NCLEX-RN Pharmacology Practice
Questions
Pain & Inflammation
20 Original ATI & NGN-Style MCQs with
Rationales
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted with osteoarthritis pain
affecting both knees. Her medical history includes chronic
kidney disease (stage 3), hypertension, and heart failure.
Current medications include lisinopril, furosemide, and low-
dose aspirin. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Laboratory results include
serum creatinine 2.0 mg/dL (baseline 1.9 mg/dL), BUN 36
mg/dL, and potassium 4.8 mEq/L. Blood pressure is 138/82 mm
Hg, and she reports pain rated 8/10.
Question Stem
,Which action should the nurse take first before administering
the prescribed ibuprofen?
A. Administer the medication with food to reduce
gastrointestinal irritation.
B. Contact the provider to discuss the client's renal impairment
and cardiovascular history.
C. Encourage the client to increase oral fluid intake after taking
the medication.
D. Administer the prescribed dose because the pain rating is
severe.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
renal impairment and cardiovascular history.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. While effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, especially in
patients with chronic kidney disease (CKD), heart failure, or
volume depletion. This client has multiple risk factors—
including CKD, heart failure, ACE inhibitor therapy (lisinopril),
and diuretic therapy (furosemide)—that substantially increase
the risk of NSAID-induced acute kidney injury. Before
,administering the medication, the nurse should contact the
provider to discuss a safer analgesic option or dosage
adjustment.
Option A is incorrect because administering NSAIDs with food
reduces gastrointestinal irritation but does not address the
greater safety concern of renal injury.
Option C is incorrect because encouraging fluids does not
eliminate the risk of nephrotoxicity and may not be appropriate
for a client with heart failure.
Option D is incorrect because pain severity does not override
significant medication contraindications. Nurses should
evaluate medication safety before administration.
This scenario demonstrates clinical judgment by requiring
prioritization of medication safety over symptom relief.
Monitoring renal function, urine output, blood pressure, and
signs of fluid retention is essential whenever NSAIDs are used in
high-risk populations.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize contraindications to NSAID therapy.
, • Prioritize medication safety before administering
analgesics.
• Explain the effect of prostaglandin inhibition on renal
perfusion.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 45-year-old man underwent laparoscopic cholecystectomy
earlier today. He reports incisional pain rated 8/10. The
provider prescribes morphine 2 mg IV every 2 hours as needed.
Assessment findings include respiratory rate 10/min, oxygen
saturation 95% on 2 L/min nasal cannula, heart rate 64/min,
blood pressure 118/70 mm Hg, and the client is difficult to
arouse.
Question Stem
Which nursing action is the priority?
A. Administer the prescribed morphine for pain relief.
B. Encourage deep breathing and reassess in 2 hours.
Questions
Pain & Inflammation
20 Original ATI & NGN-Style MCQs with
Rationales
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted with osteoarthritis pain
affecting both knees. Her medical history includes chronic
kidney disease (stage 3), hypertension, and heart failure.
Current medications include lisinopril, furosemide, and low-
dose aspirin. The provider prescribes ibuprofen 600 mg orally
every 6 hours as needed for pain. Laboratory results include
serum creatinine 2.0 mg/dL (baseline 1.9 mg/dL), BUN 36
mg/dL, and potassium 4.8 mEq/L. Blood pressure is 138/82 mm
Hg, and she reports pain rated 8/10.
Question Stem
,Which action should the nurse take first before administering
the prescribed ibuprofen?
A. Administer the medication with food to reduce
gastrointestinal irritation.
B. Contact the provider to discuss the client's renal impairment
and cardiovascular history.
C. Encourage the client to increase oral fluid intake after taking
the medication.
D. Administer the prescribed dose because the pain rating is
severe.
Correct Answer
Correct Answer: B. Contact the provider to discuss the client's
renal impairment and cardiovascular history.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. While effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, especially in
patients with chronic kidney disease (CKD), heart failure, or
volume depletion. This client has multiple risk factors—
including CKD, heart failure, ACE inhibitor therapy (lisinopril),
and diuretic therapy (furosemide)—that substantially increase
the risk of NSAID-induced acute kidney injury. Before
,administering the medication, the nurse should contact the
provider to discuss a safer analgesic option or dosage
adjustment.
Option A is incorrect because administering NSAIDs with food
reduces gastrointestinal irritation but does not address the
greater safety concern of renal injury.
Option C is incorrect because encouraging fluids does not
eliminate the risk of nephrotoxicity and may not be appropriate
for a client with heart failure.
Option D is incorrect because pain severity does not override
significant medication contraindications. Nurses should
evaluate medication safety before administration.
This scenario demonstrates clinical judgment by requiring
prioritization of medication safety over symptom relief.
Monitoring renal function, urine output, blood pressure, and
signs of fluid retention is essential whenever NSAIDs are used in
high-risk populations.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize contraindications to NSAID therapy.
, • Prioritize medication safety before administering
analgesics.
• Explain the effect of prostaglandin inhibition on renal
perfusion.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 45-year-old man underwent laparoscopic cholecystectomy
earlier today. He reports incisional pain rated 8/10. The
provider prescribes morphine 2 mg IV every 2 hours as needed.
Assessment findings include respiratory rate 10/min, oxygen
saturation 95% on 2 L/min nasal cannula, heart rate 64/min,
blood pressure 118/70 mm Hg, and the client is difficult to
arouse.
Question Stem
Which nursing action is the priority?
A. Administer the prescribed morphine for pain relief.
B. Encourage deep breathing and reassess in 2 hours.
