinical Scenario
A 27-year-old client undergoes an uncomplicated laparoscopic
appendectomy. The provider prescribes morphine 2 mg IV every
2 hours as needed for severe pain. Thirty minutes after
administration, the nurse assesses the client. Findings include
respiratory rate 8/min, oxygen saturation 88% on room air,
difficult arousal, blood pressure 98/60 mm Hg, and pinpoint
pupils.
Question Stem
Which action should the nurse take first?
A. Administer naloxone as prescribed.
B. Place the client in high-Fowler position.
C. Reassess the pain score after 15 minutes.
D. Encourage the client to cough and deep breathe.
Correct Answer
A. Administer naloxone as prescribed.
Detailed Rationale
Questions |
Pain & Inflammation |
20 ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman is admitted with severe osteoarthritis
pain involving both knees. Her medical history includes stage 3
chronic kidney disease (estimated GFR 42 mL/min/1.73 m²),
hypertension, and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Before administering the first
dose, the nurse reviews the client's laboratory results: serum
creatinine 1.8 mg/dL, BUN 34 mg/dL, potassium 5.1 mEq/L.
Question Stem
,Which nursing action is most appropriate?
A. Administer the ibuprofen as prescribed because the client is
receiving a proton pump inhibitor.
B. Hold the ibuprofen and notify the provider about the client's
renal function.
C. Administer the medication with food to reduce
gastrointestinal irritation.
D. Encourage the client to increase fluid intake after receiving
the medication.
Correct Answer
B. Hold the ibuprofen and notify the provider about the
client's renal function.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX), decreasing
prostaglandin synthesis. Although this reduces pain and
inflammation, renal prostaglandins also help maintain renal
blood flow, especially in older adults and those with chronic
kidney disease. In this client, impaired renal function (elevated
creatinine, reduced eGFR, elevated BUN) places her at
increased risk for NSAID-induced acute kidney injury.
Concurrent use of an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide) further increases this risk through the
,well-known "triple whammy" effect that reduces renal
perfusion.
Option A is incorrect because a proton pump inhibitor reduces
gastrointestinal ulcer risk but does not protect kidney function.
Option C is appropriate for minimizing gastric irritation but does
not address the greater priority of preventing nephrotoxicity.
Option D may help maintain hydration but cannot eliminate the
renal risks associated with NSAID therapy in a patient with
significant kidney impairment.
The nurse should recognize contraindications before medication
administration and collaborate with the provider regarding
safer analgesic alternatives, such as appropriately dosed
acetaminophen or other individualized pain management
strategies.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment of renal function before
administering NSAIDs.
• Recognize clinically significant drug combinations that
increase nephrotoxicity risk.
Medication Safety Focus
, Contraindication and renal function monitoring
Question 2
Clinical Scenario
A 27-year-old client undergoes an uncomplicated laparoscopic
appendectomy. The provider prescribes morphine 2 mg IV every
2 hours as needed for severe pain. Thirty minutes after
administration, the nurse assesses the client. Findings include
respiratory rate 8/min, oxygen saturation 88% on room air,
difficult arousal, blood pressure 98/60 mm Hg, and pinpoint
pupils.
Question Stem
Which action should the nurse take first?
A. Administer naloxone as prescribed.
B. Place the client in high-Fowler position.
C. Reassess the pain score after 15 minutes.
D. Encourage the client to cough and deep breathe.
Correct Answer
A. Administer naloxone as prescribed.
Detailed Rationale
