NSG 533 – Advanced Pharmacology Exam 2
Wilkes University | 2026/2027 | Verified Study Guide with Correct
Coverage
Graduate Nursing Program | AANP & ANCC Adult-Gerontology
Primary Care NP Alignment
[UNIT 1: PAIN MANAGEMENT FUNDAMENTALS – PAIN TYPES, WHO
LADDER, NON-OPIOID ANALGESICS]
Guideline References: WHO 2026, CDC 2026 Guidelines for Prescribing Opioids, AGS
Beers Criteria 2026
Q1. A 58-year-old male presents with acute onset of right great toe pain, swelling, and
erythema lasting 48 hours. He has a history of hypertension and CKD stage 3 (eGFR 48
mL/min/1.73m²). He rates his pain as 9/10. Which of the following is the MOST
appropriate initial pharmacotherapy for this acute pain?
A. Naproxen 500 mg BID
B. Acetaminophen 1000 mg q6h
C. Colchicine 1.2 mg now, then 0.6 mg in 1 hour
D. Tramadol 50 mg q6h PRN
Correct Answer: C
Clinical Judgment Skill: Generate Solutions – Acute Pain Management in Special
Populations
Rationale: [CORRECT] C: This patient presents with acute gout flare. Colchicine is
first-line for acute gout when initiated within 24-36 hours of symptom onset. The
,recommended dosing is 1.2 mg at first sign, followed by 0.6 mg one hour later (max 1.8
mg/day). A: NSAIDs (naproxen) are first-line but contraindicated in this patient due to
CKD stage 3 (eGFR <60) – NSAIDs reduce renal perfusion and worsen renal function. B:
Acetaminophen is ineffective for acute gout pain. D: Tramadol is not appropriate
first-line for acute gout and does not address the inflammatory etiology. Wilkes NSG 533
Module 5: Gout management. Common NP error: Prescribing NSAIDs without assessing
renal function.
Q2. A 72-year-old female with osteoarthritis of both knees requests medication for pain.
She has a history of hypertension, GERD, and takes omeprazole 20 mg daily. Her BP is
128/74 mmHg. Which of the following is the MOST appropriate initial
pharmacotherapy?
A. Ibuprofen 600 mg TID
B. Celecoxib 200 mg daily
C. Acetaminophen 1000 mg q6h PRN
D. Topical diclofenac gel 1% to both knees
Correct Answer: D
Clinical Judgment Skill: Generate Solutions – Osteoarthritis Pain Management
Rationale: [CORRECT] D: Topical NSAIDs (diclofenac gel) are recommended as first-line
for osteoarthritis in patients with risk factors for oral NSAIDs (age >75, GI risk,
cardiovascular risk, renal impairment). Topical NSAIDs provide local analgesia with
minimal systemic absorption, reducing GI and cardiovascular risks. A: Oral ibuprofen
increases GI bleeding risk despite PPI use; not first-line with GERD history. B: Celecoxib
(COX-2 selective) reduces GI risk but still has cardiovascular and renal risks. C:
Acetaminophen is less effective for OA pain and may not provide adequate relief; can be
,tried but topical NSAID is preferred first-line in guidelines. Wilkes NSG 533 Module 5: OA
pharmacotherapy. Common NP error: Reaching for oral NSAIDs before considering topical
options in high-risk patients.
Q3. A patient with chronic low back pain is being started on ibuprofen 600 mg TID.
Which of the following statements by the patient indicates an understanding of the
medication teaching?
A. "I should take this medication on an empty stomach for better absorption."
B. "I will watch for dark, tarry stools and report them immediately."
C. "This medication is safe to take with my daily low-dose aspirin."
D. "I can increase the dose to 800 mg if my pain is not controlled."
Correct Answer: B
Clinical Judgment Skill: Evaluate Outcomes – Patient Education
Rationale: [CORRECT] B: Dark, tarry stools are a sign of GI bleeding, a serious adverse
effect of NSAIDs. Patients should be instructed to report this immediately. A: NSAIDs
should be taken with food or milk to reduce GI irritation. C: Ibuprofen may interfere with
aspirin's antiplatelet effect and increases GI bleeding risk; concurrent use requires
careful consideration and timing (take aspirin 2 hours before ibuprofen). D: Patients
should not exceed prescribed doses without provider guidance; maximum daily dose of
ibuprofen is 3200 mg, but dose increases require evaluation. Wilkes NSG 533 Module 1:
NSAID patient education. Common NP error: Failing to counsel on GI bleeding signs.
Q4. According to the WHO 3-step analgesic ladder, which of the following represents the
correct stepwise approach for a patient with moderate cancer pain?
, A. Step 1: Non-opioid ± adjuvant → Step 2: Weak opioid + non-opioid ± adjuvant → Step
3: Strong opioid + non-opioid ± adjuvant
B. Step 1: Weak opioid alone → Step 2: Strong opioid alone → Step 3: Strong opioid +
adjuvant
C. Step 1: Non-pharmacologic therapy → Step 2: NSAIDs → Step 3: Opioids
D. Step 1: Acetaminophen → Step 2: Ibuprofen → Step 3: Morphine
Correct Answer: A
Clinical Judgment Skill: Recall – WHO Analgesic Ladder
Rationale: [CORRECT] A: The WHO 3-step analgesic ladder recommends: Step 1 –
Non-opioid (acetaminophen or NSAID) with or without adjuvant; Step 2 – Weak opioid
(codeine, tramadol) plus non-opioid with or without adjuvant; Step 3 – Strong opioid
(morphine, oxycodone, hydromorphone, fentanyl) plus non-opioid with or without
adjuvant. B, C, D: Incorrect sequences that do not follow WHO guidelines. Wilkes NSG
533 Module 1: Pain management principles. Common NP error: Skipping steps or using
opioids without non-opioid adjuncts.
Q5. A 45-year-old male with chronic pancreatitis reports constant epigastric pain
radiating to the back. He describes the pain as deep, gnawing, and poorly localized. This
type of pain is BEST classified as:
A. Somatic nociceptive pain
B. Visceral nociceptive pain
C. Neuropathic pain
D. Inflammatory pain
Wilkes University | 2026/2027 | Verified Study Guide with Correct
Coverage
Graduate Nursing Program | AANP & ANCC Adult-Gerontology
Primary Care NP Alignment
[UNIT 1: PAIN MANAGEMENT FUNDAMENTALS – PAIN TYPES, WHO
LADDER, NON-OPIOID ANALGESICS]
Guideline References: WHO 2026, CDC 2026 Guidelines for Prescribing Opioids, AGS
Beers Criteria 2026
Q1. A 58-year-old male presents with acute onset of right great toe pain, swelling, and
erythema lasting 48 hours. He has a history of hypertension and CKD stage 3 (eGFR 48
mL/min/1.73m²). He rates his pain as 9/10. Which of the following is the MOST
appropriate initial pharmacotherapy for this acute pain?
A. Naproxen 500 mg BID
B. Acetaminophen 1000 mg q6h
C. Colchicine 1.2 mg now, then 0.6 mg in 1 hour
D. Tramadol 50 mg q6h PRN
Correct Answer: C
Clinical Judgment Skill: Generate Solutions – Acute Pain Management in Special
Populations
Rationale: [CORRECT] C: This patient presents with acute gout flare. Colchicine is
first-line for acute gout when initiated within 24-36 hours of symptom onset. The
,recommended dosing is 1.2 mg at first sign, followed by 0.6 mg one hour later (max 1.8
mg/day). A: NSAIDs (naproxen) are first-line but contraindicated in this patient due to
CKD stage 3 (eGFR <60) – NSAIDs reduce renal perfusion and worsen renal function. B:
Acetaminophen is ineffective for acute gout pain. D: Tramadol is not appropriate
first-line for acute gout and does not address the inflammatory etiology. Wilkes NSG 533
Module 5: Gout management. Common NP error: Prescribing NSAIDs without assessing
renal function.
Q2. A 72-year-old female with osteoarthritis of both knees requests medication for pain.
She has a history of hypertension, GERD, and takes omeprazole 20 mg daily. Her BP is
128/74 mmHg. Which of the following is the MOST appropriate initial
pharmacotherapy?
A. Ibuprofen 600 mg TID
B. Celecoxib 200 mg daily
C. Acetaminophen 1000 mg q6h PRN
D. Topical diclofenac gel 1% to both knees
Correct Answer: D
Clinical Judgment Skill: Generate Solutions – Osteoarthritis Pain Management
Rationale: [CORRECT] D: Topical NSAIDs (diclofenac gel) are recommended as first-line
for osteoarthritis in patients with risk factors for oral NSAIDs (age >75, GI risk,
cardiovascular risk, renal impairment). Topical NSAIDs provide local analgesia with
minimal systemic absorption, reducing GI and cardiovascular risks. A: Oral ibuprofen
increases GI bleeding risk despite PPI use; not first-line with GERD history. B: Celecoxib
(COX-2 selective) reduces GI risk but still has cardiovascular and renal risks. C:
Acetaminophen is less effective for OA pain and may not provide adequate relief; can be
,tried but topical NSAID is preferred first-line in guidelines. Wilkes NSG 533 Module 5: OA
pharmacotherapy. Common NP error: Reaching for oral NSAIDs before considering topical
options in high-risk patients.
Q3. A patient with chronic low back pain is being started on ibuprofen 600 mg TID.
Which of the following statements by the patient indicates an understanding of the
medication teaching?
A. "I should take this medication on an empty stomach for better absorption."
B. "I will watch for dark, tarry stools and report them immediately."
C. "This medication is safe to take with my daily low-dose aspirin."
D. "I can increase the dose to 800 mg if my pain is not controlled."
Correct Answer: B
Clinical Judgment Skill: Evaluate Outcomes – Patient Education
Rationale: [CORRECT] B: Dark, tarry stools are a sign of GI bleeding, a serious adverse
effect of NSAIDs. Patients should be instructed to report this immediately. A: NSAIDs
should be taken with food or milk to reduce GI irritation. C: Ibuprofen may interfere with
aspirin's antiplatelet effect and increases GI bleeding risk; concurrent use requires
careful consideration and timing (take aspirin 2 hours before ibuprofen). D: Patients
should not exceed prescribed doses without provider guidance; maximum daily dose of
ibuprofen is 3200 mg, but dose increases require evaluation. Wilkes NSG 533 Module 1:
NSAID patient education. Common NP error: Failing to counsel on GI bleeding signs.
Q4. According to the WHO 3-step analgesic ladder, which of the following represents the
correct stepwise approach for a patient with moderate cancer pain?
, A. Step 1: Non-opioid ± adjuvant → Step 2: Weak opioid + non-opioid ± adjuvant → Step
3: Strong opioid + non-opioid ± adjuvant
B. Step 1: Weak opioid alone → Step 2: Strong opioid alone → Step 3: Strong opioid +
adjuvant
C. Step 1: Non-pharmacologic therapy → Step 2: NSAIDs → Step 3: Opioids
D. Step 1: Acetaminophen → Step 2: Ibuprofen → Step 3: Morphine
Correct Answer: A
Clinical Judgment Skill: Recall – WHO Analgesic Ladder
Rationale: [CORRECT] A: The WHO 3-step analgesic ladder recommends: Step 1 –
Non-opioid (acetaminophen or NSAID) with or without adjuvant; Step 2 – Weak opioid
(codeine, tramadol) plus non-opioid with or without adjuvant; Step 3 – Strong opioid
(morphine, oxycodone, hydromorphone, fentanyl) plus non-opioid with or without
adjuvant. B, C, D: Incorrect sequences that do not follow WHO guidelines. Wilkes NSG
533 Module 1: Pain management principles. Common NP error: Skipping steps or using
opioids without non-opioid adjuncts.
Q5. A 45-year-old male with chronic pancreatitis reports constant epigastric pain
radiating to the back. He describes the pain as deep, gnawing, and poorly localized. This
type of pain is BEST classified as:
A. Somatic nociceptive pain
B. Visceral nociceptive pain
C. Neuropathic pain
D. Inflammatory pain
