NCLEX Questions: Pain/Musculoskeletal

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1.

2.

3.

Before administering
celecoxib
(Celebrex), the nurse
will assess the
patient's medical
record for which of
the following
medications that
would increase the
risk of adverse
effects?
a. Aspirin
b. Scopolamine
c. Theophylline
d. Acetaminophen

Correct: A
Rationale: Celecoxib is a nonsteroidal
antiinflammatory drug (NSAID) of the
cyclooxygenase-2 (COX-2) inhibitor
type. Although celecoxib does not
inhibit COX-1 and thus has a decreased
risk of bleeding, bleeding is still of
concern as an adverse effect. For this
reason, the drug should not be taken
with other drugs that increase risk of
bleeding, such as aspirin.

After administering
acetaminophen and
oxycodone
(Percocet) for
complaints of pain,
which of the
following
interventions would
be of highest priority
for the nurse to
complete before
leaving the patient's
room?
a. Leave the overbed
light on at low
setting.
b. Ensure that the
upper two side rails
are raised.
c. Offer to turn on
the television to
provide distraction.
d. Ensure that
documentation of
intake and output is
accurate.

Correct: B
Rationale: Percocet has acetaminophen
and oxycodone (a class III controlled
substance) as ingredients. Since the
medication contains an opioid analgesic
with sedative properties, the nurse must
ensure patient safety before leaving the
room, such as leaving the top two
bedrails raised. This will help prevent
the patient from falling from bed, while
not restraining the patient (as four side
rails would do).

Which of the
following
assessments is of
highest priority for
you to complete
before
administration of
morphine?
a. Pain rating
b. Blood pressure
c. Respiratory rate
d. Level of
consciousness

Correct: C
Decreased respirations below a rate of
12/min are a sign of opioid toxicity.
Using the ABC approach in prioritization
of care, a patent airway is always the
first priority and is important to assess
as a baseline before and during the
administration of morphine.

4.

You are preparing to

administer celecoxib
(Celebrex) 200 mg PO for
pain relief. Available are
capsules containing 100 mg.
How many capsules should
the nurse administer?
a. 0.5 Capsules
b. 1 Capsule
c. 2 Capsules
d. 4 Capsules

Correct: C
Dose availability = number of
capsules to administer.
Therefore, 200 mg 100 mg = 2
capsules.

5.

The nurse should instruct a

patient receiving NSAIDs to
report which of the following
adverse effects?
a. Blurred vision
b. Nasal stuffiness
c. Urinary retention
d. Black or tarry stools

Correct: D
Black, tarry stools could
indicate GI bleeding, which is a
risk associated with NSAIDs.
For this reason, the patient
should be taught to report this
sign and other signs of bleeding
immediately.

6.

Which of the following

nursing interventions is
most appropriate when
preparing to administer an
opioid analgesic agent?
a. Give the medication on an
empty stomach.
b. Count the number of
doses on hand before
administration.
c. Give the medication with
a glass of juice or other
cold beverage.
d. Assess the patient for
allergies to aspirin before
administration.

Correct: B
Because opioid analgesics are
controlled substances, the
nurse needs to count the
number of doses and check
that it matches the number
recorded before removing and
administering the medication.

7.

To reduce the risk of adverse

effects, you should do which of
the following when caring for a
patient receiving morphine
sulfate via patient-controlled
analgesia (PCA)?
a. Teach the caregiver not to
push the button for the patient.
b. Instruct the patient not to
push the button too frequently.
c. Ask the patient to do deep
breathing exercises every
hour.
d. Administer medications to
prevent the occurrence of
diarrhea.

Correct: A
It is important to teach the
caregiver not to push the
button for the patient
because it is only the patient
who can determine the need
for the medication. If the
caregiver pushes the button,
the patient could receive
more of a dose than is
actually needed, and this
increases the risk of
adverse effects.

8.

You would question an order

written for Percocet for a
patient exhibiting which of the
following clinical
manifestations?
a. Severe jaundice
b. Oral candidiasis
c. Increased urine output
d. Elevated blood glucose

Correct: A
Acetaminophen and
oxycodone are the
ingredients in Percocet.
Because acetaminophen is
metabolized in the liver, the
patient could develop
acetaminophen toxicity in
the presence of severe liver
disease (evidenced by
jaundice). The prudent nurse
would question the order
before administration.

9.

You have been assigned to care

for a postoperative patient who
has been switched from
patient-controlled analgesia
with meperidine (Demerol) to
morphine sulfate after
experiencing restlessness and
agitation. The caregiver asks
why the change has been made.
Which of the following replies
is most appropriate?
a. "Restlessness and agitation
are symptoms of meperidine
toxicity."
b. "Meperidine is not
controlling the surgical pain
effectively."
c. "Meperidine has caused the
respiratory rate to drop too
low."
d. "Meperidine can only be
used for 24 hours
postoperatively."

10.

A patient with osteoarthritis has

been taking ibuprofen (Motrin) 400
mg every 8 hours. The patient
states that the drug does not seem
to work as well as it used to in
controlling the pain. The most
appropriate response to the
patient is based on knowledge of
which of the following?
a. Another NSAID may be
indicated because of individual
variations in response to drug
therapy.
b. The patient is probably not
compliant with the drug therapy
and therefore the nurse must
initially assess the patient's
knowledge base and initiate
appropriate teaching.
c. If NSAIDs are not effective in
controlling symptoms, systemic
corticosteroids are the next line
of therapy.
d. It may take several months for
NSAIDs to reach therapeutic
levels in the blood and thus be
effective.

Correct: A
Patients vary in their
response to medications
so when one NSAID
does not provide relief,
another should be tried.
There is no evidence in
the stem of the question
to ascertain any
noncompliance to drug
therapy.

11.

When assessing a patient

receiving morphine sulfate 2 mg
every 10 minutes via PCA pump,
the nurse should take action as
soon as the patient's respiratory
rate would drop down to or below
which of the following
parameters?
a. 16 Breaths/min
b. 14 Breaths/min
c. 12 Breaths/min
d. 10 Breaths/min

Correct: C
To protect the patient
from adverse effects of
respiratory depression
from this medication, the
nurse should alert the
physician as soon as the
respiratory rate drops
down to or below 12
breaths/min.

12.

Which of the following clinical

manifestations would you attribute
to adverse effects of morphine
sulfate administered via PCA?
a. Urinary incontinence
b. Increased blood pressure
c. Diarrhea
d. Nausea and vomiting

Correct: D
Morphine sulfate
promotes nausea and
vomiting by directly
stimulating the
chemoreceptor trigger
zone in the medulla.
Other common side
effects include
constipation, sedation,
respiratory depression,
and pruritus.

Correct: A
Confusion, restlessness,
and agitation are signs of
toxicity from normeperidine,
a toxic metabolite of
meperidine.

13.

A postoperative patient
has an order to receive
morphine sulfate 4 mg IM
every 3 to 4 hours prn for
pain. On hand are prefilled
syringes labeled morphine
sulfate 10 mg/ml. How
many milliliters should
you administer?
a. 0.4 ml
b. 0.55 ml
c. 0.6 ml
d. 0.75 ml

Correct: A
Dose (mg) availability (mg/ml) =
ml to administer. Therefore, 4 mg
10 mg/ml = 0.4 ml.

14.

A patient asks you why a

dose of morphine sulfate
by IV push is given before
starting the medication via
PCA. Which of the
following responses is
most appropriate?
a. "PCA takes at least 2
hours to begin working, so
the IV push dose will
provide pain relief in the
interim."
b. "The IV push dose will
enhance the effects of the
PCA for the next 8 hours."
c. "The IV push dose will
provide for immediate
pain relief, which can be
maintained by using the
PCA."
d. "PCA will never be
effective unless a loading
dose is given first."

Correct: C
An IV push loading dose of an
opioid analgesic provides an
effective opioid level in the body,
which results in immediate pain
control. The PCA medication
doses may be smaller and can
be used more frequently to
maintain pain control when the
loading dose begins to wear off.

15.

You are caring for a

patient who is receiving
morphine sulfate via PCA.
Which of the following
patient assessment data
demonstrate the most
therapeutic effect of this
medication?
a. Pain rating 1/10,
drowsy but arousable,
respirations 16
b. Pain rating 2/10, awake
and alert, respirations 18
c. Pain rating 3/10, awake
and alert, respirations 20
d. Pain rating 2/10,
drowsy but arousable,
respirations 18

Correct: B
Effective pain management is
achieved when there is adequate
pain control (rating of 3 or less
on a scale of 1 to 10) with
normal respirations and an
absence of sedation. These data
exhibit the best effectiveness of
the pain medication in all of
these areas.

16.

You should teach a patient

to avoid which of the
following medications
while taking ibuprofen?
a. Morphine sulfate
(generic)
b. Nitroglycerin (Nitro-Bid)
c. Aspirin
d. Furosemide (Lasix)

Correct: C
The patient should not take
aspirin while taking ibuprofen
because the combination could
increase the risk of GI bleeding.