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
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uEdition


Silvestri: Saunders Comprehensive Review for the NCLEX-RN® u u u u u u u




Examination, 9thEdition
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Pharmacology

u Test Bank u




MULTIPLE CHOICE u




1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that
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the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication
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is prescribed for:
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1. Pain relief u




2. Increasing uterine contractions u u




3. Decreasing uterine contractions u u



4. Promoting fetal lung maturity u u u




ANS: 1 u




Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
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3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for
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pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and ―promoting fetal
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lung maturity‖ are not actions of this medication.
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Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
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question. Remember that this medication is used for pain relief. Review the action of this medication if
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you had difficulty with this question and are unfamiliar with this medication.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding
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REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
u Client Needs: Physiological Integrity
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TOP: u Content Area: Pharmacology
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MSC: u Integrated Process: Nursing Process—Planning u u u




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



2. Decrease in her pain level u u u u



3. Increase in the amount of itching from the opioid used in the epidural
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,Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 5th
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uEdition


4. Decrease in the amount of itching from the opioid used in the epidural
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, Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 5th
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uEdition


ANS: 1 u




Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
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which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain
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level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the opioid used in
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the epidural,‖ and ―decrease in the amount of itching from the opioid used in the epidural‖ are incorrect.
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Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
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medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an
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antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this
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question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding
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REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
u Client Needs: Physiological Integrity u u u


TOP: u Content Area: Pharmacology
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MSC: u Integrated Process: Nursing Process—Assessment u u u




3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the
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hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that
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the medication will do which of the following?
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1. Prevent spontaneous delivery. u u



2. Stop the uterine contractions.u u u




3. Promote maturation of the fetal lungs. u u u u u



4. Accelerate the growth rate of the fetus. u u u u u u




ANS: 3 u




Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
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increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory
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distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone
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to allow time for the lungs of the fetus to mature.
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Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
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mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the strategic
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words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and knowledge of the
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problems encountered by premature infants will assist in answering this question. Review the action of
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this medication if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding u u u u


REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St.
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Louis: Saunders.
u OBJ: Client Needs: Physiological Integrity
u u u u

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


TOP: Content Area: Pharmacology
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MSC: Integrated Process: Nursing Process—Planning
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4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
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which sign of magnesium toxicity?
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1. Proteinuria
2. Hyperactive deep tendon reflexes u u u



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



4. Serum magnesium level of 5 mEq/L
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ANS: 3 u




Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
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toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of
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deep tendon 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
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develop 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
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CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive deep
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tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using medication
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knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this
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medication and the normal magnesium level if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Analyzing u u u u


REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.
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OBJ: Client Needs: Physiological Integrity u u u


TOP: Content Area: Pharmacology
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MSC: Integrated Process: Nursing Process—Assessment
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5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
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clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
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many weeks of gestation?
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1. 4
2. 14
3. 24
4. 34

ANS: 2 u




Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week
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