NCLEX-RN Pharmacology Practice Exam
Questions & Answers |
Pain and Inflammation |
20 NGN-Style NCLEX Nursing MCQs with
Rationales |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis of both knees is admitted
for worsening joint pain. His medical history includes chronic
kidney disease (stage 3), hypertension, and gastroesophageal
reflux disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. His serum creatinine is
2.0 mg/dL (baseline 1.8 mg/dL), BUN is 38 mg/dL, blood
pressure is 138/82 mm Hg, and pain is rated 8/10. The provider
prescribes ibuprofen 600 mg orally every 6 hours as needed for
pain.
Question Stem
,Which action should the nurse take first?
A. Administer the ibuprofen as prescribed.
B. Request an opioid analgesic instead of ibuprofen.
C. Clarify the prescription with the provider before
administering the medication.
D. Administer the ibuprofen with food to reduce gastric
irritation.
Correct Answer
C. Clarify the prescription with the provider before
administering the medication.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
particularly in patients with impaired kidney function. This
patient already has chronic kidney disease and an elevated
serum creatinine. Administering ibuprofen could further reduce
renal perfusion, increasing the risk of acute kidney injury. The
nurse should clarify the prescription before administration and
collaborate with the provider to identify a safer analgesic
option.
, • Option A: Administering the medication without
evaluating contraindications places the patient at
unnecessary risk for nephrotoxicity.
• Option B: Although an alternative medication may
ultimately be appropriate, the nurse should first clarify the
prescription rather than independently recommending a
specific drug.
• Option D: Giving NSAIDs with food decreases
gastrointestinal irritation but does not reduce the risk of
renal injury.
Nursing care includes reviewing renal function, monitoring
urine output, assessing pain relief, evaluating concurrent
nephrotoxic medications, and educating patients to avoid over-
the-counter NSAIDs unless approved by their provider.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing actions when contraindications are
identified.
• Interpret renal laboratory values before medication
administration.
, • Promote safe analgesic use in older adults.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 34-year-old woman is recovering from laparoscopic
abdominal surgery. Two hours after receiving intravenous
morphine, the nurse notes that the patient is difficult to arouse.
Respiratory rate is 8 breaths/minute, oxygen saturation is 88%
on room air, blood pressure is 104/62 mm Hg, and pupils are
pinpoint.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Flumazenil
B. Naloxone
C. Acetylcysteine
D. Protamine sulfate
Correct Answer
B. Naloxone
Questions & Answers |
Pain and Inflammation |
20 NGN-Style NCLEX Nursing MCQs with
Rationales |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis of both knees is admitted
for worsening joint pain. His medical history includes chronic
kidney disease (stage 3), hypertension, and gastroesophageal
reflux disease. Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. His serum creatinine is
2.0 mg/dL (baseline 1.8 mg/dL), BUN is 38 mg/dL, blood
pressure is 138/82 mm Hg, and pain is rated 8/10. The provider
prescribes ibuprofen 600 mg orally every 6 hours as needed for
pain.
Question Stem
,Which action should the nurse take first?
A. Administer the ibuprofen as prescribed.
B. Request an opioid analgesic instead of ibuprofen.
C. Clarify the prescription with the provider before
administering the medication.
D. Administer the ibuprofen with food to reduce gastric
irritation.
Correct Answer
C. Clarify the prescription with the provider before
administering the medication.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
particularly in patients with impaired kidney function. This
patient already has chronic kidney disease and an elevated
serum creatinine. Administering ibuprofen could further reduce
renal perfusion, increasing the risk of acute kidney injury. The
nurse should clarify the prescription before administration and
collaborate with the provider to identify a safer analgesic
option.
, • Option A: Administering the medication without
evaluating contraindications places the patient at
unnecessary risk for nephrotoxicity.
• Option B: Although an alternative medication may
ultimately be appropriate, the nurse should first clarify the
prescription rather than independently recommending a
specific drug.
• Option D: Giving NSAIDs with food decreases
gastrointestinal irritation but does not reduce the risk of
renal injury.
Nursing care includes reviewing renal function, monitoring
urine output, assessing pain relief, evaluating concurrent
nephrotoxic medications, and educating patients to avoid over-
the-counter NSAIDs unless approved by their provider.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing actions when contraindications are
identified.
• Interpret renal laboratory values before medication
administration.
, • Promote safe analgesic use in older adults.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 34-year-old woman is recovering from laparoscopic
abdominal surgery. Two hours after receiving intravenous
morphine, the nurse notes that the patient is difficult to arouse.
Respiratory rate is 8 breaths/minute, oxygen saturation is 88%
on room air, blood pressure is 104/62 mm Hg, and pupils are
pinpoint.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Flumazenil
B. Naloxone
C. Acetylcysteine
D. Protamine sulfate
Correct Answer
B. Naloxone
