Silvestri: Saunders Comprehensive Review for the NCLEX-RN®
Examination, 5th Edition
Pharmacology
Test Bank
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.
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
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.
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.
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., 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
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. OBJ: 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 medication. In addition, a bolus of AZT is given intravenously during labor, and
the neonate is treated for six weeks after birth.
Examination, 5th Edition
Pharmacology
Test Bank
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.
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
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.
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.
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., 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
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. OBJ: 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 medication. In addition, a bolus of AZT is given intravenously during labor, and
the neonate is treated for six weeks after birth.
