NCLEX-RN Pharmacology Practice
Questions
| Pain & Inflammation |
20 Original NGN-Style MCQs with
Rationales
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite nonpharmacologic
measures. Her provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. Her history includes hypertension and
stage 3 chronic kidney disease. Current medications include
lisinopril and hydrochlorothiazide. Assessment findings include
BP 148/86 mm Hg, HR 78/min, creatinine 1.8 mg/dL, and
estimated GFR 42 mL/min/1.73 m².
Question Stem
,Which assessment finding should prompt the nurse to contact
the provider before administering the first dose of ibuprofen?
A. Blood pressure of 148/86 mm Hg
B. Estimated GFR of 42 mL/min/1.73 m²
C. Pain rating of 7/10
D. Heart rate of 78/min
Correct Answer
Correct Answer: B. Estimated GFR of 42 mL/min/1.73 m²
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While this reduces inflammation and
pain, prostaglandins also maintain renal blood flow, particularly
in patients with impaired kidney function. An estimated GFR of
42 mL/min/1.73 m² indicates moderate chronic kidney disease,
placing the patient at increased risk for NSAID-induced acute
kidney injury and further decline in renal function. Additionally,
concurrent use of an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide) creates the "triple whammy" combination
when an NSAID is added, significantly increasing nephrotoxicity
risk. The nurse should notify the provider before administering
the medication so an alternative analgesic, such as
,acetaminophen or another appropriate therapy, can be
considered.
Option A: Mild hypertension should be monitored because
NSAIDs may increase blood pressure, but it is not the most
urgent concern before the first dose.
Option C: The pain assessment supports the need for analgesia
but does not contraindicate ibuprofen.
Option D: The heart rate is within normal limits and does not
affect medication administration.
The nurse should also educate patients to avoid dehydration,
maintain adequate fluid intake if appropriate, avoid additional
OTC NSAIDs, and report decreased urine output or swelling
promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Identify renal impairment as a contraindication or
precaution for NSAID therapy.
• Recognize medications that increase NSAID-associated
nephrotoxicity.
• Prioritize assessment findings before administering
NSAIDs.
Medication Safety Focus
, Monitoring – Assess renal function before and during NSAID
therapy.
Question 2
Clinical Scenario
A 24-year-old woman is recovering from laparoscopic
appendectomy. She is prescribed morphine 2 mg IV every 2
hours as needed for severe pain. Thirty minutes after receiving
the medication, the nurse reassesses her. Vital signs are BP
118/74 mm Hg, HR 66/min, RR 8/min, oxygen saturation 89%
on room air, and pain 2/10.
Question Stem
Which nursing action is the priority?
A. Administer the next scheduled dose of morphine.
B. Encourage oral fluids.
C. Stimulate the patient, provide supplemental oxygen, and
prepare to administer naloxone.
D. Reassess pain in 2 hours.
Correct Answer
Correct Answer: C. Stimulate the patient, provide
supplemental oxygen, and prepare to administer naloxone.
Questions
| Pain & Inflammation |
20 Original NGN-Style MCQs with
Rationales
Question 1
Clinical Scenario
A 68-year-old woman with osteoarthritis reports persistent
bilateral knee pain rated 7/10 despite nonpharmacologic
measures. Her provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. Her history includes hypertension and
stage 3 chronic kidney disease. Current medications include
lisinopril and hydrochlorothiazide. Assessment findings include
BP 148/86 mm Hg, HR 78/min, creatinine 1.8 mg/dL, and
estimated GFR 42 mL/min/1.73 m².
Question Stem
,Which assessment finding should prompt the nurse to contact
the provider before administering the first dose of ibuprofen?
A. Blood pressure of 148/86 mm Hg
B. Estimated GFR of 42 mL/min/1.73 m²
C. Pain rating of 7/10
D. Heart rate of 78/min
Correct Answer
Correct Answer: B. Estimated GFR of 42 mL/min/1.73 m²
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen inhibit cyclooxygenase (COX) enzymes, decreasing
prostaglandin synthesis. While this reduces inflammation and
pain, prostaglandins also maintain renal blood flow, particularly
in patients with impaired kidney function. An estimated GFR of
42 mL/min/1.73 m² indicates moderate chronic kidney disease,
placing the patient at increased risk for NSAID-induced acute
kidney injury and further decline in renal function. Additionally,
concurrent use of an ACE inhibitor (lisinopril) and a diuretic
(hydrochlorothiazide) creates the "triple whammy" combination
when an NSAID is added, significantly increasing nephrotoxicity
risk. The nurse should notify the provider before administering
the medication so an alternative analgesic, such as
,acetaminophen or another appropriate therapy, can be
considered.
Option A: Mild hypertension should be monitored because
NSAIDs may increase blood pressure, but it is not the most
urgent concern before the first dose.
Option C: The pain assessment supports the need for analgesia
but does not contraindicate ibuprofen.
Option D: The heart rate is within normal limits and does not
affect medication administration.
The nurse should also educate patients to avoid dehydration,
maintain adequate fluid intake if appropriate, avoid additional
OTC NSAIDs, and report decreased urine output or swelling
promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Identify renal impairment as a contraindication or
precaution for NSAID therapy.
• Recognize medications that increase NSAID-associated
nephrotoxicity.
• Prioritize assessment findings before administering
NSAIDs.
Medication Safety Focus
, Monitoring – Assess renal function before and during NSAID
therapy.
Question 2
Clinical Scenario
A 24-year-old woman is recovering from laparoscopic
appendectomy. She is prescribed morphine 2 mg IV every 2
hours as needed for severe pain. Thirty minutes after receiving
the medication, the nurse reassesses her. Vital signs are BP
118/74 mm Hg, HR 66/min, RR 8/min, oxygen saturation 89%
on room air, and pain 2/10.
Question Stem
Which nursing action is the priority?
A. Administer the next scheduled dose of morphine.
B. Encourage oral fluids.
C. Stimulate the patient, provide supplemental oxygen, and
prepare to administer naloxone.
D. Reassess pain in 2 hours.
Correct Answer
Correct Answer: C. Stimulate the patient, provide
supplemental oxygen, and prepare to administer naloxone.
