NCLEX-RN Pharmacology
Practice Exam |
Pain & Inflammation | 20 NGN-
Style Questions with Detailed
Rationales
ATI Pharmacology Made Easy
Nursing Exam Prep Study
Guide
,Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of both knees is
admitted for worsening joint pain. Her medical history includes
hypertension, stage 3 chronic kidney disease (eGFR 42
mL/min/1.73 m²), and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
every 8 hours as needed for pain.
Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Review the patient's renal function and recent serum
creatinine level.
B. Administer the medication with orange juice.
C. Encourage the patient to increase dietary potassium intake.
D. Schedule the medication to be taken at bedtime only.
Correct Answer
Correct Answer: A. Review the patient's renal function and
recent serum creatinine level.
,Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. Although this mechanism provides
analgesic and anti-inflammatory effects, prostaglandins also
help maintain renal blood flow, particularly in patients with
impaired kidney function. In older adults with chronic kidney
disease, NSAIDs can further reduce renal perfusion, resulting in
acute kidney injury, worsening renal function, fluid retention,
and elevated blood pressure. Reviewing renal function before
administration is therefore the highest-priority nursing action.
Option B is incorrect because ibuprofen should generally be
administered with food or milk to reduce gastrointestinal
irritation; orange juice offers no protective benefit.
Option C is incorrect because increasing potassium intake is
inappropriate without assessment. NSAIDs may reduce renal
potassium excretion, increasing the risk of hyperkalemia,
especially when combined with an ACE inhibitor such as
lisinopril.
Option D is incorrect because the timing of administration is
less important than evaluating whether the medication can be
administered safely. Nursing assessment always precedes
medication administration when significant contraindications
exist.
, Patient education should include avoiding over-the-counter
NSAIDs unless approved, maintaining hydration, recognizing
decreased urine output, and promptly reporting swelling or
sudden weight gain. Ongoing monitoring includes renal
function, blood pressure, edema, and gastrointestinal
symptoms.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing assessments before NSAID
administration.
• Recognize medication interactions that increase renal
complications.
• Monitor for signs of worsening renal function during NSAID
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
Practice Exam |
Pain & Inflammation | 20 NGN-
Style Questions with Detailed
Rationales
ATI Pharmacology Made Easy
Nursing Exam Prep Study
Guide
,Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis of both knees is
admitted for worsening joint pain. Her medical history includes
hypertension, stage 3 chronic kidney disease (eGFR 42
mL/min/1.73 m²), and gastroesophageal reflux disease. Current
medications include lisinopril, hydrochlorothiazide, and
omeprazole. The provider prescribes ibuprofen 600 mg orally
every 8 hours as needed for pain.
Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Review the patient's renal function and recent serum
creatinine level.
B. Administer the medication with orange juice.
C. Encourage the patient to increase dietary potassium intake.
D. Schedule the medication to be taken at bedtime only.
Correct Answer
Correct Answer: A. Review the patient's renal function and
recent serum creatinine level.
,Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, reducing
prostaglandin synthesis. Although this mechanism provides
analgesic and anti-inflammatory effects, prostaglandins also
help maintain renal blood flow, particularly in patients with
impaired kidney function. In older adults with chronic kidney
disease, NSAIDs can further reduce renal perfusion, resulting in
acute kidney injury, worsening renal function, fluid retention,
and elevated blood pressure. Reviewing renal function before
administration is therefore the highest-priority nursing action.
Option B is incorrect because ibuprofen should generally be
administered with food or milk to reduce gastrointestinal
irritation; orange juice offers no protective benefit.
Option C is incorrect because increasing potassium intake is
inappropriate without assessment. NSAIDs may reduce renal
potassium excretion, increasing the risk of hyperkalemia,
especially when combined with an ACE inhibitor such as
lisinopril.
Option D is incorrect because the timing of administration is
less important than evaluating whether the medication can be
administered safely. Nursing assessment always precedes
medication administration when significant contraindications
exist.
, Patient education should include avoiding over-the-counter
NSAIDs unless approved, maintaining hydration, recognizing
decreased urine output, and promptly reporting swelling or
sudden weight gain. Ongoing monitoring includes renal
function, blood pressure, edema, and gastrointestinal
symptoms.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize nursing assessments before NSAID
administration.
• Recognize medication interactions that increase renal
complications.
• Monitor for signs of worsening renal function during NSAID
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
