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Complete Test Bank Saunders Comprehensive Review for the NCLEX-RN Examination Silvestri 6th Edition Questions & Answers with rationales (Chapter 1-72)

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Complete Test Bank Saunders Comprehensive Review for the NCLEX-RN Examination Silvestri 6th Edition Questions & Answers with rationales (Chapter 1-72)

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Silvestri: Saunders Comprehensive Review forthe NCLEX-RN® gg gg gg gg gg




Examination, 5th Edition gg gg gg




Pharmacology

gg Test Bank
gg




MULTIPLE CHOICE gg




1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse
gg g g gg gg gg gg gg gg gg gg gg gg gg


understands that this medication is prescribed for:
gg gg gg gg gg gg gg



1. Pain relief gg



2. Increasing uterine contractions gg gg




3. Decreasing uterine contractions gg gg




4. Promoting fetal lung maturity gg gg gg




ANS: 1

Rationale: The client in labor may be given parenteral analgesia during the first stage of labor,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that
gg gg gg g g gg gg gg gg gg gg gg gg gg gg gg gg


may be prescribed for pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine
gg gg gg gg gg gg gg gg gg gg gg


contractions,‖ and ―promoting fetal lung maturity‖ are not actions of this medication.
gg gg gg gg gg gg gg gg gg gg gg gg




Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
gg gg gg gg gg gg gg gg gg gg gg gg gg


question. Remember that this medication is used for pain relief. Review the action of this
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


medication if you had difficulty with this question and are unfamiliar with this medication.
gg gg gg gg gg gg gg gg gg gg gg gg gg gg




PTS: 1
DIF: Level of Cognitive Ability: Understanding gg gg g gg


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


Louis: Saunders. OBJ:
gg ggClient Needs: Physiological Integrity gg gg gg gg


TOP: Content Area: Pharmacology g gg


MSC: Integrated Process: Nursing Process—Planning gg gg gg




2. The postpartum nurse is caring for a client with an epidural catheter in place for
gg gg g g gg gg gg gg gg gg g g g g gg g g gg


opioid analgesic administration following cesarean birth. If the client develops respiratory
gg gg gg gg gg gg gg gg gg gg gg


depression and requires naloxone (Narcan) as an antidote, the client may complain of
gg gg gg gg gg gg gg gg gg gg gg gg gg


which of the following?
gg gg gg gg



1. Increase in her pain level gg gg gg gg



2. Decrease in her pain level gg gg gg gg



3. Increase in the amount of itching from the opioid used in the epidural
gg gg gg gg gg gg gg gg gg gg gg gg



4. Decrease in the amount of itching from the opioid used in the epidural
gg gg gg gg gg gg gg gg gg gg gg gg

, ANS: 1

Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid
gg gg gg gg gg gg gg gg gg gg gg gg


antagonist, which reverses the effects of opioids. If it is given, the client may complain of an
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


increase in her pain level. Therefore ―decrease in her pain level,‖ ―increase in the amount of
gg gg gg gg g g gg gg gg gg gg gg gg gg gg gg gg


itching from the opioid used in the epidural,‖ and ―decrease in the amount of itching from the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


opioid used in the epidural‖ are incorrect.
gg gg gg gg gg gg gg




Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are
gg gg gg gg gg gg gg gg gg gg gg gg gg


the medications used with epidural analgesia to relieve pain. Therefore if naloxone is
gg gg gg gg gg gg gg gg gg gg gg gg gg


administered as an antidote for an opioid analgesic, the client’s pain will increase. Review the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


effects of naloxone if this question was difficult.
gg gg gg gg gg g g gg gg




PTS: 1
DIF: Level of Cognitive Ability: Understanding gg gg g gg


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


Louis: Saunders. OBJ:
gg gg Client Needs: Physiological Integrity gg gg gg gg


TOP: Content Area: Pharmacology g gg


MSC: Integrated Process: Nursing Process—Assessment gg gg gg




3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to
gg gg gg gg gg gg gg gg gg gg gg gg gg gg


the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse
gg gg gg gg gg gg gg gg gg gg gg gg gg


understands that the medication will do which of the following?
gg gg gg gg gg gg gg gg gg gg



1. Prevent spontaneous delivery. gg gg




2. Stop the uterine contractions.
gg gg gg




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



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




ANS: 3

Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
gg gg gg gg gg gg gg gg gg gg


increases the surfactant level and lung maturity in the fetus, which reduces the incidence of
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


respiratory distress syndrome. Delivery must be delayed for at least 48 hours after
gg gg gg gg gg gg gg gg gg gg gg gg gg


administration of betamethasone to allow time for the lungs of the fetus to mature.
gg gg gg gg gg gg gg gg gg gg gg gg gg gg




Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


in mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the
gg gg gg gg gg gg gg gg gg gg gg gg gg


strategic words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and
gg gg gg gg gg gg gg gg gg gg gg gg


knowledge of the problems encountered by premature infants will assist in answering this
gg gg gg gg gg gg gg gg gg gg gg gg gg


question. Review the action of this medication if this question was difficult.
gg gg gg g g gg gg gg gg gg gg gg gg




PTS: 1
DIF: Level of Cognitive Ability: Understanding gg gg g gg


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


St. Louis: Saunders.
gg gg OBJ: Client Needs: Physiological Integrity
gg gg gg gg

, TOP: Content Area: Pharmacology g gg


MSC: Integrated Process: Nursing Process—Planning gg gg gg




4. Aclient with preeclampsia is receiving magnesium sulfate. The nurse assesses the client
gg gg gg gg gg gg gg gg gg gg gg


closely for which sign of magnesium toxicity?
gg gg gg gg gg gg gg



1. Proteinuria
2. Hyperactive deep tendon reflexes gg gg gg



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



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




ANS: 3

Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
gg gg gg gg gg gg gg gg gg gg gg gg


magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
g g gg gg gg gg gg gg gg gg gg gg gg


depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


heart rate and blood pressure.
gg gg g g gg gg


Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
gg gg gg gg gg gg gg gg gg gg gg gg gg


develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
gg gg gg gg gg gg gg gg gg gg gg gg gg




Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate
gg gg gg gg gg gg gg gg gg gg gg gg


is a CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and
gg gg gg gg gg gg gg gg gg gg gg gg gg


―hyperactive deep tendon reflexes,‖ which are signs of preeclampsia. Select between the last
gg gg gg gg gg gg gg gg gg gg gg gg gg


two options using medication knowledge and recalling that the therapeutic serum levels
gg gg gg g g gg gg gg gg gg gg gg gg


of magnesium are 4 to 7 mEq/L. Review this medication and the normal magnesium level
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


if this question was difficult.
gg gg gg gg gg




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


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


Mosby.
gg


OBJ: Client Needs: Physiological gg gg


Integrity TOP: Content Area: Pharmacology
gg gg g g gg gg


MSC: Integrated Process: Nursing Process—Assessment gg gg gg




5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg


antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the
g g gg gg gg gg gg gg gg gg gg gg gg gg gg


fetus has reached how many weeks of gestation?
gg gg gg gg gg gg gg gg



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
gg gg gg gg gg gg gg gg gg gg gg gg gg gg


week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


medication. In
gg g g

, addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six
gg gg gg g gg gg gg gg gg gg gg gg gg gg gg gg


weeks after birth.
gg gg gg




Test-Taking Strategy: To answer this question accurately, you must be familiar with
gg gg gg gg gg gg gg gg gg gg gg


pharmacological therapy for clients who are HIV-positive. Knowing that the fetus is most
gg gg gg gg gg gg gg gg gg gg gg gg gg


vulnerable to the effects of medications and chemicals during the period of organogenesis will
gg gg gg gg gg g g gg gg gg gg gg gg gg gg


assist you in selecting the correct answer. Review treatment measures for the pregnant client with
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


HIV infection if you had difficulty with this question.
gg gg gg gg gg gg gg gg gg




PTS: 1
DIF: Level of Cognitive Ability: Understanding gg gg g gg


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


Louis: Saunders. OBJ:
gg Client Needs: Physiological Integrity
gg gg gg gg gg


TOP: Content Area: Pharmacology g gg


MSC: Integrated Process: Nursing Process—Planning gg gg gg




6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the
gg gg gg gg gg gg gg gg gg gg gg gg


eyes of a newborn. The nurse plans to explain to the parents that the purpose of
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


the medication is to:
gg gg gg gg



1. Help the newborn to see more clearly.
gg gg gg gg gg gg




2. Guard against infection acquired during intrauterine life.
gg gg gg gg gg gg



3. Ensure the sterility of the conjunctiva in the newborn.
gg gg gg gg gg gg gg gg



4. Protect the newborn from contracting an eye infection during birth.
gg gg gg gg gg gg gg gg gg




ANS: 4

Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn
gg gg gg gg gg gg gg gg gg gg gg gg gg gg


from contracting a conjunctival infection during birth. This infection, called ophthalmia
gg gg gg gg gg gg gg gg gg gg gg


neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This
gg gg gg gg gg gg gg gg gg gg gg


prophylaxis is mandatory in the United States. ―Help the newborn to see more clearly,‖ ―guard
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


against infection acquired during intrauterine life,‖ and ―ensure the sterility of the conjunctiva in
gg gg gg gg gg gg gg gg gg gg gg gg gg gg


the newborn‖ do not describe the purposes of this medication.
gg gg gg gg gg gg gg gg gg gg




Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this
gg gg gg gg gg gg gg gg gg gg gg gg gg


question. Remember erythromycin protects the newborn from contracting a conjunctival infection
gg gg gg gg gg gg gg gg gg gg gg


during birth. Review the purpose of this medication if you had difficulty with this question.
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg




PTS: 1
DIF: Level of Cognitive Ability: Applying gg gg gg gg


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


Louis: Saunders. OBJ:
gg gg Client Needs: Health Promotion and gg gg gg gg gg


Maintenance TOP: Content Area: Pharmacology
gg gg gg gg


MSC: Integrated Process: Teaching and Learning gg gg gg gg




7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin
gg gg gg gg gg gg gg gg gg gg gg gg


K) to the newborn. Before giving the medication, the nurse explains to the client that
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg


this medication will:
gg gg gg

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