NCLEX-RN Pharmacology
Pain & Inflammation Practice Exam
20 NGN-Style MCQs with
Rationales Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports persistent
bilateral knee pain rated 8/10 despite taking acetaminophen as
directed. The provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. His history includes hypertension,
chronic kidney disease (stage 3), and gastroesophageal reflux
disease (GERD). Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. Laboratory results reveal
a serum creatinine of 1.9 mg/dL (baseline 1.4 mg/dL) and an
estimated glomerular filtration rate (eGFR) of 42 mL/min/1.73
m².
Question Stem
,Which assessment finding requires the nurse to contact the
provider before administering the first dose of ibuprofen?
A. Blood pressure of 142/86 mm Hg
B. Serum creatinine of 1.9 mg/dL with chronic kidney disease
C. Pain rating of 8 out of 10
D. History of gastroesophageal reflux disease controlled with
omeprazole
Correct Answer
Correct Answer: B. Serum creatinine of 1.9 mg/dL with chronic
kidney disease
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although effective for pain and inflammation,
prostaglandins help maintain renal blood flow, particularly in
patients with impaired kidney function. This patient's elevated
creatinine and stage 3 chronic kidney disease place him at
increased risk for NSAID-induced acute kidney injury. NSAIDs
can also diminish the antihypertensive effects of ACE inhibitors
and, when combined with ACE inhibitors and diuretics, increase
the risk of the "triple whammy" effect leading to significant
renal impairment. The nurse should contact the provider before
administration to discuss safer alternatives.
,Option A: Mildly elevated blood pressure does not by itself
contraindicate ibuprofen, although monitoring is warranted
because NSAIDs may increase blood pressure.
Option C: Severe pain justifies analgesic treatment but does not
outweigh the renal safety concern.
Option D: GERD increases gastrointestinal risk, but concurrent
proton pump inhibitor therapy offers some protection. The
renal impairment remains the priority safety concern.
Nursing care includes reviewing renal function, encouraging
hydration when appropriate, monitoring urine output, and
educating patients to avoid taking additional over-the-counter
NSAIDs without provider approval.
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 involving
NSAIDs, ACE inhibitors, and diuretics.
• Prioritize laboratory assessment before NSAID
administration.
• Apply clinical judgment when evaluating analgesic safety.
Medication Safety Focus
, Monitoring—Renal function before NSAID administration
Question 2
Clinical Scenario
A 26-year-old woman undergoes outpatient laparoscopic
surgery. She is prescribed oxycodone 5 mg orally every 6 hours
as needed for moderate to severe pain. Before discharge, the
nurse provides medication education. The patient states she
plans to drive herself to a follow-up appointment the next
morning and occasionally drinks wine in the evenings.
Question Stem
Which statement by the patient indicates the need for
additional teaching?
A. "I will increase my fluid and fiber intake while taking this
medication."
B. "I should avoid drinking alcohol while using this medication."
C. "If my pain improves, I can switch to acetaminophen if my
provider approves."
D. "If I feel alert after taking the medication, I can drive to my
appointment."
Correct Answer
Pain & Inflammation Practice Exam
20 NGN-Style MCQs with
Rationales Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man with osteoarthritis reports persistent
bilateral knee pain rated 8/10 despite taking acetaminophen as
directed. The provider prescribes ibuprofen 400 mg orally
every 6 hours as needed. His history includes hypertension,
chronic kidney disease (stage 3), and gastroesophageal reflux
disease (GERD). Current medications include lisinopril,
hydrochlorothiazide, and omeprazole. Laboratory results reveal
a serum creatinine of 1.9 mg/dL (baseline 1.4 mg/dL) and an
estimated glomerular filtration rate (eGFR) of 42 mL/min/1.73
m².
Question Stem
,Which assessment finding requires the nurse to contact the
provider before administering the first dose of ibuprofen?
A. Blood pressure of 142/86 mm Hg
B. Serum creatinine of 1.9 mg/dL with chronic kidney disease
C. Pain rating of 8 out of 10
D. History of gastroesophageal reflux disease controlled with
omeprazole
Correct Answer
Correct Answer: B. Serum creatinine of 1.9 mg/dL with chronic
kidney disease
Detailed Rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that
inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin
synthesis. Although effective for pain and inflammation,
prostaglandins help maintain renal blood flow, particularly in
patients with impaired kidney function. This patient's elevated
creatinine and stage 3 chronic kidney disease place him at
increased risk for NSAID-induced acute kidney injury. NSAIDs
can also diminish the antihypertensive effects of ACE inhibitors
and, when combined with ACE inhibitors and diuretics, increase
the risk of the "triple whammy" effect leading to significant
renal impairment. The nurse should contact the provider before
administration to discuss safer alternatives.
,Option A: Mildly elevated blood pressure does not by itself
contraindicate ibuprofen, although monitoring is warranted
because NSAIDs may increase blood pressure.
Option C: Severe pain justifies analgesic treatment but does not
outweigh the renal safety concern.
Option D: GERD increases gastrointestinal risk, but concurrent
proton pump inhibitor therapy offers some protection. The
renal impairment remains the priority safety concern.
Nursing care includes reviewing renal function, encouraging
hydration when appropriate, monitoring urine output, and
educating patients to avoid taking additional over-the-counter
NSAIDs without provider approval.
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 involving
NSAIDs, ACE inhibitors, and diuretics.
• Prioritize laboratory assessment before NSAID
administration.
• Apply clinical judgment when evaluating analgesic safety.
Medication Safety Focus
, Monitoring—Renal function before NSAID administration
Question 2
Clinical Scenario
A 26-year-old woman undergoes outpatient laparoscopic
surgery. She is prescribed oxycodone 5 mg orally every 6 hours
as needed for moderate to severe pain. Before discharge, the
nurse provides medication education. The patient states she
plans to drive herself to a follow-up appointment the next
morning and occasionally drinks wine in the evenings.
Question Stem
Which statement by the patient indicates the need for
additional teaching?
A. "I will increase my fluid and fiber intake while taking this
medication."
B. "I should avoid drinking alcohol while using this medication."
C. "If my pain improves, I can switch to acetaminophen if my
provider approves."
D. "If I feel alert after taking the medication, I can drive to my
appointment."
Correct Answer
