Nursing care
NSAIDs: what to check before you give it
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
NSAIDs carry two major risks that nurses must watch for — GI bleeding and acute kidney injury — and both risks compound when the patient is also on a steroid or is older. Give with food, monitor renal function and signs of bleeding, and check for these compounding factors before every dose.
Why this drug and not another
NSAIDs are chosen when inflammation is part of the problem, not just pain — musculoskeletal injury, osteoarthritis, post-surgical inflammation, dysmenorrhoea, or fever with an inflammatory component. Unlike opioids, they do not carry dependence risk, and unlike acetaminophen, they treat inflammation directly by inhibiting cyclooxygenase (COX-1 and COX-2) and reducing prostaglandin synthesis.
That same mechanism is the source of the drug class's two defining harms. Prostaglandins protect the gastric mucosa and maintain renal blood flow, so blocking them for therapeutic benefit removes that protection at the same time. This is why NSAIDs are picked deliberately for their anti-inflammatory effect but always with an eye on the trade-off, rather than reached for automatically the way acetaminophen often is.
Administration and timing
Give oral NSAIDs with food, milk, or a full glass of water to reduce direct gastric irritation, and avoid giving on an empty stomach. Ibuprofen and naproxen are both taken with meals for this reason; injectable formulations like ketorolac still carry systemic GI and renal risk even though they bypass direct mucosal contact.
Ketorolac in particular has a strict duration limit — typically no more than five days of combined IV/IM and oral use — because its risk of GI bleeding and renal injury rises sharply with prolonged use. Check the prescribed duration against this limit and query orders that exceed it. Space doses as prescribed rather than allowing a patient to self-adjust timing, since consistent dosing intervals matter for both efficacy and minimising peak-level toxicity.
Monitoring parameters
The two parameters that matter most are renal function and signs of GI bleeding. Check baseline and trended creatinine and BUN, particularly in older adults, patients with pre-existing renal impairment, or anyone on a diuretic or ACE inhibitor alongside the NSAID, since reduced renal prostaglandins mean reduced compensatory blood flow when the kidney is already under stress.
Monitor for occult or overt GI bleeding — stool colour and consistency, haemoglobin and haematocrit trends, and any complaint of epigastric pain. Blood pressure should also be tracked, since NSAIDs can cause fluid retention and blunt the effect of antihypertensives. In a patient on long-term therapy, periodic labs rather than a one-off baseline are the standard, because both renal and GI risk accumulate with exposure.
Adverse effects to report
Report black, tarry stools (melaena), coffee-ground emesis, or frank haematemesis immediately — these indicate GI bleeding and warrant holding the drug and escalating. A sudden drop in urine output, rising creatinine, or new peripheral oedema suggests acute kidney injury and should be reported and the dose reassessed.
Also report new or worsening epigastric pain, unexplained fatigue or pallor suggesting anaemia from occult blood loss, and any sign of an allergic or hypersensitivity reaction, including bronchospasm in patients with aspirin-exacerbated respiratory disease. These two risk categories — GI bleeding and renal injury — are not independent of each other or of the patient's other medications; each compounds with age and with concurrent steroid use, so a report of either should prompt a review of the whole medication list, not just the NSAID.
Contraindications and cautions
NSAIDs are contraindicated or used with significant caution in active peptic ulcer disease or GI bleeding, severe renal impairment, and in the third trimester of pregnancy, where they can cause premature closure of the fetal ductus arteriosus. They are also avoided in patients with a history of NSAID-induced bronchospasm or anaphylaxis.
Use particular caution in older adults, who carry higher baseline risk of both GI bleeding and renal impairment even at standard doses, and in any patient concurrently on a corticosteroid, since steroids independently raise GI bleeding risk and the two drug classes compound each other rather than simply adding. The same caution applies to concurrent anticoagulant or SSRI use, both of which further raise bleeding risk when combined with an NSAID.
Teaching points the exam tests
Expect NCLEX items testing whether you recognise the two hallmark adverse effects of this drug class — GI bleeding and renal injury — and whether you know to hold the dose and report melaena, haematemesis, or a falling urine output rather than simply documenting it. Questions often present an older patient on both a steroid and an NSAID specifically to test whether you catch the compounding risk.
You should also expect to be tested on administration technique — with food, not on an empty stomach — and on the ductus arteriosus risk in late pregnancy, which is a recurring safe-medication-administration item. Prioritisation questions may ask you to identify which patient on an NSAID needs assessment first, and the correct answer is almost always the one showing a GI or renal warning sign over one reporting mild dyspepsia alone.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our pharmacology practice questions are the closest set to what this page covers.
One question from the pharmacology set
A client with heart failure is started on furosemide 40 mg PO daily. Which findings should the nurse report to the provider before administering the next dose? Select all that apply.
Rationale
Furosemide is a loop diuretic, so the two things you are watching are potassium and kidney function. A potassium of 2.9 mEq/L is below the 3.5–5.0 reference range and puts the client at risk for dysrhythmia — hold and report. Muscle cramps with palpitations are the clinical face of that same hypokalemia, so they are reported together, not separately. A creatinine that doubles signals the diuresis has outrun renal perfusion. A blood pressure of 132/78 and a 1 kg loss are the expected response to the drug working, not reasons to hold it.
Answer: A, D, E
Common questions
What are the two major risks nurses should watch for with NSAIDs?
GI bleeding and acute kidney injury. Both stem from the same mechanism — NSAIDs block prostaglandins that protect the gastric lining and maintain renal blood flow — and both risks increase further in older patients and in anyone also taking a steroid.
Why should NSAIDs be given with food?
Food reduces direct irritation of the gastric mucosa during absorption, lowering the risk of dyspepsia and bleeding. This applies to oral formulations like ibuprofen and naproxen; the systemic GI and renal risks remain even with injectable NSAIDs that bypass this step.
Why is combining an NSAID with a steroid particularly risky?
Both drug classes independently increase the risk of GI bleeding, and together the risk compounds rather than simply adding. This combination is a common test scenario for recognising which patient needs closer monitoring.
Can NSAIDs be used in pregnancy?
They are avoided in the third trimester because they can cause premature closure of the fetal ductus arteriosus. Use earlier in pregnancy should be guided by the prescriber, weighing risk against benefit on a case-by-case basis.
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