.Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
MULTIPLECHOICE
1. The nurse l#is l#caring l#for l#a l#client l#in l#labor. l#The l#nurse l#reviews l#the l#physician’s l#prescriptions l#and l#notes
e
l#that l#the l#cli l#enthas l#a l#prescription l#for l#butorphanol l#tartrate l#(Stadol). l#The l#nurse l#understands l#that this e
l#medication l#is l#prescri l#bedl#for:
1. Painl#relief
2. Increasing l#uterine l#contractions
3. Decreasinguterine l#contractions
4. Promotingl#fetall#lungl#maturity
ANS: l # 1
Rationale:l#Thel#clientl#inl#laborl#maybel#givenl#parenterall#analgesial#duringl#thel#firstl#stagel#ofl#labor,l#upl#tol#2l#tol#3l#ho
l#urs l#before l#the l#anticipated l#delivery. l#Butorphanol l#tartrate l#is l#a medication that may l#be l#prescribed l#for l#pain
e e e
l#relie
f.l#―Increasing l#uterine l#contractions,‖ l#―decreasing l#uterine contractions,‖ l#and l#―promoting fetal l#lung
e e
l#maturity‖ l#are l#not l#actions l#of l#this l#medication.
Test-
Takingl#Strategy:l#Knowledge l#ofl#the l#actionl#ofl#butorphanoll#tartratel#is l#requiredl#tol#answerl#thisl#question.l#Reme
l#mberl#thatl#this l#medication l#is l#used for l#pain l#relief. l#Reviewl#the l#action l#ofl#thisl#medication l#if l#you l#had l#difficulty
e
l#wit l#h l#this l#question and l#are l#unfamiliar l#with l#this l#medication.
e
PTS: 1
DIF: Levelofl#CognitiveAbility:l#Understanding
l#REF:
Lehne,l#R.l#(2010).l#Pharmacologyforl#nursingl#carel#(7thl#ed.).l#St.l#Louis:l#Saunders.l#O
l#BJ: Client l#Needs: l#Physiological l#Integrity
TOP: ContentArea: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Planning
e
2. The postpartum l#nurse l#is l#caring l#for l#a client l#with l#an l#epidural l#catheter l#in l#place l#for l#opioid
e e
l#analgesic l#adm l#inistration l#followingcesarean l#birth. l#If l#the l#client l#develops l#respiratorydepression
l#and l#requires l#naloxo l#ne l#(Narcan) l#as l#an l#antidote, l#the l#client l#may l#complain l#of l#which l#of l#the
l#following?
1. Increasel#in l#her l#pain l#level
2. Decreasel#in l#herl#pain l#level
3. Increasel#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used in the l#epidural
e e
4. Decreasel#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used in the l#epidural
e e
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
ANS: l # 1
Rationale: l#Rememberl#that l#opioids l#arel#used forl#epidural l#analgesia. l#Naloxonel#is l#anl#opioid l#antagonist, l#which
e
l#reversesl#thel#effectsl#ofl#opioids.l#Ifl#itl#isl#given,l#thel#clientl#mayl#complainl#ofl#an increase inl#herl#painl#level.l#Therefor
e e
l#el#―decreasel#inl#herl#painl#level,‖l#―increasel#inl#thel#amountl#ofl#itching from thel#opioid usedl#inl#thel#epidural,‖l#andl#―d
e e e
l#ecrease l#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used l#in l#the l#epidural‖ l#are l#incorrect.
Test-
Taking l#Strategy: l#To l#answerthisquestionaccurately, l#youmustknowthatopioidanalgesicsarethe
l#medication l # s l#used with epidural l#analgesia l#to l#relieve l#pain. l#Therefore l#if l#naloxone l#is l#administered as l#an
e e e
l#antidote l#for l#an l#opioi l#d l#analgesic, l#the l#client’s l#pain l#will l#increase. l#Review l#the l#effects l#of l#naloxone l#if l#this
l#question l#was l#difficult.
PTS: l # l # 1
DIF: Levelofl#CognitiveAbility:l#Understanding
l#REF:
Lehne,l#R.l#(2010).l#Pharmacologyforl#nursingl#carel#(7thl#ed.).l#St.l#Louis:l#Saunders.l#O
l#BJ: Client l#Needs: l#Physiological l#Integrity
TOP: ContentArea: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Assessment
e
3. Aclient l#experiencing preterm laborl#at l#the l#twenty-
e e
ninth l#week l#of l#gestation l#has l#been l#admitted l#to l#the l#hospital. l#The l#client l#has l#a l#prescription l#to l#receive
l#betametha l#sone l#(Celestone). l#The l#nurseunderstands l#that l#the l#medication l#will l#do l#which l#of l#the
l#following?
1. Prevent l#spontaneous l#delivery.
2. Stopl#thel#uterine contractions.
e
3. Promote l#maturation of l#the l#fetal l#lungs. e
4. Accelerate the l#growth rate l#of l#the l#fetus.
e e
ANS: l # 3
Rationale: l#Betamethasone l#(Celestone) l#is l#classified l#as l#an l#anti-
inflammatory l#and l#corticosteroid. l#It l#increases l#the l#surfactant l#level l#and l#lung l#maturity l#in l#the l#fetus, l#which
l#reduc l#es l#the l#incidence l#of l#respiratory l#distress l#syndrome. l#Deliverymust l#be l#delayed l#for l#at l#least 48 l#hours e
l#after l#admini l#stration l#of l#betamethasone l#to l#allow l#time l#for l#the l#lungs l#of l#the l#fetus l#to mature. e
Test-
Takingl#Strategy:l#Options thatl#arel#comparablel#orl#alikel#arel#notl#likelyl#tol#bel#correct.l#Withl#thisl#inl#mind,l#elimina
e
l#tel#―preventl#spontaneousl#delivery‖l#andl#―stopl#thel#uterinel#contractions.‖l#Notel#thel#strategicl#wordsl#―twenty-
l#ninthweek of l#gestation.‖ l#Specific l#knowledgel#about l#the l#medication l#and l#knowledge l#ofl#the l#problems
e
l#encount l#eredl#byl#prematurel#infants l#willl#assist in answeringl#thisl#question.l#Reviewl#thel#actionl#ofl#this
e e
l#medicationl#ifl#this q l#uestion l#was l#difficult.
e
PTS: l # l # 1
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
DIF: Levelof l#CognitiveAbility: l#Understanding
REF: McKinney,l#E.,l#James,l#S.,l#Murray,l#S.,&Ashwill,l#J.l#(2009).l#Maternal-
childnursing (3rdl#ed.).l#St. l#Louis:l#Saunders. OBJ: Client l#Needs: l#Physiological l#Integrity
e
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
TOP: ContentArea: l#Pharmacology
MSC: l # Integratedl#Process:l#Nursingl#Process—Planning
4. Aclientl#withl#preeclampsial#isl#receivingmagnesium l#sulfate.l#Thel#nursel#assessesl#thel#clientl#closelyforl#wh
l#ich l#sign l#of l#magnesium l#toxicity?
1. Proteinuria
2. Hyperactive l#deep l#tendon reflexes e
3. Respiratoryrate l#of l#10 l#breaths/min
4. Serum magnesium level l#of l#5 l#mEq/L
e e
ANS: l # 3
Rationale: l#Magnesium l#toxicityisa l#risk l#associated l#withmagnesium l#sulfate l#therapy. l#Signsofmagnesium
l#tox l#icity l#relate l#to l#central l#nervous l#system l#(CNS) l#depression and include l#respiratory l#depression, l#loss l#of
e e
l#deep l#tend l#on l#reflexes, l#and l#sudden drop l#in fetal l#heart rate l#and/or l#maternal l#heart l#rate l#and l#blood
e e e
l#pressure.
Magnesium l#is l#excreted through l#the l#kidneys. l#If l#renal l#impairment l#is l#present, l#magnesium l#toxicity l#can
e
l#develop l#v l#eryquickly. l#Therapeutic l#serum l#levels l#of l#magnesium l#are l#4 l#to l#7 l#mEq/L.
Test-
Taking l#Strategy: l#To l#answer l#this l#question l#accurately, l#you l#must l#recall l#that magnesium l#sulfate l#is l#a l#CNS
e
l#depre l#ssant. l#Begin l#to l#answer l#this l#question l#by l#eliminating l#―proteinuria‖ l#and ―hyperactive deep l#tendon
e e
l#reflexes,‖ l#w l#hich l#are l#signs l#of l#preeclampsia. l#Select l#between l#the l#last l#two l#options l#usingmedication
l#knowledge l#and l#recallin l#g l#that l#the l#therapeutic l#serum l#levels l#of l#magnesium l#are l#4 l#to l#7 l#mEq/L. l#Review
l#this l#medication l#and l#the l#normal l#m l#agnesium l#level l#if l#this l#question l#was l#difficult.
PTS: 1
DIF: l # l # Levelofl#Cognitivel#Ability:l#Analyzing
REF: l # l # Lowdermilk,l#D.,l#Perry,l#S.,l#&l#Cashion,l#K.l#(2010).l#Maternitynursingl#(8thl#ed.).l#St.l#Louis:l#Mosby.
OBJ:
Clientl#Needs:l#Physiological l#Integrity l#TOP:
Content l#Area: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Assessment
e
5. Apregnant client l#who l#has l#human l#immunodeficiencyvirus l#(HIV) l#infection is l#being l#seen l#in l#the l#antenatal
e e
l#clin l#ic. l#The l#nurse l#recalls that l#zidovudine l#(AZT) l#therapy l#will l#be l#initiated l#when l#the l#fetus l#has l#reached
e
l#how l#many l#w l#eeks l#of l#gestation?
1. 4
2. 14
3. 24
4. 34
ANS: l # 2
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
MULTIPLECHOICE
1. The nurse l#is l#caring l#for l#a l#client l#in l#labor. l#The l#nurse l#reviews l#the l#physician’s l#prescriptions l#and l#notes
e
l#that l#the l#cli l#enthas l#a l#prescription l#for l#butorphanol l#tartrate l#(Stadol). l#The l#nurse l#understands l#that this e
l#medication l#is l#prescri l#bedl#for:
1. Painl#relief
2. Increasing l#uterine l#contractions
3. Decreasinguterine l#contractions
4. Promotingl#fetall#lungl#maturity
ANS: l # 1
Rationale:l#Thel#clientl#inl#laborl#maybel#givenl#parenterall#analgesial#duringl#thel#firstl#stagel#ofl#labor,l#upl#tol#2l#tol#3l#ho
l#urs l#before l#the l#anticipated l#delivery. l#Butorphanol l#tartrate l#is l#a medication that may l#be l#prescribed l#for l#pain
e e e
l#relie
f.l#―Increasing l#uterine l#contractions,‖ l#―decreasing l#uterine contractions,‖ l#and l#―promoting fetal l#lung
e e
l#maturity‖ l#are l#not l#actions l#of l#this l#medication.
Test-
Takingl#Strategy:l#Knowledge l#ofl#the l#actionl#ofl#butorphanoll#tartratel#is l#requiredl#tol#answerl#thisl#question.l#Reme
l#mberl#thatl#this l#medication l#is l#used for l#pain l#relief. l#Reviewl#the l#action l#ofl#thisl#medication l#if l#you l#had l#difficulty
e
l#wit l#h l#this l#question and l#are l#unfamiliar l#with l#this l#medication.
e
PTS: 1
DIF: Levelofl#CognitiveAbility:l#Understanding
l#REF:
Lehne,l#R.l#(2010).l#Pharmacologyforl#nursingl#carel#(7thl#ed.).l#St.l#Louis:l#Saunders.l#O
l#BJ: Client l#Needs: l#Physiological l#Integrity
TOP: ContentArea: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Planning
e
2. The postpartum l#nurse l#is l#caring l#for l#a client l#with l#an l#epidural l#catheter l#in l#place l#for l#opioid
e e
l#analgesic l#adm l#inistration l#followingcesarean l#birth. l#If l#the l#client l#develops l#respiratorydepression
l#and l#requires l#naloxo l#ne l#(Narcan) l#as l#an l#antidote, l#the l#client l#may l#complain l#of l#which l#of l#the
l#following?
1. Increasel#in l#her l#pain l#level
2. Decreasel#in l#herl#pain l#level
3. Increasel#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used in the l#epidural
e e
4. Decreasel#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used in the l#epidural
e e
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
ANS: l # 1
Rationale: l#Rememberl#that l#opioids l#arel#used forl#epidural l#analgesia. l#Naloxonel#is l#anl#opioid l#antagonist, l#which
e
l#reversesl#thel#effectsl#ofl#opioids.l#Ifl#itl#isl#given,l#thel#clientl#mayl#complainl#ofl#an increase inl#herl#painl#level.l#Therefor
e e
l#el#―decreasel#inl#herl#painl#level,‖l#―increasel#inl#thel#amountl#ofl#itching from thel#opioid usedl#inl#thel#epidural,‖l#andl#―d
e e e
l#ecrease l#in l#the l#amount l#of l#itching l#from l#the l#opioid l#used l#in l#the l#epidural‖ l#are l#incorrect.
Test-
Taking l#Strategy: l#To l#answerthisquestionaccurately, l#youmustknowthatopioidanalgesicsarethe
l#medication l # s l#used with epidural l#analgesia l#to l#relieve l#pain. l#Therefore l#if l#naloxone l#is l#administered as l#an
e e e
l#antidote l#for l#an l#opioi l#d l#analgesic, l#the l#client’s l#pain l#will l#increase. l#Review l#the l#effects l#of l#naloxone l#if l#this
l#question l#was l#difficult.
PTS: l # l # 1
DIF: Levelofl#CognitiveAbility:l#Understanding
l#REF:
Lehne,l#R.l#(2010).l#Pharmacologyforl#nursingl#carel#(7thl#ed.).l#St.l#Louis:l#Saunders.l#O
l#BJ: Client l#Needs: l#Physiological l#Integrity
TOP: ContentArea: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Assessment
e
3. Aclient l#experiencing preterm laborl#at l#the l#twenty-
e e
ninth l#week l#of l#gestation l#has l#been l#admitted l#to l#the l#hospital. l#The l#client l#has l#a l#prescription l#to l#receive
l#betametha l#sone l#(Celestone). l#The l#nurseunderstands l#that l#the l#medication l#will l#do l#which l#of l#the
l#following?
1. Prevent l#spontaneous l#delivery.
2. Stopl#thel#uterine contractions.
e
3. Promote l#maturation of l#the l#fetal l#lungs. e
4. Accelerate the l#growth rate l#of l#the l#fetus.
e e
ANS: l # 3
Rationale: l#Betamethasone l#(Celestone) l#is l#classified l#as l#an l#anti-
inflammatory l#and l#corticosteroid. l#It l#increases l#the l#surfactant l#level l#and l#lung l#maturity l#in l#the l#fetus, l#which
l#reduc l#es l#the l#incidence l#of l#respiratory l#distress l#syndrome. l#Deliverymust l#be l#delayed l#for l#at l#least 48 l#hours e
l#after l#admini l#stration l#of l#betamethasone l#to l#allow l#time l#for l#the l#lungs l#of l#the l#fetus l#to mature. e
Test-
Takingl#Strategy:l#Options thatl#arel#comparablel#orl#alikel#arel#notl#likelyl#tol#bel#correct.l#Withl#thisl#inl#mind,l#elimina
e
l#tel#―preventl#spontaneousl#delivery‖l#andl#―stopl#thel#uterinel#contractions.‖l#Notel#thel#strategicl#wordsl#―twenty-
l#ninthweek of l#gestation.‖ l#Specific l#knowledgel#about l#the l#medication l#and l#knowledge l#ofl#the l#problems
e
l#encount l#eredl#byl#prematurel#infants l#willl#assist in answeringl#thisl#question.l#Reviewl#thel#actionl#ofl#this
e e
l#medicationl#ifl#this q l#uestion l#was l#difficult.
e
PTS: l # l # 1
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
DIF: Levelof l#CognitiveAbility: l#Understanding
REF: McKinney,l#E.,l#James,l#S.,l#Murray,l#S.,&Ashwill,l#J.l#(2009).l#Maternal-
childnursing (3rdl#ed.).l#St. l#Louis:l#Saunders. OBJ: Client l#Needs: l#Physiological l#Integrity
e
, .Silvestri: Saunders Comprehensive Review for the
l# l# l# l# l#
NCLEX- RN® Examination, 5th
l# l# l# l#
Edition Pharmacology l#
TOP: ContentArea: l#Pharmacology
MSC: l # Integratedl#Process:l#Nursingl#Process—Planning
4. Aclientl#withl#preeclampsial#isl#receivingmagnesium l#sulfate.l#Thel#nursel#assessesl#thel#clientl#closelyforl#wh
l#ich l#sign l#of l#magnesium l#toxicity?
1. Proteinuria
2. Hyperactive l#deep l#tendon reflexes e
3. Respiratoryrate l#of l#10 l#breaths/min
4. Serum magnesium level l#of l#5 l#mEq/L
e e
ANS: l # 3
Rationale: l#Magnesium l#toxicityisa l#risk l#associated l#withmagnesium l#sulfate l#therapy. l#Signsofmagnesium
l#tox l#icity l#relate l#to l#central l#nervous l#system l#(CNS) l#depression and include l#respiratory l#depression, l#loss l#of
e e
l#deep l#tend l#on l#reflexes, l#and l#sudden drop l#in fetal l#heart rate l#and/or l#maternal l#heart l#rate l#and l#blood
e e e
l#pressure.
Magnesium l#is l#excreted through l#the l#kidneys. l#If l#renal l#impairment l#is l#present, l#magnesium l#toxicity l#can
e
l#develop l#v l#eryquickly. l#Therapeutic l#serum l#levels l#of l#magnesium l#are l#4 l#to l#7 l#mEq/L.
Test-
Taking l#Strategy: l#To l#answer l#this l#question l#accurately, l#you l#must l#recall l#that magnesium l#sulfate l#is l#a l#CNS
e
l#depre l#ssant. l#Begin l#to l#answer l#this l#question l#by l#eliminating l#―proteinuria‖ l#and ―hyperactive deep l#tendon
e e
l#reflexes,‖ l#w l#hich l#are l#signs l#of l#preeclampsia. l#Select l#between l#the l#last l#two l#options l#usingmedication
l#knowledge l#and l#recallin l#g l#that l#the l#therapeutic l#serum l#levels l#of l#magnesium l#are l#4 l#to l#7 l#mEq/L. l#Review
l#this l#medication l#and l#the l#normal l#m l#agnesium l#level l#if l#this l#question l#was l#difficult.
PTS: 1
DIF: l # l # Levelofl#Cognitivel#Ability:l#Analyzing
REF: l # l # Lowdermilk,l#D.,l#Perry,l#S.,l#&l#Cashion,l#K.l#(2010).l#Maternitynursingl#(8thl#ed.).l#St.l#Louis:l#Mosby.
OBJ:
Clientl#Needs:l#Physiological l#Integrity l#TOP:
Content l#Area: l#Pharmacology
MSC: l # Integrated Process:l#Nursingl#Process—Assessment
e
5. Apregnant client l#who l#has l#human l#immunodeficiencyvirus l#(HIV) l#infection is l#being l#seen l#in l#the l#antenatal
e e
l#clin l#ic. l#The l#nurse l#recalls that l#zidovudine l#(AZT) l#therapy l#will l#be l#initiated l#when l#the l#fetus l#has l#reached
e
l#how l#many l#w l#eeks l#of l#gestation?
1. 4
2. 14
3. 24
4. 34
ANS: l # 2
