NCLEX-RN Pharmacology Practice Exam
Pain & Inflammation
Original NGN-Style Questions with
Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted with severe osteoarthritis
pain involving both knees. Her medical history includes chronic
kidney disease (stage 3), hypertension, heart failure with
preserved ejection fraction, and gastroesophageal reflux
disease. Current medications include lisinopril, furosemide, and
omeprazole. Vital signs are stable. The provider prescribes
ibuprofen 600 mg orally every 6 hours as needed for pain.
Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Assess the patient's bowel sounds.
,B. Review the patient's renal function and notify the provider of
the chronic kidney disease.
C. Encourage the patient to increase dietary potassium intake.
D. Administer the medication with orange juice to improve
absorption.
Correct Answer
B. Review the patient's renal function and notify the provider
of the chronic kidney disease.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis to reduce pain and inflammation.
However, prostaglandins also help maintain renal blood flow,
particularly in patients with chronic kidney disease, heart
failure, or volume depletion. In this patient, ibuprofen may
significantly worsen renal function and increase fluid retention,
especially when combined with lisinopril (an ACE inhibitor) and
furosemide (a diuretic), creating the well-known "triple
whammy" combination associated with acute kidney injury.
Option A is incorrect because bowel sounds are not the priority
assessment before NSAID administration. Option C is incorrect
because increasing potassium intake could be unsafe in a
patient taking lisinopril and does not address the primary
,medication risk. Option D is incorrect because ibuprofen should
be taken with food or milk—not acidic beverages—to minimize
gastrointestinal irritation.
The nurse should review serum creatinine, estimated
glomerular filtration rate (eGFR), and recent renal status before
administering the medication. If significant renal impairment
exists, the nurse should contact the provider to discuss safer
alternatives such as acetaminophen or topical therapies.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize important medication interactions affecting
renal perfusion.
• Prioritize assessment before administering NSAIDs.
• Apply clinical judgment when questioning potentially
unsafe medication orders.
Medication Safety Focus: Contraindication and renal function
monitoring.
Question 2
Clinical Scenario
, A 45-year-old man undergoes laparoscopic cholecystectomy.
Four hours after surgery, he reports incisional pain rated 8/10.
The provider prescribes morphine 2 mg IV every 2 hours as
needed. Before administration, the nurse notes the following
assessment findings:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 91% on room air
• Blood pressure: 118/70 mm Hg
• Heart rate: 74 beats/min
• Patient is difficult to arouse.
Question Stem
What is the nurse's priority action?
A. Administer morphine as prescribed to relieve pain.
B. Administer naloxone as prescribed for suspected opioid-
induced respiratory depression and notify the provider.
C. Encourage the patient to cough and deep breathe before
administering morphine.
D. Reassess pain in one hour.
Correct Answer
B. Administer naloxone as prescribed for suspected opioid-
induced respiratory depression and notify the provider.
Pain & Inflammation
Original NGN-Style Questions with
Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted with severe osteoarthritis
pain involving both knees. Her medical history includes chronic
kidney disease (stage 3), hypertension, heart failure with
preserved ejection fraction, and gastroesophageal reflux
disease. Current medications include lisinopril, furosemide, and
omeprazole. Vital signs are stable. The provider prescribes
ibuprofen 600 mg orally every 6 hours as needed for pain.
Question Stem
Which nursing action is the priority before administering the
first dose of ibuprofen?
A. Assess the patient's bowel sounds.
,B. Review the patient's renal function and notify the provider of
the chronic kidney disease.
C. Encourage the patient to increase dietary potassium intake.
D. Administer the medication with orange juice to improve
absorption.
Correct Answer
B. Review the patient's renal function and notify the provider
of the chronic kidney disease.
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis to reduce pain and inflammation.
However, prostaglandins also help maintain renal blood flow,
particularly in patients with chronic kidney disease, heart
failure, or volume depletion. In this patient, ibuprofen may
significantly worsen renal function and increase fluid retention,
especially when combined with lisinopril (an ACE inhibitor) and
furosemide (a diuretic), creating the well-known "triple
whammy" combination associated with acute kidney injury.
Option A is incorrect because bowel sounds are not the priority
assessment before NSAID administration. Option C is incorrect
because increasing potassium intake could be unsafe in a
patient taking lisinopril and does not address the primary
,medication risk. Option D is incorrect because ibuprofen should
be taken with food or milk—not acidic beverages—to minimize
gastrointestinal irritation.
The nurse should review serum creatinine, estimated
glomerular filtration rate (eGFR), and recent renal status before
administering the medication. If significant renal impairment
exists, the nurse should contact the provider to discuss safer
alternatives such as acetaminophen or topical therapies.
Learning Objectives
After completing this question, the learner should be able to:
• Identify patients at increased risk for NSAID-induced
kidney injury.
• Recognize important medication interactions affecting
renal perfusion.
• Prioritize assessment before administering NSAIDs.
• Apply clinical judgment when questioning potentially
unsafe medication orders.
Medication Safety Focus: Contraindication and renal function
monitoring.
Question 2
Clinical Scenario
, A 45-year-old man undergoes laparoscopic cholecystectomy.
Four hours after surgery, he reports incisional pain rated 8/10.
The provider prescribes morphine 2 mg IV every 2 hours as
needed. Before administration, the nurse notes the following
assessment findings:
• Respiratory rate: 8 breaths/min
• Oxygen saturation: 91% on room air
• Blood pressure: 118/70 mm Hg
• Heart rate: 74 beats/min
• Patient is difficult to arouse.
Question Stem
What is the nurse's priority action?
A. Administer morphine as prescribed to relieve pain.
B. Administer naloxone as prescribed for suspected opioid-
induced respiratory depression and notify the provider.
C. Encourage the patient to cough and deep breathe before
administering morphine.
D. Reassess pain in one hour.
Correct Answer
B. Administer naloxone as prescribed for suspected opioid-
induced respiratory depression and notify the provider.
