.Silvestri- Saunders Comprehensive Review for the NCLEX-RN Examination, 5th

.Silvestri: Saunders Comprehensive Review for the
i# i# i# i# i#



NCLEX- RN® Examination, 5th
i# i# i# i#



Edition Pharmacology i#




MULTIPLECHOICE

1. The nurse i#is i#caring i#for i#a i#client i#in i#labor. i#The i#nurse i#reviews i#the i#physician’s i#prescriptions i#and i#notes
e


i#that i#the i#cli i#enthas i#a i#prescription i#for i#butorphanol i#tartrate i#(Stadol). i#The i#nurse i#understands i#that this e


i#medication i#is i#prescri i#bedi#for:


1. Paini#relief
2. Increasing i#uterine i#contractions
3. Decreasinguterine i#contractions
4. Promotingi#fetali#lungi#maturity

ANS: i # 1

Rationale:i#Thei#clienti#ini#labori#maybei#giveni#parenterali#analgesiai#duringi#thei#firsti#stagei#ofi#labor,i#upi#toi#2i#toi#3i#ho
i#urs i#before i#the i#anticipated i#delivery. i#Butorphanol i#tartrate i#is i#a medication that may i#be i#prescribed i#for i#pain
e e e


i#relie

f.i#―Increasing i#uterine i#contractions,‖ i#―decreasing i#uterine contractions,‖ i#and i#―promoting fetal i#lung
e e


i#maturity‖ i#are i#not i#actions i#of i#this i#medication.




Test-
Takingi#Strategy:i#Knowledge i#ofi#the i#actioni#ofi#butorphanoli#tartratei#is i#requiredi#toi#answeri#thisi#question.i#Reme
i#mberi#thati#this i#medication i#is i#used for i#pain i#relief. i#Reviewi#the i#action i#ofi#thisi#medication i#if i#you i#had i#difficulty
e


i#wit i#h i#this i#question and i#are i#unfamiliar i#with i#this i#medication.
e




PTS: 1
DIF: Levelofi#CognitiveAbility:i#Understanding
i#REF:

Lehne,i#R.i#(2010).i#Pharmacologyfori#nursingi#carei#(7thi#ed.).i#St.i#Louis:i#Saunders.i#O
i#BJ: Client i#Needs: i#Physiological i#Integrity
TOP: ContentArea: i#Pharmacology
MSC: i # Integrated Process:i#Nursingi#Process—Planning
e




2. The postpartum i#nurse i#is i#caring i#for i#a client i#with i#an i#epidural i#catheter i#in i#place i#for i#opioid
e e


i#analgesic i#adm i#inistration i#followingcesarean i#birth. i#If i#the i#client i#develops i#respiratorydepression

i#and i#requires i#naloxo i#ne i#(Narcan) i#as i#an i#antidote, i#the i#client i#may i#complain i#of i#which i#of i#the

i#following?


1. Increasei#in i#her i#pain i#level
2. Decreasei#in i#heri#pain i#level
3. Increasei#in i#the i#amount i#of i#itching i#from i#the i#opioid i#used in the i#epidural
e e



4. Decreasei#in i#the i#amount i#of i#itching i#from i#the i#opioid i#used in the i#epidural
e e

, .Silvestri: Saunders Comprehensive Review for the
i# i# i# i# i#



NCLEX- RN® Examination, 5th
i# i# i# i#



Edition Pharmacology i#




ANS: i # 1

Rationale: i#Rememberi#that i#opioids i#arei#used fori#epidural i#analgesia. i#Naloxonei#is i#ani#opioid i#antagonist, i#which
e


i#reversesi#thei#effectsi#ofi#opioids.i#Ifi#iti#isi#given,i#thei#clienti#mayi#complaini#ofi#an increase ini#heri#paini#level.i#Therefor
e e


i#ei#―decreasei#ini#heri#paini#level,‖i#―increasei#ini#thei#amounti#ofi#itching from thei#opioid usedi#ini#thei#epidural,‖i#andi#―d
e e e


i#ecrease i#in i#the i#amount i#of i#itching i#from i#the i#opioid i#used i#in i#the i#epidural‖ i#are i#incorrect.




Test-
Taking i#Strategy: i#To i#answerthisquestionaccurately, i#youmustknowthatopioidanalgesicsarethe
i#medication i # s i#used with epidural i#analgesia i#to i#relieve i#pain. i#Therefore i#if i#naloxone i#is i#administered as i#an
e e e


i#antidote i#for i#an i#opioi i#d i#analgesic, i#the i#client’s i#pain i#will i#increase. i#Review i#the i#effects i#of i#naloxone i#if i#this

i#question i#was i#difficult.




PTS: i # i # 1
DIF: Levelofi#CognitiveAbility:i#Understanding
i#REF:

Lehne,i#R.i#(2010).i#Pharmacologyfori#nursingi#carei#(7thi#ed.).i#St.i#Louis:i#Saunders.i#O
i#BJ: Client i#Needs: i#Physiological i#Integrity
TOP: ContentArea: i#Pharmacology
MSC: i # Integrated Process:i#Nursingi#Process—Assessment
e




3. Aclient i#experiencing preterm labori#at i#the i#twenty-
e e


ninth i#week i#of i#gestation i#has i#been i#admitted i#to i#the i#hospital. i#The i#client i#has i#a i#prescription i#to i#receive
i#betametha i#sone i#(Celestone). i#The i#nurseunderstands i#that i#the i#medication i#will i#do i#which i#of i#the

i#following?


1. Prevent i#spontaneous i#delivery.
2. Stopi#thei#uterine contractions.
e



3. Promote i#maturation of i#the i#fetal i#lungs. e



4. Accelerate the i#growth rate i#of i#the i#fetus.
e e




ANS: i # 3

Rationale: i#Betamethasone i#(Celestone) i#is i#classified i#as i#an i#anti-
inflammatory i#and i#corticosteroid. i#It i#increases i#the i#surfactant i#level i#and i#lung i#maturity i#in i#the i#fetus, i#which
i#reduc i#es i#the i#incidence i#of i#respiratory i#distress i#syndrome. i#Deliverymust i#be i#delayed i#for i#at i#least 48 i#hours e


i#after i#admini i#stration i#of i#betamethasone i#to i#allow i#time i#for i#the i#lungs i#of i#the i#fetus i#to mature. e




Test-
Takingi#Strategy:i#Options thati#arei#comparablei#ori#alikei#arei#noti#likelyi#toi#bei#correct.i#Withi#thisi#ini#mind,i#elimina
e


i#tei#―preventi#spontaneousi#delivery‖i#andi#―stopi#thei#uterinei#contractions.‖i#Notei#thei#strategici#wordsi#―twenty-

i#ninthweek of i#gestation.‖ i#Specific i#knowledgei#about i#the i#medication i#and i#knowledge i#ofi#the i#problems
e


i#encount i#eredi#byi#prematurei#infants i#willi#assist in answeringi#thisi#question.i#Reviewi#thei#actioni#ofi#this
e e


i#medicationi#ifi#this q i#uestion i#was i#difficult.
e




PTS: i # i # 1

, .Silvestri: Saunders Comprehensive Review for the
i# i# i# i# i#



NCLEX- RN® Examination, 5th
i# i# i# i#



Edition Pharmacology i#




DIF: Levelof i#CognitiveAbility: i#Understanding
REF: McKinney,i#E.,i#James,i#S.,i#Murray,i#S.,&Ashwill,i#J.i#(2009).i#Maternal-
childnursing (3rdi#ed.).i#St. i#Louis:i#Saunders. OBJ: Client i#Needs: i#Physiological i#Integrity
e

, .Silvestri: Saunders Comprehensive Review for the
i# i# i# i# i#



NCLEX- RN® Examination, 5th
i# i# i# i#



Edition Pharmacology i#




TOP: ContentArea: i#Pharmacology
MSC: i # Integratedi#Process:i#Nursingi#Process—Planning

4. Aclienti#withi#preeclampsiai#isi#receivingmagnesium i#sulfate.i#Thei#nursei#assessesi#thei#clienti#closelyfori#wh
i#ich i#sign i#of i#magnesium i#toxicity?


1. Proteinuria
2. Hyperactive i#deep i#tendon reflexes e



3. Respiratoryrate i#of i#10 i#breaths/min
4. Serum magnesium level i#of i#5 i#mEq/L
e e




ANS: i # 3

Rationale: i#Magnesium i#toxicityisa i#risk i#associated i#withmagnesium i#sulfate i#therapy. i#Signsofmagnesium
i#tox i#icity i#relate i#to i#central i#nervous i#system i#(CNS) i#depression and include i#respiratory i#depression, i#loss i#of
e e


i#deep i#tend i#on i#reflexes, i#and i#sudden drop i#in fetal i#heart rate i#and/or i#maternal i#heart i#rate i#and i#blood
e e e


i#pressure.

Magnesium i#is i#excreted through i#the i#kidneys. i#If i#renal i#impairment i#is i#present, i#magnesium i#toxicity i#can
e


i#develop i#v i#eryquickly. i#Therapeutic i#serum i#levels i#of i#magnesium i#are i#4 i#to i#7 i#mEq/L.




Test-
Taking i#Strategy: i#To i#answer i#this i#question i#accurately, i#you i#must i#recall i#that magnesium i#sulfate i#is i#a i#CNS
e


i#depre i#ssant. i#Begin i#to i#answer i#this i#question i#by i#eliminating i#―proteinuria‖ i#and ―hyperactive deep i#tendon
e e


i#reflexes,‖ i#w i#hich i#are i#signs i#of i#preeclampsia. i#Select i#between i#the i#last i#two i#options i#usingmedication

i#knowledge i#and i#recallin i#g i#that i#the i#therapeutic i#serum i#levels i#of i#magnesium i#are i#4 i#to i#7 i#mEq/L. i#Review

i#this i#medication i#and i#the i#normal i#m i#agnesium i#level i#if i#this i#question i#was i#difficult.




PTS: 1
DIF: i # i # Levelofi#Cognitivei#Ability:i#Analyzing
REF: i # i # Lowdermilk,i#D.,i#Perry,i#S.,i#&i#Cashion,i#K.i#(2010).i#Maternitynursingi#(8thi#ed.).i#St.i#Louis:i#Mosby.
OBJ:
Clienti#Needs:i#Physiological i#Integrity i#TOP:
Content i#Area: i#Pharmacology
MSC: i # Integrated Process:i#Nursingi#Process—Assessment
e




5. Apregnant client i#who i#has i#human i#immunodeficiencyvirus i#(HIV) i#infection is i#being i#seen i#in i#the i#antenatal
e e


i#clin i#ic. i#The i#nurse i#recalls that i#zidovudine i#(AZT) i#therapy i#will i#be i#initiated i#when i#the i#fetus i#has i#reached
e


i#how i#many i#w i#eeks i#of i#gestation?


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

ANS: i # 2