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