NCLEX-RN Pharmacology
Pain & Inflammation Exam
Questions
Original ATI & NGN Style MCQs
with Rationales
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain rated 8/10 over the past month. 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. Administer the medication with food.
B. Review the client's renal function and notify the provider of
impaired kidney function.
C. Instruct the client to avoid alcohol while taking the
medication.
D. Assess the client's pain level after 30 minutes.
Correct Answer
Correct Answer: B. Review the client's renal function and
notify the provider of impaired kidney function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis and reducing pain and inflammation.
However, prostaglandins also help maintain renal blood flow. In
patients with chronic kidney disease, NSAIDs may further
decrease renal perfusion, leading to acute kidney injury and
worsening renal function. This client already has stage 3 CKD
and is taking an ACE inhibitor and a diuretic—a combination
that further increases the risk of NSAID-induced kidney injury.
The nurse should review renal function and consult the provider
before administering the medication.
,Option A is appropriate patient teaching because taking NSAIDs
with food reduces gastrointestinal irritation, but it does not
address the greatest immediate safety concern.
Option C is correct education since alcohol increases the risk of
gastrointestinal bleeding, but this is not the priority before the
first dose.
Option D is appropriate after administration but should occur
only after determining that the medication can be safely given.
The nursing priority is preventing medication-related harm by
recognizing contraindications and assessing organ function
before administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment of renal function before NSAID
administration.
• Recognize medication combinations that increase
nephrotoxicity risk.
• Apply clinical judgment when administering analgesics.
Medication Safety Focus
Contraindication and Renal Function Monitoring
, Question 2
Clinical Scenario
A 45-year-old man underwent laparoscopic cholecystectomy
earlier today. He rates his incisional pain as 9/10. The provider
prescribes morphine 2 mg IV every 2 hours as needed for
severe pain. Assessment findings include:
• Blood pressure: 124/76 mm Hg
• Heart rate: 82/min
• Respiratory rate: 10/min
• Oxygen saturation: 94% on room air
• Patient is difficult to arouse but answers questions
appropriately.
Question Stem
Which nursing action should the nurse take first?
A. Administer the prescribed morphine.
B. Encourage deep breathing exercises.
C. Withhold morphine and notify the provider of the
assessment findings.
D. Reassess pain in one hour.
Pain & Inflammation Exam
Questions
Original ATI & NGN Style MCQs
with Rationales
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports increasing
bilateral knee pain rated 8/10 over the past month. 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. Administer the medication with food.
B. Review the client's renal function and notify the provider of
impaired kidney function.
C. Instruct the client to avoid alcohol while taking the
medication.
D. Assess the client's pain level after 30 minutes.
Correct Answer
Correct Answer: B. Review the client's renal function and
notify the provider of impaired kidney function.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis and reducing pain and inflammation.
However, prostaglandins also help maintain renal blood flow. In
patients with chronic kidney disease, NSAIDs may further
decrease renal perfusion, leading to acute kidney injury and
worsening renal function. This client already has stage 3 CKD
and is taking an ACE inhibitor and a diuretic—a combination
that further increases the risk of NSAID-induced kidney injury.
The nurse should review renal function and consult the provider
before administering the medication.
,Option A is appropriate patient teaching because taking NSAIDs
with food reduces gastrointestinal irritation, but it does not
address the greatest immediate safety concern.
Option C is correct education since alcohol increases the risk of
gastrointestinal bleeding, but this is not the priority before the
first dose.
Option D is appropriate after administration but should occur
only after determining that the medication can be safely given.
The nursing priority is preventing medication-related harm by
recognizing contraindications and assessing organ function
before administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Prioritize assessment of renal function before NSAID
administration.
• Recognize medication combinations that increase
nephrotoxicity risk.
• Apply clinical judgment when administering analgesics.
Medication Safety Focus
Contraindication and Renal Function Monitoring
, Question 2
Clinical Scenario
A 45-year-old man underwent laparoscopic cholecystectomy
earlier today. He rates his incisional pain as 9/10. The provider
prescribes morphine 2 mg IV every 2 hours as needed for
severe pain. Assessment findings include:
• Blood pressure: 124/76 mm Hg
• Heart rate: 82/min
• Respiratory rate: 10/min
• Oxygen saturation: 94% on room air
• Patient is difficult to arouse but answers questions
appropriately.
Question Stem
Which nursing action should the nurse take first?
A. Administer the prescribed morphine.
B. Encourage deep breathing exercises.
C. Withhold morphine and notify the provider of the
assessment findings.
D. Reassess pain in one hour.
