NCLEX-RN Pharmacology Pain & Inflammation:
20 Original NGN-Style Questions with
Rationales for Nursing Students
Question 1
Clinical Scenario
A 68-year-old male with a history of hypertension and type 2
diabetes is admitted to the medical-surgical unit following a
total knee arthroplasty. The patient rates his pain as 8 out of 10
on the numeric rating scale. The healthcare provider prescribes
morphine sulfate 4 mg IV push every 4 hours as needed for
severe pain. The patient's current vital signs are: blood pressure
148/92 mmHg, heart rate 96 bpm, respiratory rate 18
breaths/min, temperature 98.6°F, and oxygen saturation 95%
on room air. The patient has received two doses of morphine in
the past 8 hours. During the assessment, the nurse notes the
patient is somnolent and has a respiratory rate of 10
breaths/min.
,Question Stem
Which action should the nurse take first?
A. Administer naloxone 0.4 mg IV push.
B. Place the patient in a high-Fowler's position.
C. Stimulate the patient and reassess respiratory status.
D. Notify the healthcare provider immediately.
Correct Answer: C. Stimulate the patient and reassess
respiratory status.
Detailed Rationale
The correct answer is to stimulate the patient and reassess
respiratory status. In opioid-induced respiratory depression, the
first nursing action is to attempt to arouse the patient and
obtain a more accurate respiratory assessment. The patient has
a respiratory rate of 10 breaths/min with somnolence, which
indicates mild to moderate respiratory depression. Before
administering naloxone, the nurse must determine if the
respiratory depression is clinically significant and if the patient
can be stimulated to breathe adequately. Naloxone
administration is reserved for severe respiratory depression
(respiratory rate <8 breaths/min or apnea) and should be
,administered slowly to avoid acute withdrawal symptoms,
especially in patients who may be opioid-tolerant.
Option A is incorrect because naloxone should not be
administered for a respiratory rate of 10 breaths/min without
first attempting non-pharmacological interventions.
Administering naloxone prematurely could precipitate acute
withdrawal, including severe pain, hypertension, tachycardia,
and agitation. Option B is incorrect because while positioning is
important for respiratory function, it does not address the
underlying opioid-induced respiratory depression and is not the
priority action. Option D is incorrect because the nurse must
first complete a thorough assessment before notifying the
provider; the provider will need accurate assessment data to
determine the appropriate intervention.
Nursing considerations include monitoring respiratory rate,
depth, and pattern; assessing sedation levels using the Pasero
Opioid-Induced Sedation Scale; and implementing protocols for
opioid administration including baseline respiratory assessment
before each dose. The nurse should also evaluate for other
factors contributing to respiratory depression such as age,
concurrent medications (benzodiazepines, muscle relaxants),
and underlying pulmonary conditions.
Learning Objective
After completing this question, the learner should be able to:
, • Prioritize nursing interventions for opioid-induced
respiratory depression.
• Identify parameters for naloxone administration.
• Differentiate between mild, moderate, and severe
respiratory depression in opioid-treated patients.
• Implement appropriate assessment techniques for patients
receiving opioids.
Medication Safety Focus: Adverse effect monitoring and
medication administration safety
Question 2
Clinical Scenario
A 45-year-old female with rheumatoid arthritis has been taking
naproxen 500 mg twice daily for the past 6 months. She reports
to the clinic for a routine follow-up appointment. The patient
states, "My joint pain is much better, but I've been having some
stomach pain and heartburn." Her complete blood count (CBC)
reveals hemoglobin of 10.2 g/dL (normal: 12-16 g/dL),
hematocrit of 30.1% (normal: 36-48%), and platelet count of
150,000/mm³ (normal: 150,000-400,000/mm³). Her stool
guaiac test is positive. She denies any visual changes, ringing in
the ears, or headaches.
20 Original NGN-Style Questions with
Rationales for Nursing Students
Question 1
Clinical Scenario
A 68-year-old male with a history of hypertension and type 2
diabetes is admitted to the medical-surgical unit following a
total knee arthroplasty. The patient rates his pain as 8 out of 10
on the numeric rating scale. The healthcare provider prescribes
morphine sulfate 4 mg IV push every 4 hours as needed for
severe pain. The patient's current vital signs are: blood pressure
148/92 mmHg, heart rate 96 bpm, respiratory rate 18
breaths/min, temperature 98.6°F, and oxygen saturation 95%
on room air. The patient has received two doses of morphine in
the past 8 hours. During the assessment, the nurse notes the
patient is somnolent and has a respiratory rate of 10
breaths/min.
,Question Stem
Which action should the nurse take first?
A. Administer naloxone 0.4 mg IV push.
B. Place the patient in a high-Fowler's position.
C. Stimulate the patient and reassess respiratory status.
D. Notify the healthcare provider immediately.
Correct Answer: C. Stimulate the patient and reassess
respiratory status.
Detailed Rationale
The correct answer is to stimulate the patient and reassess
respiratory status. In opioid-induced respiratory depression, the
first nursing action is to attempt to arouse the patient and
obtain a more accurate respiratory assessment. The patient has
a respiratory rate of 10 breaths/min with somnolence, which
indicates mild to moderate respiratory depression. Before
administering naloxone, the nurse must determine if the
respiratory depression is clinically significant and if the patient
can be stimulated to breathe adequately. Naloxone
administration is reserved for severe respiratory depression
(respiratory rate <8 breaths/min or apnea) and should be
,administered slowly to avoid acute withdrawal symptoms,
especially in patients who may be opioid-tolerant.
Option A is incorrect because naloxone should not be
administered for a respiratory rate of 10 breaths/min without
first attempting non-pharmacological interventions.
Administering naloxone prematurely could precipitate acute
withdrawal, including severe pain, hypertension, tachycardia,
and agitation. Option B is incorrect because while positioning is
important for respiratory function, it does not address the
underlying opioid-induced respiratory depression and is not the
priority action. Option D is incorrect because the nurse must
first complete a thorough assessment before notifying the
provider; the provider will need accurate assessment data to
determine the appropriate intervention.
Nursing considerations include monitoring respiratory rate,
depth, and pattern; assessing sedation levels using the Pasero
Opioid-Induced Sedation Scale; and implementing protocols for
opioid administration including baseline respiratory assessment
before each dose. The nurse should also evaluate for other
factors contributing to respiratory depression such as age,
concurrent medications (benzodiazepines, muscle relaxants),
and underlying pulmonary conditions.
Learning Objective
After completing this question, the learner should be able to:
, • Prioritize nursing interventions for opioid-induced
respiratory depression.
• Identify parameters for naloxone administration.
• Differentiate between mild, moderate, and severe
respiratory depression in opioid-treated patients.
• Implement appropriate assessment techniques for patients
receiving opioids.
Medication Safety Focus: Adverse effect monitoring and
medication administration safety
Question 2
Clinical Scenario
A 45-year-old female with rheumatoid arthritis has been taking
naproxen 500 mg twice daily for the past 6 months. She reports
to the clinic for a routine follow-up appointment. The patient
states, "My joint pain is much better, but I've been having some
stomach pain and heartburn." Her complete blood count (CBC)
reveals hemoglobin of 10.2 g/dL (normal: 12-16 g/dL),
hematocrit of 30.1% (normal: 36-48%), and platelet count of
150,000/mm³ (normal: 150,000-400,000/mm³). Her stool
guaiac test is positive. She denies any visual changes, ringing in
the ears, or headaches.
