What medication should a nurse question for a patient with a history of chronic kidney disease (CKD) experiencing acute shoulder pain?

In patients with chronic kidney disease (CKD), using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be problematic. NSAIDs can lead to adverse effects on kidney function due to their mechanism of action, which inhibits prostaglandin synthesis. Prostaglandins play a crucial role in maintaining renal blood flow, especially in compromised kidneys. When these drugs are used in patients with CKD, there is an increased risk of worsening kidney function and potential acute kidney injury.

In the context of a patient with CKD experiencing acute shoulder pain, the choice of ibuprofen is particularly concerning. Its use can exacerbate the underlying kidney issues and can lead to complications that may further complicate management. In acute pain management for these patients, alternative analgesics that are safer for renal function should be considered, which is why questioning the use of ibuprofen in this scenario is appropriate.

In contrast, other medications like metoprolol and digoxin, while they need monitoring in CKD patients, do not carry the same immediate risk of renal deterioration as ibuprofen. Regular laboratory assessments can help ensure that these medications remain safe to use. The mention of "pan cultures for a temperature >38.5 C" indicates a different clinical context