TEST BANK FOR SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN® EXAMINATION, 9TH EDITION BY LINDA ANNE SILVESTRI AND ANGELA SILVESTRI COMPLETE QUESTIONS AND ANSWERS

, Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 5th
Edition
Pharmacology

Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that
the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication
is prescribed for:
1. Pain relief
2. Increasing uterine contractions
3. Decreasing uterine contractions
4. Promoting fetal lung maturity

ANS: 1

Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for
pain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and “promoting fetal
lung maturity” are not actions of this medication.

Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
question. Remember that this medication is used for pain relief. Review the action of this medication if
you had difficulty with this question and are unfamiliar with this medication.

PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Pharmacology
MSC: Integrated Process: Nursing Process—Planning

2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
administration following cesarean birth. If the client develops respiratory depression and requires
naloxone (Narcan) as an antidote, the client may complain of which of the following?
1. Increase in her pain level
2. Decrease in her pain level
3. Increase in the amount of itching from the opioid used in the epidural
4. Decrease in the amount of itching from the opioid used in the epidural

, ANS: 1

Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain
level. Therefore “decrease in her pain level,” “increase in the amount of itching from the opioid used in
the epidural,” and “decrease in the amount of itching from the opioid used in the epidural” are incorrect.

Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an
antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this
question was difficult.

PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Pharmacology
MSC: Integrated Process: Nursing Process—Assessment

3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the
hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that
the medication will do which of the following?
1. Prevent spontaneous delivery.
2. Stop the uterine contractions.
3. Promote maturation of the fetal lungs.
4. Accelerate the growth rate of the fetus.

ANS: 3

Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory
distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone
to allow time for the lungs of the fetus to mature.

Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
mind, eliminate “prevent spontaneous delivery” and “stop the uterine contractions.” Note the strategic
words “twenty-ninth week of gestation.” Specific knowledge about the medication and knowledge of the
problems encountered by premature infants will assist in answering this question. Review the action of
this medication if this question was difficult.

PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St.
Louis: Saunders. OBJ: Client Needs: Physiological Integrity

, TOP: Content Area: Pharmacology rt rt



MSC: Integrated Process: Nursing Process—Planning
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4. Aclient with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for whi
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ch sign of magnesium toxicity?
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1. Proteinuria
2. Hyperactive deep tendon reflexes rt rt rt




3. Respiratory rate of 10 breaths/min rt rt rt rt




4. Serum magnesium level of 5 mEq/L rt rt rt rt rt




ANS: 3 r t r t




Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxi
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city relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tend
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on reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
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Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop
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very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
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Test-
Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a CNS depre
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ssant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep tendon reflexes,” w
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hich are signs of preeclampsia. Select between the last two options using medication knowledge and recallin
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g that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this medication and the normal
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magnesium level if this question was difficult. rt rt rt rt rt rt




PTS: 1
DIF: Level of Cognitive Ability: Analyzing rt rt rt rt



REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby. rt rt rt rt rt rt rt rt rt rt rt rt rt rt



OBJ:
Client Needs: Physiological Integrity TOP: rt rt rt rt



Content Area: Pharmacology rt rt



MSC: Integrated Process: Nursing Process—Assessment
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5. Apregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal clin
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ic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how many w
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eeks of gestation? rt rt




1. 4
2. 14
3. 24
4. 34

ANS: 2 r t r t




Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week of ge
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station. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
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