NCLEX-RN Pharmacology Practice Exam
| Pain & Inflammation
| 20 ATI & NGN-Style Questions with
Detailed Rationales |
NSAIDs, Opioids, Corticosteroids, Gout
Medications |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports increasing
bilateral knee pain despite taking over-the-counter ibuprofen
for the past 3 months. His medical history includes
hypertension, chronic kidney disease (stage 3), and heart
failure. Current medications include lisinopril, furosemide, and
aspirin 81 mg daily. Assessment findings include BP 152/88 mm
Hg, HR 76/min, RR 18/min, and mild bilateral ankle edema.
,Laboratory results reveal serum creatinine 2.0 mg/dL (baseline
1.5 mg/dL), BUN 34 mg/dL, and potassium 5.3 mEq/L.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue ibuprofen with meals.
B. Notify the provider about worsening renal function and
recent NSAID use.
C. Recommend increasing the ibuprofen dose for better pain
relief.
D. Administer the scheduled aspirin before notifying the
provider.
Correct Answer
Correct Answer: B. Notify the provider about worsening renal
function and recent NSAID use.
Detailed Rationale
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID),
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. While effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, particularly
in patients with chronic kidney disease, heart failure, or volume
depletion. In this client, the rising serum creatinine, elevated
BUN, hyperkalemia, and edema strongly suggest NSAID-
,associated deterioration of renal function. Prompt notification
of the provider is the safest priority to prevent further kidney
injury and evaluate alternative pain management.
Option A is incorrect because taking NSAIDs with food may
reduce gastrointestinal irritation but does not prevent
nephrotoxicity.
Option C is unsafe because increasing the NSAID dose would
likely worsen renal impairment and cardiovascular risk.
Option D is incorrect because aspirin does not address the
immediate concern, and the client's declining renal function
requires prompt evaluation before routine medication
administration.
Nurses should assess renal function before and during
prolonged NSAID therapy, especially in older adults and those
taking ACE inhibitors and diuretics. This combination ("triple
whammy") significantly increases the risk of acute kidney injury.
Monitoring urine output, electrolytes, blood pressure, and fluid
status is essential. Patients should also be taught to avoid self-
medicating with OTC NSAIDs unless specifically approved by
their healthcare 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 interventions for declining renal function.
• Recognize clinically significant laboratory changes
associated with NSAID toxicity.
• Educate patients regarding safe OTC analgesic use.
Medication Safety Focus
Monitoring—Renal function during NSAID therapy
Question 2
Clinical Scenario
A 45-year-old woman is prescribed prednisone for an acute
exacerbation of systemic lupus erythematosus. During
discharge teaching, she asks how to safely take the medication.
She has no history of diabetes but reports occasional heartburn.
Question Stem
Which statement by the client indicates correct understanding
of prednisone therapy?
A. "I will stop taking the medication once my symptoms
improve."
| Pain & Inflammation
| 20 ATI & NGN-Style Questions with
Detailed Rationales |
NSAIDs, Opioids, Corticosteroids, Gout
Medications |
Nursing Exam Study Guide
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports increasing
bilateral knee pain despite taking over-the-counter ibuprofen
for the past 3 months. His medical history includes
hypertension, chronic kidney disease (stage 3), and heart
failure. Current medications include lisinopril, furosemide, and
aspirin 81 mg daily. Assessment findings include BP 152/88 mm
Hg, HR 76/min, RR 18/min, and mild bilateral ankle edema.
,Laboratory results reveal serum creatinine 2.0 mg/dL (baseline
1.5 mg/dL), BUN 34 mg/dL, and potassium 5.3 mEq/L.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue ibuprofen with meals.
B. Notify the provider about worsening renal function and
recent NSAID use.
C. Recommend increasing the ibuprofen dose for better pain
relief.
D. Administer the scheduled aspirin before notifying the
provider.
Correct Answer
Correct Answer: B. Notify the provider about worsening renal
function and recent NSAID use.
Detailed Rationale
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID),
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. While effective for pain and inflammation,
prostaglandins also help maintain renal blood flow, particularly
in patients with chronic kidney disease, heart failure, or volume
depletion. In this client, the rising serum creatinine, elevated
BUN, hyperkalemia, and edema strongly suggest NSAID-
,associated deterioration of renal function. Prompt notification
of the provider is the safest priority to prevent further kidney
injury and evaluate alternative pain management.
Option A is incorrect because taking NSAIDs with food may
reduce gastrointestinal irritation but does not prevent
nephrotoxicity.
Option C is unsafe because increasing the NSAID dose would
likely worsen renal impairment and cardiovascular risk.
Option D is incorrect because aspirin does not address the
immediate concern, and the client's declining renal function
requires prompt evaluation before routine medication
administration.
Nurses should assess renal function before and during
prolonged NSAID therapy, especially in older adults and those
taking ACE inhibitors and diuretics. This combination ("triple
whammy") significantly increases the risk of acute kidney injury.
Monitoring urine output, electrolytes, blood pressure, and fluid
status is essential. Patients should also be taught to avoid self-
medicating with OTC NSAIDs unless specifically approved by
their healthcare 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 interventions for declining renal function.
• Recognize clinically significant laboratory changes
associated with NSAID toxicity.
• Educate patients regarding safe OTC analgesic use.
Medication Safety Focus
Monitoring—Renal function during NSAID therapy
Question 2
Clinical Scenario
A 45-year-old woman is prescribed prednisone for an acute
exacerbation of systemic lupus erythematosus. During
discharge teaching, she asks how to safely take the medication.
She has no history of diabetes but reports occasional heartburn.
Question Stem
Which statement by the client indicates correct understanding
of prednisone therapy?
A. "I will stop taking the medication once my symptoms
improve."
