Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 9th
g g g g g g g g
Edition
g
Pharmacology
gTest Bank g
MULTIPLE CHOICE g
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that
g g g g g g g g g g g g g g g g g
the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication
g g g g g g g g g g g g g g g
is prescribed for:
g g g
1. Pain relief g
2. Increasing uterine contractions g g
3. Decreasing uterine contractions g g
4. Promoting fetal lung maturity g g g
ANS: 1 g g
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
g g g g g g g g g g g g g g g g g g g
3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for
g g g g g g g g g g g g g g g g
pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and ―promoting fetal
g g g g g g g g g g g
lung maturity‖ are not actions of this medication.
g g g g g g g g
Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
g g g g g g g g g g g g g
question. Remember that this medication is used for pain relief. Review the action of this medication if
g g g g g g g g g g g g g g g g g
you had difficulty with this question and are unfamiliar with this medication.
g g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Planning g g g
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
g g g g g g g g g g g g g g g g
administration following cesarean birth. If the client develops respiratory depression and requires
g g g g g g g g g g g g
naloxone (Narcan) as an antidote, the client may complain of which of the following?
g g g g g g g g g g g g g g
1. Increase in her pain level g g g g
2. Decrease in her pain level g g g g
3. Increase in the amount of itching from the opioid used in the epidural
g g g g g g g g g g g g
4. Decrease in the amount of itching from the opioid used in the epidural
g g g g g g g g g g g g
, ANS: 1 g g
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
g g g g g g g g g g g g g
which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain
g g g g g g g g g g g g g g g g g g g g
level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the opioid used in
g g g g g g g g g g g g g g g g g g
the epidural,‖ and ―decrease in the amount of itching from the opioid used in the epidural‖ are incorrect.
g g g g g g g g g g g g g g g g g g
Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
g g g g g g g g g g g g g g
medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an
g g g g g g g g g g g g g g g
antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this
g g g g g g g g g g g g g g g g g
question was difficult.
g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity
g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Assessment g g g
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the
g g g g g g g g g g g g g g g
hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that
g g g g g g g g g g g g g g
the medication will do which of the following?
g g g g g g g g
1. Prevent spontaneous delivery. g g
2. Stop the uterine contractions.
g g g
3. Promote maturation of the fetal lungs. g g g g g
4. Accelerate the growth rate of the fetus. g g g g g g
ANS: 3 g g
Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
g g g g g g g g g g
increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory
g g g g g g g g g g g g g g g g
distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone
g g g g g g g g g g g g g g g
to allow time for the lungs of the fetus to mature.
g g g g g g g g g g g
Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
g g g g g g g g g g g g g g g g
mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the strategic
g g g g g g g g g g g g g
words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and knowledge of the
g g g g g g g g g g g g g g
problems encountered by premature infants will assist in answering this question. Review the action of
g g g g g g g g g g g g g g g
this medication if this question was difficult.
g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding g g g g
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St.
g g g g g g g g g g g g g g
Louis: Saunders.
g OBJ: Client Needs: Physiological Integrity
g g g g
, TOP: Content Area: Pharmacology g g
MSC: Integrated Process: Nursing Process—Planning
g g g g
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
g g g g g g g g g g g g g g
which sign of magnesium toxicity?
g g g g g
1. Proteinuria
2. Hyperactive deep tendon reflexes g g g
3. Respiratory rate of 10 breaths/min g g g g
4. Serum magnesium level of 5 mEq/L g g g g g
ANS: 3 g g
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
g g g g g g g g g g g g g
toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of
g g g g g g g g g g g g g g
deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
g g g g g g g g g g g g g g g g g
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
g g g g g g g g g g g g g
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
g g g g g g g g g g g g g
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a
g g g g g g g g g g g g g g
CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive deep
g g g g g g g g g g g g g
tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using medication
g g g g g g g g g g g g g g g
knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this
g g g g g g g g g g g g g g g g g
medication and the normal magnesium level if this question was difficult.
g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Analyzing g g g g
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.g g g g g g g g g g g g g g
OBJ: Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology
g g g
MSC: Integrated Process: Nursing Process—Assessment
g g g g
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
g g g g g g g g g g g g g g g
clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
g g g g g g g g g g g g g g g g g
many weeks of gestation?
g g g g
1. 4
2. 14
3. 24
4. 34
ANS: 2 g g
Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week
g g g g g g g g g g g g g g g
of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
g g g g g g g g g g g g g g g g g g g
, addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks
g g g g g g g g g g g g g g g g g
after birth.
g g
Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological
g g g g g g g g g g g g
therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of
g g g g g g g g g g g g g g g g g
medications and chemicals during the period of organogenesis will assist you in selecting the correct
g g g g g g g g g g g g g g g
answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with
g g g g g g g g g g g g g g g g
this question.
g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Planning g g g
6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a
g g g g g g g g g g g g g g g
newborn. The nurse plans to explain to the parents that the purpose of the medication is to:
g g g g g g g g g g g g g g g g g
1. Help the newborn to see more clearly.
g g g g g g
2. Guard against infection acquired during intrauterine life.
g g g g g g
3. Ensure the sterility of the conjunctiva in the newborn.
g g g g g g g g
4. Protect the newborn from contracting an eye infection during birth.
g g g g g g g g g
ANS: 4 g g
Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from
g g g g g g g g g g g g g g g
contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results
g g g g g g g g g g g g
from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the
g g g g g g g g g g g g g g
United States. ―Help the newborn to see more clearly,‖ ―guard against infection acquired during
g g g g g g g g g g g g g g
intrauterine life,‖ and ―ensure the sterility of the conjunctiva in the newborn‖ do not describe the
g g g g g g g g g g g g g g g g
purposes of this medication.
g g g g
Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question.
g g g g g g g g g g g g g g
Remember erythromycin protects the newborn from contracting a conjunctival infection during birth.
g g g g g g g g g g g g
Review the purpose of this medication if you had difficulty with this question.
g g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Applying g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Health Promotion and Maintenance
g g g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Teaching and Learning g g g g
7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the
g g g g g g g g g g g g g g g
newborn. Before giving the medication, the nurse explains to the client that this medication will:
g g g g g g g g g g g g g g g
g g g g g g g g
Edition
g
Pharmacology
gTest Bank g
MULTIPLE CHOICE g
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that
g g g g g g g g g g g g g g g g g
the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication
g g g g g g g g g g g g g g g
is prescribed for:
g g g
1. Pain relief g
2. Increasing uterine contractions g g
3. Decreasing uterine contractions g g
4. Promoting fetal lung maturity g g g
ANS: 1 g g
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
g g g g g g g g g g g g g g g g g g g
3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for
g g g g g g g g g g g g g g g g
pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and ―promoting fetal
g g g g g g g g g g g
lung maturity‖ are not actions of this medication.
g g g g g g g g
Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
g g g g g g g g g g g g g
question. Remember that this medication is used for pain relief. Review the action of this medication if
g g g g g g g g g g g g g g g g g
you had difficulty with this question and are unfamiliar with this medication.
g g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Planning g g g
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
g g g g g g g g g g g g g g g g
administration following cesarean birth. If the client develops respiratory depression and requires
g g g g g g g g g g g g
naloxone (Narcan) as an antidote, the client may complain of which of the following?
g g g g g g g g g g g g g g
1. Increase in her pain level g g g g
2. Decrease in her pain level g g g g
3. Increase in the amount of itching from the opioid used in the epidural
g g g g g g g g g g g g
4. Decrease in the amount of itching from the opioid used in the epidural
g g g g g g g g g g g g
, ANS: 1 g g
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
g g g g g g g g g g g g g
which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain
g g g g g g g g g g g g g g g g g g g g
level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the opioid used in
g g g g g g g g g g g g g g g g g g
the epidural,‖ and ―decrease in the amount of itching from the opioid used in the epidural‖ are incorrect.
g g g g g g g g g g g g g g g g g g
Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
g g g g g g g g g g g g g g
medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an
g g g g g g g g g g g g g g g
antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this
g g g g g g g g g g g g g g g g g
question was difficult.
g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity
g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Assessment g g g
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the
g g g g g g g g g g g g g g g
hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that
g g g g g g g g g g g g g g
the medication will do which of the following?
g g g g g g g g
1. Prevent spontaneous delivery. g g
2. Stop the uterine contractions.
g g g
3. Promote maturation of the fetal lungs. g g g g g
4. Accelerate the growth rate of the fetus. g g g g g g
ANS: 3 g g
Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
g g g g g g g g g g
increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory
g g g g g g g g g g g g g g g g
distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone
g g g g g g g g g g g g g g g
to allow time for the lungs of the fetus to mature.
g g g g g g g g g g g
Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
g g g g g g g g g g g g g g g g
mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the strategic
g g g g g g g g g g g g g
words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and knowledge of the
g g g g g g g g g g g g g g
problems encountered by premature infants will assist in answering this question. Review the action of
g g g g g g g g g g g g g g g
this medication if this question was difficult.
g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding g g g g
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St.
g g g g g g g g g g g g g g
Louis: Saunders.
g OBJ: Client Needs: Physiological Integrity
g g g g
, TOP: Content Area: Pharmacology g g
MSC: Integrated Process: Nursing Process—Planning
g g g g
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
g g g g g g g g g g g g g g
which sign of magnesium toxicity?
g g g g g
1. Proteinuria
2. Hyperactive deep tendon reflexes g g g
3. Respiratory rate of 10 breaths/min g g g g
4. Serum magnesium level of 5 mEq/L g g g g g
ANS: 3 g g
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
g g g g g g g g g g g g g
toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of
g g g g g g g g g g g g g g
deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
g g g g g g g g g g g g g g g g g
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
g g g g g g g g g g g g g
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
g g g g g g g g g g g g g
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a
g g g g g g g g g g g g g g
CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive deep
g g g g g g g g g g g g g
tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using medication
g g g g g g g g g g g g g g g
knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this
g g g g g g g g g g g g g g g g g
medication and the normal magnesium level if this question was difficult.
g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Analyzing g g g g
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.g g g g g g g g g g g g g g
OBJ: Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology
g g g
MSC: Integrated Process: Nursing Process—Assessment
g g g g
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
g g g g g g g g g g g g g g g
clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
g g g g g g g g g g g g g g g g g
many weeks of gestation?
g g g g
1. 4
2. 14
3. 24
4. 34
ANS: 2 g g
Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week
g g g g g g g g g g g g g g g
of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
g g g g g g g g g g g g g g g g g g g
, addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks
g g g g g g g g g g g g g g g g g
after birth.
g g
Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological
g g g g g g g g g g g g
therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of
g g g g g g g g g g g g g g g g g
medications and chemicals during the period of organogenesis will assist you in selecting the correct
g g g g g g g g g g g g g g g
answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with
g g g g g g g g g g g g g g g g
this question.
g g
PTS: 1
DIF: Level of Cognitive Ability: Understanding
g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Physiological Integrity g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Nursing Process—Planning g g g
6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a
g g g g g g g g g g g g g g g
newborn. The nurse plans to explain to the parents that the purpose of the medication is to:
g g g g g g g g g g g g g g g g g
1. Help the newborn to see more clearly.
g g g g g g
2. Guard against infection acquired during intrauterine life.
g g g g g g
3. Ensure the sterility of the conjunctiva in the newborn.
g g g g g g g g
4. Protect the newborn from contracting an eye infection during birth.
g g g g g g g g g
ANS: 4 g g
Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from
g g g g g g g g g g g g g g g
contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results
g g g g g g g g g g g g
from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the
g g g g g g g g g g g g g g
United States. ―Help the newborn to see more clearly,‖ ―guard against infection acquired during
g g g g g g g g g g g g g g
intrauterine life,‖ and ―ensure the sterility of the conjunctiva in the newborn‖ do not describe the
g g g g g g g g g g g g g g g g
purposes of this medication.
g g g g
Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question.
g g g g g g g g g g g g g g
Remember erythromycin protects the newborn from contracting a conjunctival infection during birth.
g g g g g g g g g g g g
Review the purpose of this medication if you had difficulty with this question.
g g g g g g g g g g g g
PTS: 1
DIF: Level of Cognitive Ability: Applying g g g g
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
g g g g g g g g g g g
OBJ:
g Client Needs: Health Promotion and Maintenance
g g g g g
TOP: Content Area: Pharmacology g g
MSC: g Integrated Process: Teaching and Learning g g g g
7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the
g g g g g g g g g g g g g g g
newborn. Before giving the medication, the nurse explains to the client that this medication will:
g g g g g g g g g g g g g g g
