NCLEX-RN Pharmacology Pain & Inflammation:
20 High-Yield NGN-Style Questions with
Rationales - ATI Made Easy Compatible
Question 1
Clinical Scenario
A 72-year-old male client with a history of hypertension, stage 3
chronic kidney disease (eGFR 45 mL/min), and peptic ulcer
disease is admitted with severe osteoarthritis pain in both
knees. The client reports taking over-the-counter ibuprofen 800
mg three times daily for the past two weeks with minimal relief.
The provider orders a new medication for pain management.
The client's current medications include lisinopril 10 mg daily
and omeprazole 20 mg daily.
Question Stem
Which medication order should the nurse question?
,A. Acetaminophen 650 mg every 6 hours PRN for pain
B. Celecoxib 100 mg twice daily
C. Tramadol 50 mg every 6 hours PRN for pain
D. Topical diclofenac gel 1% applied to affected knees four times
daily
Correct Answer: B. Celecoxib 100 mg twice daily
Detailed Rationale
The correct answer is B because celecoxib is a COX-2 selective
NSAID that is contraindicated in clients with advanced renal
disease and should be used with extreme caution in those with
cardiovascular risk factors. This client has stage 3 CKD (eGFR 45
mL/min), which places them at increased risk for further renal
impairment, fluid retention, and electrolyte disturbances with
NSAID use. Additionally, the client is taking lisinopril, an ACE
inhibitor, which when combined with NSAIDs can reduce the
antihypertensive effect and increase the risk of acute kidney
injury through afferent arteriolar vasoconstriction.
Option A (acetaminophen) is appropriate as it is the preferred
analgesic for clients with renal impairment and peptic ulcer
disease since it does not affect platelet function, renal
,perfusion, or gastric mucosa. However, the nurse must monitor
total daily dose (maximum 3,000-4,000 mg/day) and assess
liver function.
Option C (tramadol) is acceptable for this client but requires
cautious dosing due to renal impairment (extended intervals or
reduced doses) and monitoring for respiratory depression,
serotonin syndrome, and seizures. The dose of 50 mg every 6
hours is appropriate with renal adjustment.
Option D (topical diclofenac) is appropriate for localized
osteoarthritis pain as systemic absorption is minimal, reducing
the risk of renal and gastrointestinal effects compared to oral
NSAIDs.
Key Nursing Considerations: Assess renal function before and
during therapy, monitor serum creatinine and BUN, assess for
signs of fluid retention (edema, weight gain), and educate client
about reporting decreased urine output. The nurse should also
be aware that celecoxib carries Black Box Warnings for
increased risk of serious cardiovascular thrombotic events and
gastrointestinal bleeding.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify contraindications for NSAID use in clients with
renal impairment.
• Recognize drug-drug interactions between NSAIDs and ACE
inhibitors.
• Select appropriate analgesic therapy for clients with
multiple comorbidities.
• Apply renal dosing principles to pain management
medications.
Medication Safety Focus: Contraindication
Question 2
Clinical Scenario
A 45-year-old female client is admitted to the medical-surgical
unit following a right total hip arthroplasty. The client has a
patient-controlled analgesia (PCA) pump with morphine sulfate
1 mg/mL with a 1 mg bolus, 6-minute lockout interval, and 4-
hour limit of 24 mg. The client's vital signs are: blood pressure
132/78 mmHg, heart rate 92 bpm, respiratory rate 14
breaths/min, oxygen saturation 96% on room air, and
temperature 37.2°C (99°F). The client reports pain at 7 on a 0-
20 High-Yield NGN-Style Questions with
Rationales - ATI Made Easy Compatible
Question 1
Clinical Scenario
A 72-year-old male client with a history of hypertension, stage 3
chronic kidney disease (eGFR 45 mL/min), and peptic ulcer
disease is admitted with severe osteoarthritis pain in both
knees. The client reports taking over-the-counter ibuprofen 800
mg three times daily for the past two weeks with minimal relief.
The provider orders a new medication for pain management.
The client's current medications include lisinopril 10 mg daily
and omeprazole 20 mg daily.
Question Stem
Which medication order should the nurse question?
,A. Acetaminophen 650 mg every 6 hours PRN for pain
B. Celecoxib 100 mg twice daily
C. Tramadol 50 mg every 6 hours PRN for pain
D. Topical diclofenac gel 1% applied to affected knees four times
daily
Correct Answer: B. Celecoxib 100 mg twice daily
Detailed Rationale
The correct answer is B because celecoxib is a COX-2 selective
NSAID that is contraindicated in clients with advanced renal
disease and should be used with extreme caution in those with
cardiovascular risk factors. This client has stage 3 CKD (eGFR 45
mL/min), which places them at increased risk for further renal
impairment, fluid retention, and electrolyte disturbances with
NSAID use. Additionally, the client is taking lisinopril, an ACE
inhibitor, which when combined with NSAIDs can reduce the
antihypertensive effect and increase the risk of acute kidney
injury through afferent arteriolar vasoconstriction.
Option A (acetaminophen) is appropriate as it is the preferred
analgesic for clients with renal impairment and peptic ulcer
disease since it does not affect platelet function, renal
,perfusion, or gastric mucosa. However, the nurse must monitor
total daily dose (maximum 3,000-4,000 mg/day) and assess
liver function.
Option C (tramadol) is acceptable for this client but requires
cautious dosing due to renal impairment (extended intervals or
reduced doses) and monitoring for respiratory depression,
serotonin syndrome, and seizures. The dose of 50 mg every 6
hours is appropriate with renal adjustment.
Option D (topical diclofenac) is appropriate for localized
osteoarthritis pain as systemic absorption is minimal, reducing
the risk of renal and gastrointestinal effects compared to oral
NSAIDs.
Key Nursing Considerations: Assess renal function before and
during therapy, monitor serum creatinine and BUN, assess for
signs of fluid retention (edema, weight gain), and educate client
about reporting decreased urine output. The nurse should also
be aware that celecoxib carries Black Box Warnings for
increased risk of serious cardiovascular thrombotic events and
gastrointestinal bleeding.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify contraindications for NSAID use in clients with
renal impairment.
• Recognize drug-drug interactions between NSAIDs and ACE
inhibitors.
• Select appropriate analgesic therapy for clients with
multiple comorbidities.
• Apply renal dosing principles to pain management
medications.
Medication Safety Focus: Contraindication
Question 2
Clinical Scenario
A 45-year-old female client is admitted to the medical-surgical
unit following a right total hip arthroplasty. The client has a
patient-controlled analgesia (PCA) pump with morphine sulfate
1 mg/mL with a 1 mg bolus, 6-minute lockout interval, and 4-
hour limit of 24 mg. The client's vital signs are: blood pressure
132/78 mmHg, heart rate 92 bpm, respiratory rate 14
breaths/min, oxygen saturation 96% on room air, and
temperature 37.2°C (99°F). The client reports pain at 7 on a 0-
