NCLEX-RN Pharmacology Exam Prep: Pain &
Inflammation |
20 NGN-Style Questions with Detailed
Rationales
Question 1
Clinical Scenario
A 64-year-old male with a history of severe osteoarthritis and
chronic kidney disease (CKD Stage 3, baseline creatinine 1.9
mg/dL) reports to the clinic complaining of increased knee pain
that is limiting his mobility. He states, "My neighbor takes
ibuprofen and says it works wonders. Can I start taking that
over the counter?"
Question Stem
Which response by the nurse is most appropriate?
A. "Yes, but you must limit your intake to no more than 1,200
mg per day to protect your kidneys."
,B. "NSAIDs like ibuprofen can further decline your kidney
function; we should discuss safer alternatives like
acetaminophen with your provider."
C. "You can take it safely if you ensure you drink at least 3 liters
of fluid daily to flush your kidneys."
D. "Ibuprofen is safe for your joints, but we will need to monitor
your liver enzymes closely while you take it."
Correct Answer
Correct Answer: B. "NSAIDs like ibuprofen can further decline
your kidney function; we should discuss safer alternatives like
acetaminophen with your provider."
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen work by inhibiting cyclooxygenase (COX) enzymes,
which decreases prostaglandin synthesis. In the kidneys,
prostaglandins cause vasodilation of the afferent arterioles,
maintaining adequate renal blood flow and glomerular filtration
rate (GFR). By blocking prostaglandins, NSAIDs induce afferent
arteriolar vasoconstriction, significantly reducing renal
perfusion. In a patient with pre-existing Stage 3 chronic kidney
disease (CKD), this sudden drop in perfusion can precipitate
acute kidney injury (AKI) on chronic renal failure.
,Limiting the dose (Option A) or increasing fluid intake (Option C)
does not eliminate this hemodynamically mediated nephrotoxic
risk in a vulnerable patient. While acetaminophen has a
maximum daily limit to prevent hepatotoxicity, it does not alter
renal hemodynamics the way NSAIDs do, making it a safer
frontline selection for mild-to-moderate pain in CKD patients,
provided liver function is normal. Monitoring liver enzymes
(Option D) is more relevant to long-term acetaminophen use
than NSAID use, and misidentifies the primary organ system at
immediate risk.
Learning Objective
After completing this question, the learner should be able to:
• Explain the pathophysiological mechanism of NSAID-
induced nephrotoxicity.
• Identify high-risk patient populations for whom NSAID
therapy is contraindicated.
• Select appropriate alternative analgesics for patients with
impaired renal function.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
, A 45-year-old female is admitted to the post-anesthesia care
unit (PACU) following an open abdominal hysterectomy. She is
receiving intravenous morphine sulfate via a patient-controlled
analgesia (PCA) pump. During an hourly assessment, the nurse
notes the patient is drowsy, difficult to arouse by verbal
command, and has a respiratory rate of 8 breaths/minute. Her
oxygen saturation is 89% on room air.
Question Stem
Which action should the nurse take first?
A. Administer a rapid bolus of normal saline to increase
clearance of the opioid.
B. Apply supplemental oxygen via a non-rebreather mask and
re-evaluate in 15 minutes.
C. Stop the PCA pump, attempt physical stimulation, and
prepare to administer naloxone.
D. Call the healthcare provider immediately to request an
arterial blood gas (ABG) panel.
Correct Answer
Correct Answer: C. Stop the PCA pump, attempt physical
stimulation, and prepare to administer naloxone.
Detailed Rationale
Inflammation |
20 NGN-Style Questions with Detailed
Rationales
Question 1
Clinical Scenario
A 64-year-old male with a history of severe osteoarthritis and
chronic kidney disease (CKD Stage 3, baseline creatinine 1.9
mg/dL) reports to the clinic complaining of increased knee pain
that is limiting his mobility. He states, "My neighbor takes
ibuprofen and says it works wonders. Can I start taking that
over the counter?"
Question Stem
Which response by the nurse is most appropriate?
A. "Yes, but you must limit your intake to no more than 1,200
mg per day to protect your kidneys."
,B. "NSAIDs like ibuprofen can further decline your kidney
function; we should discuss safer alternatives like
acetaminophen with your provider."
C. "You can take it safely if you ensure you drink at least 3 liters
of fluid daily to flush your kidneys."
D. "Ibuprofen is safe for your joints, but we will need to monitor
your liver enzymes closely while you take it."
Correct Answer
Correct Answer: B. "NSAIDs like ibuprofen can further decline
your kidney function; we should discuss safer alternatives like
acetaminophen with your provider."
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen work by inhibiting cyclooxygenase (COX) enzymes,
which decreases prostaglandin synthesis. In the kidneys,
prostaglandins cause vasodilation of the afferent arterioles,
maintaining adequate renal blood flow and glomerular filtration
rate (GFR). By blocking prostaglandins, NSAIDs induce afferent
arteriolar vasoconstriction, significantly reducing renal
perfusion. In a patient with pre-existing Stage 3 chronic kidney
disease (CKD), this sudden drop in perfusion can precipitate
acute kidney injury (AKI) on chronic renal failure.
,Limiting the dose (Option A) or increasing fluid intake (Option C)
does not eliminate this hemodynamically mediated nephrotoxic
risk in a vulnerable patient. While acetaminophen has a
maximum daily limit to prevent hepatotoxicity, it does not alter
renal hemodynamics the way NSAIDs do, making it a safer
frontline selection for mild-to-moderate pain in CKD patients,
provided liver function is normal. Monitoring liver enzymes
(Option D) is more relevant to long-term acetaminophen use
than NSAID use, and misidentifies the primary organ system at
immediate risk.
Learning Objective
After completing this question, the learner should be able to:
• Explain the pathophysiological mechanism of NSAID-
induced nephrotoxicity.
• Identify high-risk patient populations for whom NSAID
therapy is contraindicated.
• Select appropriate alternative analgesics for patients with
impaired renal function.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
, A 45-year-old female is admitted to the post-anesthesia care
unit (PACU) following an open abdominal hysterectomy. She is
receiving intravenous morphine sulfate via a patient-controlled
analgesia (PCA) pump. During an hourly assessment, the nurse
notes the patient is drowsy, difficult to arouse by verbal
command, and has a respiratory rate of 8 breaths/minute. Her
oxygen saturation is 89% on room air.
Question Stem
Which action should the nurse take first?
A. Administer a rapid bolus of normal saline to increase
clearance of the opioid.
B. Apply supplemental oxygen via a non-rebreather mask and
re-evaluate in 15 minutes.
C. Stop the PCA pump, attempt physical stimulation, and
prepare to administer naloxone.
D. Call the healthcare provider immediately to request an
arterial blood gas (ABG) panel.
Correct Answer
Correct Answer: C. Stop the PCA pump, attempt physical
stimulation, and prepare to administer naloxone.
Detailed Rationale
