NCLEX-RN Pharmacology Practice Questions:
Pain & Inflammation - 20 High-Yield MCQs
with Rationales for Nursing Students
Question 1
Clinical Scenario
A 68-year-old male with a history of stage 3 chronic kidney
disease (eGFR 42 mL/min) and osteoarthritis presents to the
emergency department with severe right hip pain after a fall at
home. The client rates pain as 9/10. Vital signs: BP 158/92
mmHg, HR 102 bpm, RR 20/min, temperature 98.6°F. The client
has no known drug allergies. The healthcare provider orders
morphine 4 mg IV push for acute pain management.
Question Stem
Which action should the nurse take before administering the
prescribed morphine?
A. Assess the client's pain level using a 0-10 scale
,B. Verify the client's baseline creatinine clearance
C. Administer the morphine as ordered without delay
D. Request an order for naloxone to have available at the
bedside
Correct Answer
B. Verify the client's baseline creatinine clearance
Detailed Rationale
Correct Answer Rationale: Morphine is primarily metabolized
by the liver to active metabolites (morphine-6-glucuronide and
morphine-3-glucuronide), which are eliminated renally. In
clients with renal impairment (eGFR < 60 mL/min), these active
metabolites accumulate, leading to prolonged sedation,
respiratory depression, and increased risk of toxicity. The
client's eGFR of 42 mL/min indicates significant renal
impairment, necessitating dose adjustment, extended dosing
intervals, or consideration of an alternative analgesic. The nurse
should verify the client's actual creatinine clearance to
determine appropriate dosing or consult with the provider for
modifications. This is a priority safety action before
administration of any opioid in a client with renal dysfunction.
Incorrect Option Analysis: Option A, while a standard nursing
assessment, is not the priority action before administering
morphine to a client with known renal impairment. Pain
,assessment should occur but safety considerations take
precedence. Option C demonstrates unsafe practice—
administering morphine without considering the client's renal
status could lead to serious adverse effects. Option D is
premature; while having naloxone available is prudent when
administering opioids, it is not the immediate priority action
before the first dose, and the client is not currently exhibiting
signs of opioid toxicity.
Pharmacology Principles: Morphine's active metabolites
accumulate in renal impairment, causing increased risk of
adverse effects. The half-life of morphine can double in renal
failure. This client requires a 50-75% dose reduction or
extended intervals (every 4-6 hours instead of every 3-4 hours).
Nursing Considerations: Monitor for excessive sedation,
respiratory rate < 12/min, and decreased level of
consciousness. Alternative analgesics such as fentanyl or
hydromorphone may be preferred in renal impairment as they
have fewer active metabolites. The nurse should advocate for
dose adjustment and initiate fall precautions.
Learning Objective
After completing this question, the learner should be able to:
• Identify the pharmacokinetic considerations of morphine
in clients with renal impairment
, • Prioritize medication safety assessments before opioid
administration in vulnerable populations
• Recognize the need for dose modification in clients with
decreased renal function
• Implement appropriate nursing interventions to prevent
opioid-related adverse effects
Medication Safety Focus
Medication Administration; High-Alert Medication; Renal
Impairment
Question 2
Clinical Scenario
A 72-year-old female with a history of peptic ulcer disease is
admitted with acute gout affecting her left great toe. The client
rates pain as 7/10. The healthcare provider orders
indomethacin 50 mg orally three times daily. The client's
current medications include omeprazole 40 mg daily, lisinopril
10 mg daily, and aspirin 81 mg daily for cardiovascular
protection.
Question Stem
Which action should the nurse take regarding the prescribed
indomethacin?
Pain & Inflammation - 20 High-Yield MCQs
with Rationales for Nursing Students
Question 1
Clinical Scenario
A 68-year-old male with a history of stage 3 chronic kidney
disease (eGFR 42 mL/min) and osteoarthritis presents to the
emergency department with severe right hip pain after a fall at
home. The client rates pain as 9/10. Vital signs: BP 158/92
mmHg, HR 102 bpm, RR 20/min, temperature 98.6°F. The client
has no known drug allergies. The healthcare provider orders
morphine 4 mg IV push for acute pain management.
Question Stem
Which action should the nurse take before administering the
prescribed morphine?
A. Assess the client's pain level using a 0-10 scale
,B. Verify the client's baseline creatinine clearance
C. Administer the morphine as ordered without delay
D. Request an order for naloxone to have available at the
bedside
Correct Answer
B. Verify the client's baseline creatinine clearance
Detailed Rationale
Correct Answer Rationale: Morphine is primarily metabolized
by the liver to active metabolites (morphine-6-glucuronide and
morphine-3-glucuronide), which are eliminated renally. In
clients with renal impairment (eGFR < 60 mL/min), these active
metabolites accumulate, leading to prolonged sedation,
respiratory depression, and increased risk of toxicity. The
client's eGFR of 42 mL/min indicates significant renal
impairment, necessitating dose adjustment, extended dosing
intervals, or consideration of an alternative analgesic. The nurse
should verify the client's actual creatinine clearance to
determine appropriate dosing or consult with the provider for
modifications. This is a priority safety action before
administration of any opioid in a client with renal dysfunction.
Incorrect Option Analysis: Option A, while a standard nursing
assessment, is not the priority action before administering
morphine to a client with known renal impairment. Pain
,assessment should occur but safety considerations take
precedence. Option C demonstrates unsafe practice—
administering morphine without considering the client's renal
status could lead to serious adverse effects. Option D is
premature; while having naloxone available is prudent when
administering opioids, it is not the immediate priority action
before the first dose, and the client is not currently exhibiting
signs of opioid toxicity.
Pharmacology Principles: Morphine's active metabolites
accumulate in renal impairment, causing increased risk of
adverse effects. The half-life of morphine can double in renal
failure. This client requires a 50-75% dose reduction or
extended intervals (every 4-6 hours instead of every 3-4 hours).
Nursing Considerations: Monitor for excessive sedation,
respiratory rate < 12/min, and decreased level of
consciousness. Alternative analgesics such as fentanyl or
hydromorphone may be preferred in renal impairment as they
have fewer active metabolites. The nurse should advocate for
dose adjustment and initiate fall precautions.
Learning Objective
After completing this question, the learner should be able to:
• Identify the pharmacokinetic considerations of morphine
in clients with renal impairment
, • Prioritize medication safety assessments before opioid
administration in vulnerable populations
• Recognize the need for dose modification in clients with
decreased renal function
• Implement appropriate nursing interventions to prevent
opioid-related adverse effects
Medication Safety Focus
Medication Administration; High-Alert Medication; Renal
Impairment
Question 2
Clinical Scenario
A 72-year-old female with a history of peptic ulcer disease is
admitted with acute gout affecting her left great toe. The client
rates pain as 7/10. The healthcare provider orders
indomethacin 50 mg orally three times daily. The client's
current medications include omeprazole 40 mg daily, lisinopril
10 mg daily, and aspirin 81 mg daily for cardiovascular
protection.
Question Stem
Which action should the nurse take regarding the prescribed
indomethacin?
