ATI Pharmacology Made Easy Pain and
Inflammation Exam
20 NCLEX-RN Next Generation (NGN)
Practice Questions with Detailed
Rationales
NSAIDs, Opioids, Corticosteroids,
Analgesics & Medication Safety Study
Guide
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite taking acetaminophen as
prescribed. Her provider prescribes ibuprofen 400 mg orally
every 8 hours as needed. Her medical history includes
hypertension, chronic kidney disease stage 3, and
gastroesophageal reflux disease. Current medications include
lisinopril, hydrochlorothiazide, and omeprazole. Baseline
laboratory results include serum creatinine 1.8 mg/dL, BUN 34
,mg/dL, potassium 4.6 mEq/L, and blood pressure 146/84 mm
Hg.
Question Stem
Which assessment finding should cause the nurse to question
the prescription for ibuprofen before administration?
A. History of gastroesophageal reflux disease
B. Chronic kidney disease with elevated serum creatinine
C. Blood pressure of 146/84 mm Hg
D. Current use of omeprazole
Correct Answer
Correct Answer: B. Chronic kidney disease with elevated
serum creatinine
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. Although this reduces inflammation
and pain, prostaglandins are also responsible for maintaining
renal blood flow, particularly in patients with impaired kidney
function. In individuals with chronic kidney disease (CKD),
NSAIDs may further reduce renal perfusion, leading to acute
kidney injury, worsening serum creatinine, fluid retention, and
electrolyte disturbances. Because this patient already has stage
,3 CKD and an elevated creatinine level, the nurse should clarify
the prescription before administration.
Option A is incorrect because GERD increases the risk of
gastrointestinal irritation, but the patient is receiving
omeprazole, which provides some gastric protection. While
caution is warranted, GERD alone is not the strongest reason to
question the prescription.
Option C is incorrect because mild hypertension does not
independently contraindicate ibuprofen, although NSAIDs may
contribute to elevated blood pressure over time.
Option D is incorrect because omeprazole may help reduce the
risk of NSAID-associated gastric ulcers and is not a
contraindication.
The nurse should review renal function, monitor urine output,
assess for edema, and collaborate with the provider regarding
safer analgesic alternatives if appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize renal contraindications to NSAID therapy.
• Identify patients at increased risk for NSAID-induced
nephrotoxicity.
, • Prioritize assessment findings before administering anti-
inflammatory medications.
Medication Safety Focus
Contraindication and renal function monitoring
Question 2
Clinical Scenario
A 54-year-old man underwent abdominal surgery yesterday and
is receiving morphine 2 mg IV every 2 hours as needed for
severe pain. Thirty minutes after receiving a dose, the nurse
finds the patient asleep but arousable to verbal stimulation.
Respiratory rate is 8 breaths/min, oxygen saturation is 89% on
room air, heart rate is 58 beats/min, and blood pressure is
100/60 mm Hg.
Question Stem
Which nursing action is the priority?
A. Encourage deep breathing exercises and reassess in one
hour.
B. Administer naloxone as prescribed and notify the provider.
C. Administer the next scheduled pain medication later.
D. Place the patient in a high-Fowler position only.
Inflammation Exam
20 NCLEX-RN Next Generation (NGN)
Practice Questions with Detailed
Rationales
NSAIDs, Opioids, Corticosteroids,
Analgesics & Medication Safety Study
Guide
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite taking acetaminophen as
prescribed. Her provider prescribes ibuprofen 400 mg orally
every 8 hours as needed. Her medical history includes
hypertension, chronic kidney disease stage 3, and
gastroesophageal reflux disease. Current medications include
lisinopril, hydrochlorothiazide, and omeprazole. Baseline
laboratory results include serum creatinine 1.8 mg/dL, BUN 34
,mg/dL, potassium 4.6 mEq/L, and blood pressure 146/84 mm
Hg.
Question Stem
Which assessment finding should cause the nurse to question
the prescription for ibuprofen before administration?
A. History of gastroesophageal reflux disease
B. Chronic kidney disease with elevated serum creatinine
C. Blood pressure of 146/84 mm Hg
D. Current use of omeprazole
Correct Answer
Correct Answer: B. Chronic kidney disease with elevated
serum creatinine
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. Although this reduces inflammation
and pain, prostaglandins are also responsible for maintaining
renal blood flow, particularly in patients with impaired kidney
function. In individuals with chronic kidney disease (CKD),
NSAIDs may further reduce renal perfusion, leading to acute
kidney injury, worsening serum creatinine, fluid retention, and
electrolyte disturbances. Because this patient already has stage
,3 CKD and an elevated creatinine level, the nurse should clarify
the prescription before administration.
Option A is incorrect because GERD increases the risk of
gastrointestinal irritation, but the patient is receiving
omeprazole, which provides some gastric protection. While
caution is warranted, GERD alone is not the strongest reason to
question the prescription.
Option C is incorrect because mild hypertension does not
independently contraindicate ibuprofen, although NSAIDs may
contribute to elevated blood pressure over time.
Option D is incorrect because omeprazole may help reduce the
risk of NSAID-associated gastric ulcers and is not a
contraindication.
The nurse should review renal function, monitor urine output,
assess for edema, and collaborate with the provider regarding
safer analgesic alternatives if appropriate.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize renal contraindications to NSAID therapy.
• Identify patients at increased risk for NSAID-induced
nephrotoxicity.
, • Prioritize assessment findings before administering anti-
inflammatory medications.
Medication Safety Focus
Contraindication and renal function monitoring
Question 2
Clinical Scenario
A 54-year-old man underwent abdominal surgery yesterday and
is receiving morphine 2 mg IV every 2 hours as needed for
severe pain. Thirty minutes after receiving a dose, the nurse
finds the patient asleep but arousable to verbal stimulation.
Respiratory rate is 8 breaths/min, oxygen saturation is 89% on
room air, heart rate is 58 beats/min, and blood pressure is
100/60 mm Hg.
Question Stem
Which nursing action is the priority?
A. Encourage deep breathing exercises and reassess in one
hour.
B. Administer naloxone as prescribed and notify the provider.
C. Administer the next scheduled pain medication later.
D. Place the patient in a high-Fowler position only.
