NCLEX-RN Pharmacology Practice Questions
Bank:
20 Original ATI & NGN-Style MCQs with Detailed Rationales
(Comprehensive Introduction to Pharmacology Guide)
Question 1
Clinical Scenario
A 74-year-old female patient with a history of stage 3 chronic
kidney disease (CKD) and chronic osteoarthritis is being
discharged from an orthopedic unit. During medication
reconciliation, the nurse notes the patient has been taking over-
the-counter ibuprofen 400 mg three times daily for joint pain.
The patient asks, "Can I just keep taking my ibuprofen at home
like I used to?"
Question Stem
Which response by the nurse is most appropriate?
,A. "Yes, but you should take it with food or a full glass of milk to
prevent stomach upset."
B. "No, you should switch to naproxen, as it is processed by the
liver rather than the kidneys."
C. "No, nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen can further decline your kidney function."
D. "Yes, but we will need to have your doctor check your liver
function tests every month."
Correct Answer
Correct Answer: C. "No, nonsteroidal anti-inflammatory drugs
(NSAIDs) like ibuprofen can further decline your kidney
function."
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, inhibit cyclooxygenase (COX) enzymes, which leads
to a decrease in prostaglandin synthesis. In the kidneys,
prostaglandins cause vasodilation of the afferent arterioles to
maintain adequate glomerular filtration rate (GFR). By blocking
this mechanisms, NSAIDs cause afferent arteriolar
vasoconstriction, decreasing renal blood flow and potentially
triggering acute-on-chronic kidney injury. This patient already
has stage 3 chronic kidney disease, making NSAID use highly
risky.
,Option A is incorrect because while taking NSAIDs with food
reduces gastrointestinal irritation, it does not mitigate the renal
risks. Option B is incorrect because naproxen is also an NSAID
and shares the exact same nephrotoxic profile; it is not a safe
alternative for a renal patient. Option D is incorrect because the
primary concern with NSAIDs in this patient is renal impairment
rather than hepatotoxicity, so monitoring liver function tests
would not address the core safety issue.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action by which NSAIDs affect
renal perfusion.
• Identify underlying conditions that contraindicate the use
of over-the-counter NSAIDs.
• Perform effective medication reconciliation and patient
education for an older adult with renal impairment.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A nurse on a medical-surgical unit is preparing to administer
medications to a 68-year-old male client diagnosed with heart
, failure. The client’s current scheduled medications include
digoxin 0.125 mg PO daily and furosemide 400 mg PO daily. The
morning laboratory values reveal a serum potassium level of 3.1
mEq/L (3.1 mmol/L) and a digoxin level of 1.2 ng/mL. The client
reports mild nausea and seeing "yellow halos" around the
lights.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled digoxin and furosemide doses.
B. Hold the digoxin and notify the healthcare provider
immediately.
C. Request a repeat serum digoxin level to verify the results.
D. Encourage the client to eat a banana or drink orange juice.
Correct Answer
Correct Answer: B. Hold the digoxin and notify the healthcare
provider immediately.
Detailed Rationale
The client is exhibiting classic signs of digoxin toxicity, which
include gastrointestinal disturbances (nausea) and visual
changes (yellow halos around lights). Although the client’s
serum digoxin level (1.2 ng/mL) falls within the standard
therapeutic range (typically 0.5–2.0 ng/mL for heart failure,
Bank:
20 Original ATI & NGN-Style MCQs with Detailed Rationales
(Comprehensive Introduction to Pharmacology Guide)
Question 1
Clinical Scenario
A 74-year-old female patient with a history of stage 3 chronic
kidney disease (CKD) and chronic osteoarthritis is being
discharged from an orthopedic unit. During medication
reconciliation, the nurse notes the patient has been taking over-
the-counter ibuprofen 400 mg three times daily for joint pain.
The patient asks, "Can I just keep taking my ibuprofen at home
like I used to?"
Question Stem
Which response by the nurse is most appropriate?
,A. "Yes, but you should take it with food or a full glass of milk to
prevent stomach upset."
B. "No, you should switch to naproxen, as it is processed by the
liver rather than the kidneys."
C. "No, nonsteroidal anti-inflammatory drugs (NSAIDs) like
ibuprofen can further decline your kidney function."
D. "Yes, but we will need to have your doctor check your liver
function tests every month."
Correct Answer
Correct Answer: C. "No, nonsteroidal anti-inflammatory drugs
(NSAIDs) like ibuprofen can further decline your kidney
function."
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, inhibit cyclooxygenase (COX) enzymes, which leads
to a decrease in prostaglandin synthesis. In the kidneys,
prostaglandins cause vasodilation of the afferent arterioles to
maintain adequate glomerular filtration rate (GFR). By blocking
this mechanisms, NSAIDs cause afferent arteriolar
vasoconstriction, decreasing renal blood flow and potentially
triggering acute-on-chronic kidney injury. This patient already
has stage 3 chronic kidney disease, making NSAID use highly
risky.
,Option A is incorrect because while taking NSAIDs with food
reduces gastrointestinal irritation, it does not mitigate the renal
risks. Option B is incorrect because naproxen is also an NSAID
and shares the exact same nephrotoxic profile; it is not a safe
alternative for a renal patient. Option D is incorrect because the
primary concern with NSAIDs in this patient is renal impairment
rather than hepatotoxicity, so monitoring liver function tests
would not address the core safety issue.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action by which NSAIDs affect
renal perfusion.
• Identify underlying conditions that contraindicate the use
of over-the-counter NSAIDs.
• Perform effective medication reconciliation and patient
education for an older adult with renal impairment.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A nurse on a medical-surgical unit is preparing to administer
medications to a 68-year-old male client diagnosed with heart
, failure. The client’s current scheduled medications include
digoxin 0.125 mg PO daily and furosemide 400 mg PO daily. The
morning laboratory values reveal a serum potassium level of 3.1
mEq/L (3.1 mmol/L) and a digoxin level of 1.2 ng/mL. The client
reports mild nausea and seeing "yellow halos" around the
lights.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled digoxin and furosemide doses.
B. Hold the digoxin and notify the healthcare provider
immediately.
C. Request a repeat serum digoxin level to verify the results.
D. Encourage the client to eat a banana or drink orange juice.
Correct Answer
Correct Answer: B. Hold the digoxin and notify the healthcare
provider immediately.
Detailed Rationale
The client is exhibiting classic signs of digoxin toxicity, which
include gastrointestinal disturbances (nausea) and visual
changes (yellow halos around lights). Although the client’s
serum digoxin level (1.2 ng/mL) falls within the standard
therapeutic range (typically 0.5–2.0 ng/mL for heart failure,
