NCLEX-RN Pharmacology Test Bank: 20 NGN
Pain & Inflammation MCQs with Rationales
(ATI Style)
Question 1
Clinical Scenario
A 68-year-old male with a history of chronic kidney disease
(Stage 3) and severe osteoarthritis of the knees presents to the
clinic reporting increased joint pain. He states, "I've been taking
over-the-counter ibuprofen 800 mg three times a day for the
past two weeks, but it's not helping as much anymore, and my
stomach has been burning."
Question Stem
Which action should the nurse take first?
A. Suggest switching to an equivalent daily dose of naproxen.
,B. Obtain a prescription for an oral proton pump inhibitor (PPI)
to treat the gastric burning.
C. Check the client’s serum creatinine and blood urea nitrogen
(BUN) levels.
D. Educate the client on taking the ibuprofen with food or a full
glass of milk.
Correct Answer
Correct Answer: C. Check the client’s serum creatinine and
blood urea nitrogen (BUN) levels.
Detailed Rationale
The primary concern in this clinical scenario is the client's
underlying Stage 3 chronic kidney disease (CKD) coupled with
high-dose, frequent use of a nonsteroidal anti-inflammatory
drug (NSAID) like ibuprofen. NSAIDs inhibit cyclooxygenase
(COX) enzymes, leading to decreased prostaglandin synthesis.
Prostaglandins are essential for maintaining renal perfusion via
afferent arteriolar vasodilation. In a patient with pre-existing
renal impairment, blocking this mechanism can precipitate
acute kidney injury (AKI) or accelerate progression to end-stage
renal disease. Therefore, checking the client's serum creatinine
and BUN levels is the priority nursing action to assess current
renal function before executing other interventions.
,Switching to another nonselective NSAID like naproxen (Option
A) would carry the same, if not worse, renal and gastrointestinal
risks and is contraindicated in this patient. While managing the
client’s gastric burning is important (Option B), administering a
PPI addresses a side effect rather than the potentially life-
threatening threat of acute-on-chronic renal failure. Educating
the client to take NSAIDs with food (Option D) reduces local GI
irritation but does not mitigate the systemic renal or mucosal
risks driven by systemic prostaglandin inhibition. The drug
should be discontinued under provider supervision, but
establishing baseline renal damage is the immediate priority.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the risk of acute kidney injury associated with
NSAID use in patients with chronic kidney disease.
• Prioritize nursing assessments (laboratory evaluation) for
high-risk clients taking nephrotoxic medications.
• Differentiate between local GI irritation interventions and
systemic adverse effect risks of NSAIDs.
Medication Safety Focus
Contraindication
Question 2
, Clinical Scenario
A 45-year-old female is being discharged following an
orthopedic procedure. She is prescribed an oral combination
opioid/non-opioid analgesic containing hydrocodone 5 mg and
acetaminophen 325 mg, 1 to 2 tablets every 4 to 6 hours as
needed for moderate to severe pain.
Question Stem
Which instruction is most important for the nurse to include in
the discharge teaching?
A. "Do not exceed 12 tablets of this medication in any 24-hour
period."
B. "Check all over-the-counter cold and pain remedies to ensure
they do not contain acetaminophen."
C. "Take this medication on an empty stomach to ensure rapid
and effective pain relief."
D. "Incorporate a high-protein diet to help accelerate surgical
wound healing while taking this drug."
Correct Answer
Correct Answer: B. "Check all over-the-counter cold and pain
remedies to ensure they do not contain acetaminophen."
Detailed Rationale
Pain & Inflammation MCQs with Rationales
(ATI Style)
Question 1
Clinical Scenario
A 68-year-old male with a history of chronic kidney disease
(Stage 3) and severe osteoarthritis of the knees presents to the
clinic reporting increased joint pain. He states, "I've been taking
over-the-counter ibuprofen 800 mg three times a day for the
past two weeks, but it's not helping as much anymore, and my
stomach has been burning."
Question Stem
Which action should the nurse take first?
A. Suggest switching to an equivalent daily dose of naproxen.
,B. Obtain a prescription for an oral proton pump inhibitor (PPI)
to treat the gastric burning.
C. Check the client’s serum creatinine and blood urea nitrogen
(BUN) levels.
D. Educate the client on taking the ibuprofen with food or a full
glass of milk.
Correct Answer
Correct Answer: C. Check the client’s serum creatinine and
blood urea nitrogen (BUN) levels.
Detailed Rationale
The primary concern in this clinical scenario is the client's
underlying Stage 3 chronic kidney disease (CKD) coupled with
high-dose, frequent use of a nonsteroidal anti-inflammatory
drug (NSAID) like ibuprofen. NSAIDs inhibit cyclooxygenase
(COX) enzymes, leading to decreased prostaglandin synthesis.
Prostaglandins are essential for maintaining renal perfusion via
afferent arteriolar vasodilation. In a patient with pre-existing
renal impairment, blocking this mechanism can precipitate
acute kidney injury (AKI) or accelerate progression to end-stage
renal disease. Therefore, checking the client's serum creatinine
and BUN levels is the priority nursing action to assess current
renal function before executing other interventions.
,Switching to another nonselective NSAID like naproxen (Option
A) would carry the same, if not worse, renal and gastrointestinal
risks and is contraindicated in this patient. While managing the
client’s gastric burning is important (Option B), administering a
PPI addresses a side effect rather than the potentially life-
threatening threat of acute-on-chronic renal failure. Educating
the client to take NSAIDs with food (Option D) reduces local GI
irritation but does not mitigate the systemic renal or mucosal
risks driven by systemic prostaglandin inhibition. The drug
should be discontinued under provider supervision, but
establishing baseline renal damage is the immediate priority.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the risk of acute kidney injury associated with
NSAID use in patients with chronic kidney disease.
• Prioritize nursing assessments (laboratory evaluation) for
high-risk clients taking nephrotoxic medications.
• Differentiate between local GI irritation interventions and
systemic adverse effect risks of NSAIDs.
Medication Safety Focus
Contraindication
Question 2
, Clinical Scenario
A 45-year-old female is being discharged following an
orthopedic procedure. She is prescribed an oral combination
opioid/non-opioid analgesic containing hydrocodone 5 mg and
acetaminophen 325 mg, 1 to 2 tablets every 4 to 6 hours as
needed for moderate to severe pain.
Question Stem
Which instruction is most important for the nurse to include in
the discharge teaching?
A. "Do not exceed 12 tablets of this medication in any 24-hour
period."
B. "Check all over-the-counter cold and pain remedies to ensure
they do not contain acetaminophen."
C. "Take this medication on an empty stomach to ensure rapid
and effective pain relief."
D. "Incorporate a high-protein diet to help accelerate surgical
wound healing while taking this drug."
Correct Answer
Correct Answer: B. "Check all over-the-counter cold and pain
remedies to ensure they do not contain acetaminophen."
Detailed Rationale
