Summary Saunders Review for NCLEX-RN, 8th edition

Saunders
Comprehensiv
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e
v forthe
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NCLEX-RN®
Examination 2022

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

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MULTIPLE CHOICE v




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




2. Increasing uterine contractions v v




3. Decreasing uterine contractions v v




4. Promoting fetal lung maturity v v v




ANS: 1

Rationale: The client in labor may be given parenteral analgesia during the first stage of
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vlabor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a
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vmedication that may be prescribed for pain relief. ―Increasing uterine contractions,‖
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v―decreasing uterine v



contractions,‖ and ―promoting fetal 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
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vanswer this question. Remember that this medication is used for pain relief. Review the
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action of this medication if you had difficulty with this question and are unfamiliar
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vwith this medication.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding v v v v



REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. v v v v v v v v v



Louis: Saunders. OBJ:
v Client Needs: Physiological Integrity
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TOP: Content Area: Pharmacology v v



MSC: Integrated Process: Nursing Process—Planning v v v




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




2. Decrease in her pain level v v v v




3. Increase in the amount of itching from the opioid used in the
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epidural
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4. Decrease in the amount of itching from the opioid used in the
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epidural
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, ANS: 1

Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an
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vopioid antagonist, which reverses the effects of opioids. If it is given, the client
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vmay complain of an increase in her pain level. Therefore ―decrease in her pain level,‖
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―increase in the amount of itching from the opioid used in the epidural,‖ and ―decrease
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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
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analgesics are the medications used with epidural analgesia to relieve pain. Therefore
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vif naloxone is administered as an antidote for an opioid analgesic, the client’s pain
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will increase. Review the effects of naloxone if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding v v v v



REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. v v v v v v v v v



Louis: Saunders. OBJ:
v Client Needs: Physiological Integrity
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TOP: Content Area: Pharmacology v v



MSC: Integrated Process: Nursing Process—Assessment v v v




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




2. Stop the uterine contractions. v v v




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




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




ANS: 3

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




PTS: 1
DIF: Level of Cognitive Ability: Understanding v v v v



REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing v v v v v v v v v v v



(3rd ed.). St. Louis: Saunders. OBJ:
v v Client Needs: Physiological Integrity
v v v v v v v

, TOP: Content Area: Pharmacology v v



MSC: Integrated Process: Nursing Process—Planning v v v




4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the
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client closely for which sign of magnesium toxicity?
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1. Proteinuria
2. Hyperactive deep tendon reflexes v v v




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




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




ANS: 3

Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
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magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
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vdepression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or
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maternal heart rate and blood pressure.
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Magnesium is excreted through the kidneys. If renal impairment is present, magnesium
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toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to
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v7 mEq/L.
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Test-Taking Strategy: To answer this question accurately, you must recall that
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vmagnesium sulfate is a CNS depressant. Begin to answer this question by eliminating
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―proteinuria‖ and
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―hyperactive deep tendon reflexes,‖ which are signs of preeclampsia. Select between the
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last two options using medication knowledge and recalling that the therapeutic serum
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vlevels of magnesium are 4 to 7 mEq/L. Review this medication and the normal
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vmagnesium level if this question was difficult. v v v v v v




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



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



vLouis: Mosby. v



OBJ: Client Needs: Physiological v v



Integrity TOP:
v Content Area: Pharmacology
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MSC: Integrated Process: Nursing Process—Assessment v v v




5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
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vclinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the
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fetus has reached how many weeks of gestation?
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1. 4
2. 14
3. 24
4. 34

ANS: 2

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