NCLEX-RN Pharmacology Exam |
20 Original Pain & Inflammation Practice
Questions with Detailed Rationales |
ATI & NGN Style Nursing Study Guide
Question 1
Clinical Scenario
A 72-year-old woman with osteoarthritis is admitted for
worsening knee pain. Her history includes hypertension, chronic
kidney disease stage 3, and gastroesophageal reflux disease.
Home medications include lisinopril, hydrochlorothiazide,
omeprazole, and ibuprofen 600 mg three times daily as needed.
Laboratory results show creatinine 1.9 mg/dL (baseline 1.3
mg/dL), BUN 34 mg/dL, and potassium 5.2 mEq/L. The provider
prescribes naproxen 500 mg twice daily for pain.
Question Stem
Which action should the nurse take first?
,A. Administer the naproxen with food B. Hold the naproxen and
notify the provider C. Give the naproxen and recheck creatinine
in 48 hr D. Ask the provider to add misoprostol
Correct Answer
Correct Answer: B. Hold the naproxen and notify the provider
Detailed Rationale
This client has evidence of worsening renal function and is
already taking an ACE inhibitor and a diuretic. Adding or
continuing an NSAID creates the classic “triple-whammy”
interaction (ACE inhibitor/ARB + diuretic + NSAID), which can
significantly reduce renal perfusion and precipitate acute kidney
injury. The rise in creatinine from 1.3 to 1.9 mg/dL and the
elevated potassium are concerning and require provider
notification before administering another NSAID.
Administering the medication with food may reduce
gastrointestinal irritation but does not address the renal risk.
Giving the naproxen and monitoring later delays intervention
and may worsen kidney injury. Adding misoprostol would target
gastrointestinal protection, not nephrotoxicity.
Nursing priorities include reviewing renal function, assessing
urine output, avoiding nephrotoxic medications, and advocating
for alternative analgesics such as acetaminophen or
nonpharmacologic measures when appropriate.
,Learning Objective
After completing this question, the learner should be able to:
• Recognize NSAID-associated nephrotoxicity in older adults.
• Identify the ACE inhibitor–diuretic–NSAID interaction.
• Prioritize holding potentially harmful medications and
notifying the provider.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 24-year-old woman is 10 weeks pregnant and reports severe
migraine headaches occurring twice weekly. She has been
taking over-the-counter ibuprofen with good relief. The
provider prescribes acetaminophen as needed and schedules
follow-up.
Question Stem
Which statement by the client indicates understanding of the
teaching?
A. “Ibuprofen is safe during the first trimester.” B. “I should
avoid NSAIDs during pregnancy unless my provider tells me to
use them.” C. “Aspirin is preferred for migraine pain during
, pregnancy.” D. “Naproxen is safer than acetaminophen while I
am pregnant.”
Correct Answer
Correct Answer: B. “I should avoid NSAIDs during pregnancy
unless my provider tells me to use them.”
Detailed Rationale
NSAIDs such as ibuprofen and naproxen are generally avoided
during pregnancy, particularly later in gestation, because they
can affect fetal circulation and renal function. Although the
greatest concern is after 20 weeks and especially in the third
trimester, clients should be taught not to self-medicate with
NSAIDs during pregnancy unless specifically instructed by their
provider.
Acetaminophen is commonly recommended as a first-line
analgesic during pregnancy when used appropriately. Aspirin is
not preferred for routine migraine treatment in pregnancy
because it can increase bleeding risk and has fetal safety
concerns depending on dose and timing. Naproxen is not safer
than acetaminophen.
The nurse should reinforce reading medication labels, avoiding
combination cold or headache products that may contain
NSAIDs, and discussing any persistent or severe headaches with
the obstetric provider.
20 Original Pain & Inflammation Practice
Questions with Detailed Rationales |
ATI & NGN Style Nursing Study Guide
Question 1
Clinical Scenario
A 72-year-old woman with osteoarthritis is admitted for
worsening knee pain. Her history includes hypertension, chronic
kidney disease stage 3, and gastroesophageal reflux disease.
Home medications include lisinopril, hydrochlorothiazide,
omeprazole, and ibuprofen 600 mg three times daily as needed.
Laboratory results show creatinine 1.9 mg/dL (baseline 1.3
mg/dL), BUN 34 mg/dL, and potassium 5.2 mEq/L. The provider
prescribes naproxen 500 mg twice daily for pain.
Question Stem
Which action should the nurse take first?
,A. Administer the naproxen with food B. Hold the naproxen and
notify the provider C. Give the naproxen and recheck creatinine
in 48 hr D. Ask the provider to add misoprostol
Correct Answer
Correct Answer: B. Hold the naproxen and notify the provider
Detailed Rationale
This client has evidence of worsening renal function and is
already taking an ACE inhibitor and a diuretic. Adding or
continuing an NSAID creates the classic “triple-whammy”
interaction (ACE inhibitor/ARB + diuretic + NSAID), which can
significantly reduce renal perfusion and precipitate acute kidney
injury. The rise in creatinine from 1.3 to 1.9 mg/dL and the
elevated potassium are concerning and require provider
notification before administering another NSAID.
Administering the medication with food may reduce
gastrointestinal irritation but does not address the renal risk.
Giving the naproxen and monitoring later delays intervention
and may worsen kidney injury. Adding misoprostol would target
gastrointestinal protection, not nephrotoxicity.
Nursing priorities include reviewing renal function, assessing
urine output, avoiding nephrotoxic medications, and advocating
for alternative analgesics such as acetaminophen or
nonpharmacologic measures when appropriate.
,Learning Objective
After completing this question, the learner should be able to:
• Recognize NSAID-associated nephrotoxicity in older adults.
• Identify the ACE inhibitor–diuretic–NSAID interaction.
• Prioritize holding potentially harmful medications and
notifying the provider.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 24-year-old woman is 10 weeks pregnant and reports severe
migraine headaches occurring twice weekly. She has been
taking over-the-counter ibuprofen with good relief. The
provider prescribes acetaminophen as needed and schedules
follow-up.
Question Stem
Which statement by the client indicates understanding of the
teaching?
A. “Ibuprofen is safe during the first trimester.” B. “I should
avoid NSAIDs during pregnancy unless my provider tells me to
use them.” C. “Aspirin is preferred for migraine pain during
, pregnancy.” D. “Naproxen is safer than acetaminophen while I
am pregnant.”
Correct Answer
Correct Answer: B. “I should avoid NSAIDs during pregnancy
unless my provider tells me to use them.”
Detailed Rationale
NSAIDs such as ibuprofen and naproxen are generally avoided
during pregnancy, particularly later in gestation, because they
can affect fetal circulation and renal function. Although the
greatest concern is after 20 weeks and especially in the third
trimester, clients should be taught not to self-medicate with
NSAIDs during pregnancy unless specifically instructed by their
provider.
Acetaminophen is commonly recommended as a first-line
analgesic during pregnancy when used appropriately. Aspirin is
not preferred for routine migraine treatment in pregnancy
because it can increase bleeding risk and has fetal safety
concerns depending on dose and timing. Naproxen is not safer
than acetaminophen.
The nurse should reinforce reading medication labels, avoiding
combination cold or headache products that may contain
NSAIDs, and discussing any persistent or severe headaches with
the obstetric provider.
