NCLEX-RN Pharmacology Practice
Questions
Pain & Inflammation
20 Original NCLEX-Style MCQs with
Detailed Rationales, Clinical Judgment,
Medication Safety & NGN Review Guide
Question 1
Clinical Scenario
A 67-year-old man with osteoarthritis reports worsening
bilateral knee pain rated 8/10. His medical history includes
hypertension, chronic kidney disease (stage 3), and
gastroesophageal reflux disease. Current medications include
lisinopril, hydrochlorothiazide, and omeprazole. Vital signs are
stable. Laboratory results reveal a serum creatinine of 2.0
mg/dL (baseline 1.9 mg/dL) and an estimated glomerular
filtration rate (eGFR) of 38 mL/min/1.73 m².
Question Stem
,Which prescribed medication should the nurse question before
administration?
A. Acetaminophen 650 mg orally every 6 hours as needed
B. Ibuprofen 600 mg orally every 8 hours
C. Topical diclofenac gel applied to both knees
D. Lidocaine 5% topical patch
Correct Answer
Correct Answer: B. Ibuprofen 600 mg orally every 8 hours
Detailed Rationale
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID),
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
particularly in patients with chronic kidney disease. NSAIDs can
reduce renal perfusion, precipitate acute kidney injury, worsen
hypertension, and diminish the effectiveness of
antihypertensive medications such as ACE inhibitors. Given this
patient's reduced kidney function, oral ibuprofen presents the
greatest safety concern and should be questioned before
administration.
Option A: Acetaminophen is generally considered the preferred
first-line analgesic for osteoarthritis in patients with chronic
,kidney disease when used within recommended daily limits.
Although liver toxicity is possible with excessive doses, it is not
the primary concern in this scenario.
Option C: Topical diclofenac results in significantly lower
systemic absorption than oral NSAIDs and may be appropriate
with careful monitoring.
Option D: Lidocaine patches provide localized pain relief
without significant renal effects and are generally considered
safe.
Medication Safety: Nurses should assess renal function before
administering NSAIDs, monitor serum creatinine, evaluate urine
output, and educate patients to avoid over-the-counter NSAIDs
without consulting 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.
• Differentiate safer analgesic options for patients with
chronic kidney disease.
• Recognize the importance of reviewing renal laboratory
values before medication administration.
Medication Safety Focus
, Contraindication and Renal Function Monitoring
Question 2
Clinical Scenario
A 58-year-old woman underwent abdominal surgery 24 hours
ago. She is receiving morphine via patient-controlled analgesia
(PCA). During assessment, the nurse notes that the patient is
difficult to awaken, has a respiratory rate of 8 breaths/minute,
oxygen saturation of 89% on room air, and pinpoint pupils.
Question Stem
What is the nurse's priority action?
A. Encourage deep breathing and reassess in 30 minutes.
B. Administer naloxone as prescribed and support the airway.
C. Increase intravenous fluids to improve medication clearance.
D. Place the patient in a high-Fowler position and continue
monitoring.
Correct Answer
Correct Answer: B. Administer naloxone as prescribed and
support the airway.
Detailed Rationale
Questions
Pain & Inflammation
20 Original NCLEX-Style MCQs with
Detailed Rationales, Clinical Judgment,
Medication Safety & NGN Review Guide
Question 1
Clinical Scenario
A 67-year-old man with osteoarthritis reports worsening
bilateral knee pain rated 8/10. His medical history includes
hypertension, chronic kidney disease (stage 3), and
gastroesophageal reflux disease. Current medications include
lisinopril, hydrochlorothiazide, and omeprazole. Vital signs are
stable. Laboratory results reveal a serum creatinine of 2.0
mg/dL (baseline 1.9 mg/dL) and an estimated glomerular
filtration rate (eGFR) of 38 mL/min/1.73 m².
Question Stem
,Which prescribed medication should the nurse question before
administration?
A. Acetaminophen 650 mg orally every 6 hours as needed
B. Ibuprofen 600 mg orally every 8 hours
C. Topical diclofenac gel applied to both knees
D. Lidocaine 5% topical patch
Correct Answer
Correct Answer: B. Ibuprofen 600 mg orally every 8 hours
Detailed Rationale
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID),
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While effective for pain and
inflammation, prostaglandins help maintain renal blood flow,
particularly in patients with chronic kidney disease. NSAIDs can
reduce renal perfusion, precipitate acute kidney injury, worsen
hypertension, and diminish the effectiveness of
antihypertensive medications such as ACE inhibitors. Given this
patient's reduced kidney function, oral ibuprofen presents the
greatest safety concern and should be questioned before
administration.
Option A: Acetaminophen is generally considered the preferred
first-line analgesic for osteoarthritis in patients with chronic
,kidney disease when used within recommended daily limits.
Although liver toxicity is possible with excessive doses, it is not
the primary concern in this scenario.
Option C: Topical diclofenac results in significantly lower
systemic absorption than oral NSAIDs and may be appropriate
with careful monitoring.
Option D: Lidocaine patches provide localized pain relief
without significant renal effects and are generally considered
safe.
Medication Safety: Nurses should assess renal function before
administering NSAIDs, monitor serum creatinine, evaluate urine
output, and educate patients to avoid over-the-counter NSAIDs
without consulting 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.
• Differentiate safer analgesic options for patients with
chronic kidney disease.
• Recognize the importance of reviewing renal laboratory
values before medication administration.
Medication Safety Focus
, Contraindication and Renal Function Monitoring
Question 2
Clinical Scenario
A 58-year-old woman underwent abdominal surgery 24 hours
ago. She is receiving morphine via patient-controlled analgesia
(PCA). During assessment, the nurse notes that the patient is
difficult to awaken, has a respiratory rate of 8 breaths/minute,
oxygen saturation of 89% on room air, and pinpoint pupils.
Question Stem
What is the nurse's priority action?
A. Encourage deep breathing and reassess in 30 minutes.
B. Administer naloxone as prescribed and support the airway.
C. Increase intravenous fluids to improve medication clearance.
D. Place the patient in a high-Fowler position and continue
monitoring.
Correct Answer
Correct Answer: B. Administer naloxone as prescribed and
support the airway.
Detailed Rationale
