Test Bank for Saunders Comprehensive Review for the NCLEX-RN® Examination, 9th Edition by Linda Anne Silvestri and Angela Silvestri Complete Questions and Answers Pass Guaranteed

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

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MULTIPLE CHOICE i




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 understands
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that this medication is prescribed for:
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1. Pain relief i



2. Increasing uterine contractions i i




3. Decreasing uterine contractions i i




4. Promoting fetal lung maturity i i i




ANS: 1

Rationale: The client in labor may be given parenteral analgesia during the first stage of labor,
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up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be
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prescribed for pain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and
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“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 answer this
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question. Remember that this medication is used for pain relief. Review the action of this
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medication if you had difficulty with this question and are unfamiliar with this medication.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding i i i i


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


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


MSC: Integrated Process: Nursing Process—Planning i i i




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




2. Decrease in her pain level i i i i



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

Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid
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antagonist, which reverses the effects of opioids. If it is given, the client may complain of an
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increase in her pain level. Therefore “decrease in her pain level,” “increase in the amount of
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itching from the opioid used in the epidural,” and “decrease in the amount of itching from the
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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
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as an antidote for an opioid analgesic, the client’s pain will increase. Review the effects of
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naloxone if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding i i i i


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


Saunders. OBJ:
i Client Needs: Physiological Integrity i i i i


TOP: Content Area: Pharmacology i i


MSC: Integrated Process: Nursing Process—Assessment i i i




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




2. Stop the uterine contractions. i i i



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




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




ANS: 3

Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid.
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It increases the surfactant level and lung maturity in the fetus, which reduces the incidence
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of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after
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administration of betamethasone 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
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this in mind, eliminate “prevent spontaneous delivery” and “stop the uterine contractions.”
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Note the strategic words “twenty-ninth week of gestation.” Specific knowledge about the
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medication and knowledge of the problems encountered by premature infants will assist in
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answering this question. Review the action of this medication if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding i i i i


REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. i i i i i i i i i i i i i i


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


MSC: Integrated Process: Nursing Process—Planning i i i




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



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



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




ANS: 3

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


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


iLouis: Mosby. i


OBJ: Client Needs: Physiological i i


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




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
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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 fourteenth
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week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
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medication. In
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, addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six
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weeks after birth.
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Test-Taking Strategy: To answer this question accurately, you must be familiar with
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pharmacological therapy for clients who are HIV-positive. Knowing that the fetus is most
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vulnerable to the effects of medications and chemicals during the period of organogenesis will
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assist you in selecting the correct answer. Review treatment measures for the pregnant client with
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HIV infection if you had difficulty with this question.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding i i i i


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


Saunders. OBJ:
i Client Needs: Physiological Integrity i i i i


TOP: Content Area: Pharmacology i i


MSC: Integrated Process: Nursing Process—Planning i i i




6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the
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eyes of a newborn. The nurse plans to explain to the parents that the purpose of the
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medication is to:
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1. Help the newborn to see more clearly.
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2. Guard against infection acquired during intrauterine life.
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3. Ensure the sterility of the conjunctiva in the newborn.
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4. Protect the newborn from contracting an eye infection during birth.
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ANS: 4

Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the
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newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia
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neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This
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prophylaxis is mandatory in the United States. “Help the newborn to see more clearly,” “guard
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against infection acquired during intrauterine life,” and “ensure the sterility of the conjunctiva
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in the newborn” do not describe the purposes of this medication.
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Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question.
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Remember erythromycin protects the newborn from contracting a conjunctival infection during
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birth.
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Review the purpose of this medication if you had difficulty with this question.
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PTS: 1
DIF: Level of Cognitive Ability: Applying i i i i


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


Saunders. OBJ:
i Client Needs: Health Promotion and Maintenance
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TOP: Content Area: Pharmacology i i


MSC: Integrated Process: Teaching and Learning i i i i




7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin
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K) to the newborn. Before giving the medication, the nurse explains to the client that
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this medication will:
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