TEST BANK For Saunders Comprehensive Review for
the NCLEX-RN® Examination, 9th Edition by Linda
Anne Silvestri and Angela 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
ANS: 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. OBʝ: 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
, ANS: 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. OBʝ: 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.
ANS: 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., ʝames, S., Murray, S., & Ashwill, ʝ. (2009). Maternal-child nursing (3rd ed.). St.
Louis: Saunders. OBʝ: 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
4. Serum magnesium level of 5 mEq/L
ANS: 3
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart
rate and blood pressure.
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is
a CNS depressant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep
tendon reflexes,” which are signs of preeclampsia. Select between the last two options using
medication knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7
mEq/L. Review this medication and the normal magnesium level if this question was difficult.
PTS: 1
DIF: Level of Cognitive Ability: Analyzing
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.
OBʝ: Client Needs: Physiological Integrity
TOP: Content Area: Pharmacology
MSC: Integrated Process: Nursing Process—Assessment
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the
antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has
reached how many weeks of gestation?
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
week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
the NCLEX-RN® Examination, 9th Edition by Linda
Anne Silvestri and Angela 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
ANS: 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. OBʝ: 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
, ANS: 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. OBʝ: 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.
ANS: 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., ʝames, S., Murray, S., & Ashwill, ʝ. (2009). Maternal-child nursing (3rd ed.). St.
Louis: Saunders. OBʝ: 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
4. Serum magnesium level of 5 mEq/L
ANS: 3
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart
rate and blood pressure.
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is
a CNS depressant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep
tendon reflexes,” which are signs of preeclampsia. Select between the last two options using
medication knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7
mEq/L. Review this medication and the normal magnesium level if this question was difficult.
PTS: 1
DIF: Level of Cognitive Ability: Analyzing
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.
OBʝ: Client Needs: Physiological Integrity
TOP: Content Area: Pharmacology
MSC: Integrated Process: Nursing Process—Assessment
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the
antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has
reached how many weeks of gestation?
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
week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
