NCLEX Pharmacology 2026: Pain &
Inflammation Exam Review Notes
Question 1
Clinical Scenario
An 82-year-old female with a history of osteoarthritis,
hypertension, and stage 3 chronic kidney disease (CKD)
presents to the outpatient clinic reporting worsening right knee
pain (rated 7/10). She states, "I've been taking over-the-counter
ibuprofen 800 mg three times a day for the past three weeks,
but my swelling hasn't gone down much." Her laboratory
results reveal a serum creatinine of $2.1\text{ mg/dL}$
(baseline $1.3\text{ mg/dL}$) and a Blood Urea Nitrogen (BUN)
of $34\text{ mg/dL}$.
Question Stem
Which action should the nurse take first?
A. Advise the client to decrease the ibuprofen dose to 400 mg
twice daily.
B. Instruct the client to immediately stop taking ibuprofen and
notify the primary care provider.
,C. Recommend switching to naproxen to better manage the
joint inflammation.
D. Educate the client to take ibuprofen with an H2 receptor
antagonist to protect her kidney function.
Correct Answer
Correct Answer: B. Instruct the client to immediately stop
taking ibuprofen and notify the primary care provider.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
inhibit cyclooxygenase (COX-1 and COX-2) enzymes, which
decreases prostaglandin synthesis. In the kidneys,
prostaglandins cause renal vasodilation to maintain adequate
renal blood flow and glomerular filtration rate (GFR). By
blocking prostaglandin synthesis, NSAIDs cause afferent
arteriolar constriction, leading to decreased renal perfusion and
acute kidney injury (AKI)—especially in older adults and
patients with underlying chronic kidney disease. This client's
rising serum creatinine and BUN indicate NSAID-induced
nephrotoxicity. The priority intervention is to stop the offending
agent immediately to prevent further irreversible renal damage
and report the findings to the provider for alternative pain
management options (such as acetaminophen or physical
therapy).
, • A is incorrect because reducing the dose of ibuprofen does
not eliminate the nephrotoxic risk in a client with active
acute kidney injury and baseline stage 3 CKD.
• C is incorrect because naproxen is also a nonselective
NSAID and carries the same renal risk as ibuprofen.
• D is incorrect because H2 blockers (or proton pump
inhibitors) provide gastroprotection against NSAID-induced
gastric ulcers, but they offer zero protection against NSAID-
induced renal vasoconstriction or nephrotoxicity.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the nephrotoxic effects of NSAIDs in older adults
with chronic kidney disease.
• Analyze laboratory trends (BUN/creatinine) indicative of
NSAID-induced acute kidney injury.
• Prioritize patient safety by discontinuing nephrotoxic
medications in the setting of acute renal impairment.
Medication Safety Focus
Black Box Warning / Nephrotoxicity
Question 2
Clinical Scenario
, A 45-year-old male is admitted to the surgical unit following an
open cholecystectomy. He is receiving morphine sulfate
$2\text{ mg}$ IV push every 3 hours PRN for severe pain. During
a routine assessment 20 minutes after the last dose, the nurse
notes: blood pressure $102/64\text{ mmHg}$, heart rate
$62\text{ bpm}$, respiratory rate $7\text{ breaths/min}$, and
$SpO_2$ $88\%$ on room air. The client is difficult to arouse,
opening his eyes only briefly to tactile stimulation before falling
back asleep.
Question Stem
Which nursing action is the priority?
A. Administer oxygen at 2 L/min via nasal cannula.
B. Prepare and administer IV naloxone as prescribed or via
standing order.
C. Attempt to arouse the client by sternal rub and encourage
deep breathing.
D. Document the sedated state and re-assess vital signs in 15
minutes.
Correct Answer
Correct Answer: B. Prepare and administer IV naloxone as
prescribed or via standing order.
Detailed Rationale
Inflammation Exam Review Notes
Question 1
Clinical Scenario
An 82-year-old female with a history of osteoarthritis,
hypertension, and stage 3 chronic kidney disease (CKD)
presents to the outpatient clinic reporting worsening right knee
pain (rated 7/10). She states, "I've been taking over-the-counter
ibuprofen 800 mg three times a day for the past three weeks,
but my swelling hasn't gone down much." Her laboratory
results reveal a serum creatinine of $2.1\text{ mg/dL}$
(baseline $1.3\text{ mg/dL}$) and a Blood Urea Nitrogen (BUN)
of $34\text{ mg/dL}$.
Question Stem
Which action should the nurse take first?
A. Advise the client to decrease the ibuprofen dose to 400 mg
twice daily.
B. Instruct the client to immediately stop taking ibuprofen and
notify the primary care provider.
,C. Recommend switching to naproxen to better manage the
joint inflammation.
D. Educate the client to take ibuprofen with an H2 receptor
antagonist to protect her kidney function.
Correct Answer
Correct Answer: B. Instruct the client to immediately stop
taking ibuprofen and notify the primary care provider.
Detailed Rationale
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
inhibit cyclooxygenase (COX-1 and COX-2) enzymes, which
decreases prostaglandin synthesis. In the kidneys,
prostaglandins cause renal vasodilation to maintain adequate
renal blood flow and glomerular filtration rate (GFR). By
blocking prostaglandin synthesis, NSAIDs cause afferent
arteriolar constriction, leading to decreased renal perfusion and
acute kidney injury (AKI)—especially in older adults and
patients with underlying chronic kidney disease. This client's
rising serum creatinine and BUN indicate NSAID-induced
nephrotoxicity. The priority intervention is to stop the offending
agent immediately to prevent further irreversible renal damage
and report the findings to the provider for alternative pain
management options (such as acetaminophen or physical
therapy).
, • A is incorrect because reducing the dose of ibuprofen does
not eliminate the nephrotoxic risk in a client with active
acute kidney injury and baseline stage 3 CKD.
• C is incorrect because naproxen is also a nonselective
NSAID and carries the same renal risk as ibuprofen.
• D is incorrect because H2 blockers (or proton pump
inhibitors) provide gastroprotection against NSAID-induced
gastric ulcers, but they offer zero protection against NSAID-
induced renal vasoconstriction or nephrotoxicity.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the nephrotoxic effects of NSAIDs in older adults
with chronic kidney disease.
• Analyze laboratory trends (BUN/creatinine) indicative of
NSAID-induced acute kidney injury.
• Prioritize patient safety by discontinuing nephrotoxic
medications in the setting of acute renal impairment.
Medication Safety Focus
Black Box Warning / Nephrotoxicity
Question 2
Clinical Scenario
, A 45-year-old male is admitted to the surgical unit following an
open cholecystectomy. He is receiving morphine sulfate
$2\text{ mg}$ IV push every 3 hours PRN for severe pain. During
a routine assessment 20 minutes after the last dose, the nurse
notes: blood pressure $102/64\text{ mmHg}$, heart rate
$62\text{ bpm}$, respiratory rate $7\text{ breaths/min}$, and
$SpO_2$ $88\%$ on room air. The client is difficult to arouse,
opening his eyes only briefly to tactile stimulation before falling
back asleep.
Question Stem
Which nursing action is the priority?
A. Administer oxygen at 2 L/min via nasal cannula.
B. Prepare and administer IV naloxone as prescribed or via
standing order.
C. Attempt to arouse the client by sternal rub and encourage
deep breathing.
D. Document the sedated state and re-assess vital signs in 15
minutes.
Correct Answer
Correct Answer: B. Prepare and administer IV naloxone as
prescribed or via standing order.
Detailed Rationale
