SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN EXAMINATION 5TH
EDITION SILVESTRI
,Multiple choice
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and
notes that the client has a prescription for butorphanol tartrate (stadol). The nurse understands
that this medication is prescribed for:
1. Pain relief
2. Increasing uterine contractions
3. Decreasing uterine contractions
4. Promoting fetal lung maturity
Answer: 1
Rationale: the client in labor may be given parenteral analgesia during the first stage of
labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a
medication that may be prescribed for pain relief. “increasing uterine contractions,”
“decreasing uterine contractions,” and “promoting fetal lung maturity” are not actions of
this medication.
Test-taking strategy: knowledge of the action of butorphanol tartrate is required to
answer this question. Remember that this medication is used for pain relief. Review the
action of this medication if you had difficulty with this question and are unfamiliar with
this medication.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: lehne, r. (2010). Pharmacology for nursing care (7th ed.). St. Louis: saunders. Obj:
client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—planning
,2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid
analgesic administration following cesarean birth. If the client develops respiratory depression
and requires naloxone (narcan) as an antidote, the client may complain of which of the following?
1. Increase in her pain level
2. Decrease in her pain level
3. Increase in the amount of itching from the opioid used in the epidural
4. Decrease in the amount of itching from the opioid used in the epidural
Answer: 1
Rationale: remember that opioids are used for epidural analgesia. Naloxone is an opioid
antagonist, which reverses the effects of opioids. If it is given, the client may complain of
an increase in her pain level. Therefore “decrease in her pain level,” “increase in the
amount of itching from the opioid used in the epidural,” and “decrease in the amount of
itching from the opioid used in the epidural” are incorrect.
Test-taking strategy: to answer this question accurately, you must know that opioid
analgesics are the medications used with epidural analgesia to relieve pain. Therefore if
naloxone is administered as an antidote for an opioid analgesic, the client’s pain will
increase. Review the effects of naloxone if this question was difficult.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: lehne, r. (2010). Pharmacology for nursing care (7th ed.). St. Louis: saunders. Obj:
client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—assessment
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to
the hospital. The client has a prescription to receive betamethasone (celestone). The nurse
understands that the medication will do which of the following?
1. Prevent spontaneous delivery.
, 2. Stop the uterine contractions.
3. Promote maturation of the fetal lungs.
4. Accelerate the growth rate of the fetus.
Answer: 3
Rationale: betamethasone (celestone) is classified as an anti-inflammatory and
corticosteroid. It increases the surfactant level and lung maturity in the fetus, which
reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at
least 48 hours after administration of betamethasone to allow time for the lungs of the
fetus to mature.
Test-taking strategy: options that are comparable or alike are not likely to be correct.
With this in mind, eliminate “prevent spontaneous delivery” and “stop the uterine
contractions.” Note the strategic words “twenty-ninth week of gestation.” Specific
knowledge about the medication and knowledge of the problems encountered by
premature infants will assist in answering this question. Review the action of this
medication if this question was difficult.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: mckinney, e., james, s., murray, s., & ashwill, j. (2009). Maternal-child nursing (3rd
ed.). St. Louis: saunders. Obj: client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—planning
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely
for which sign of magnesium toxicity?
1. Proteinuria
2. Hyperactive deep tendon reflexes
3. Respiratory rate of 10 breaths/min
EDITION SILVESTRI
,Multiple choice
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and
notes that the client has a prescription for butorphanol tartrate (stadol). The nurse understands
that this medication is prescribed for:
1. Pain relief
2. Increasing uterine contractions
3. Decreasing uterine contractions
4. Promoting fetal lung maturity
Answer: 1
Rationale: the client in labor may be given parenteral analgesia during the first stage of
labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a
medication that may be prescribed for pain relief. “increasing uterine contractions,”
“decreasing uterine contractions,” and “promoting fetal lung maturity” are not actions of
this medication.
Test-taking strategy: knowledge of the action of butorphanol tartrate is required to
answer this question. Remember that this medication is used for pain relief. Review the
action of this medication if you had difficulty with this question and are unfamiliar with
this medication.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: lehne, r. (2010). Pharmacology for nursing care (7th ed.). St. Louis: saunders. Obj:
client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—planning
,2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid
analgesic administration following cesarean birth. If the client develops respiratory depression
and requires naloxone (narcan) as an antidote, the client may complain of which of the following?
1. Increase in her pain level
2. Decrease in her pain level
3. Increase in the amount of itching from the opioid used in the epidural
4. Decrease in the amount of itching from the opioid used in the epidural
Answer: 1
Rationale: remember that opioids are used for epidural analgesia. Naloxone is an opioid
antagonist, which reverses the effects of opioids. If it is given, the client may complain of
an increase in her pain level. Therefore “decrease in her pain level,” “increase in the
amount of itching from the opioid used in the epidural,” and “decrease in the amount of
itching from the opioid used in the epidural” are incorrect.
Test-taking strategy: to answer this question accurately, you must know that opioid
analgesics are the medications used with epidural analgesia to relieve pain. Therefore if
naloxone is administered as an antidote for an opioid analgesic, the client’s pain will
increase. Review the effects of naloxone if this question was difficult.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: lehne, r. (2010). Pharmacology for nursing care (7th ed.). St. Louis: saunders. Obj:
client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—assessment
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to
the hospital. The client has a prescription to receive betamethasone (celestone). The nurse
understands that the medication will do which of the following?
1. Prevent spontaneous delivery.
, 2. Stop the uterine contractions.
3. Promote maturation of the fetal lungs.
4. Accelerate the growth rate of the fetus.
Answer: 3
Rationale: betamethasone (celestone) is classified as an anti-inflammatory and
corticosteroid. It increases the surfactant level and lung maturity in the fetus, which
reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at
least 48 hours after administration of betamethasone to allow time for the lungs of the
fetus to mature.
Test-taking strategy: options that are comparable or alike are not likely to be correct.
With this in mind, eliminate “prevent spontaneous delivery” and “stop the uterine
contractions.” Note the strategic words “twenty-ninth week of gestation.” Specific
knowledge about the medication and knowledge of the problems encountered by
premature infants will assist in answering this question. Review the action of this
medication if this question was difficult.
Pts: 1
Dif: level of cognitive ability: understanding
Ref: mckinney, e., james, s., murray, s., & ashwill, j. (2009). Maternal-child nursing (3rd
ed.). St. Louis: saunders. Obj: client needs: physiological integrity
Top: content area: pharmacology
Msc: integrated process: nursing process—planning
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely
for which sign of magnesium toxicity?
1. Proteinuria
2. Hyperactive deep tendon reflexes
3. Respiratory rate of 10 breaths/min
