, Silvestri: Saunders Comprehensive Review forthe NCLEX-RN® Examination, 5th
ss s ss ss ss ss ss
Edition
ss
Pharmacology
ss Test Bank ss
MULTIPLE CHOICE ss
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse understands
ss s s ss ss ss ss ss ss ss ss ss ss ss ss
that this medication is prescribed for:
ss ss ss ss ss ss
1. Pain relief ss
2. Increasing uterine contractions ss ss
3. Decreasing uterine contractions ss ss
4. Promoting fetal lung maturity ss ss ss
ANS: 1
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
prescribed for pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and
ss ss ss ss ss ss ss ss ss ss ss
―promoting fetal lung maturity‖ are not actions of this medication.
ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
ss ss ss ss ss ss ss ss ss ss ss ss ss
question. Remember that this medication is used for pain relief. Review the action of this
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication if you had difficulty with this question and are unfamiliar with this medication.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St.
ss ss ss ss ss ss ss ss ss
Louis: Saunders. OBJ:
ss Client Needs: Physiological Integrity
ss ss ss ss ss
TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Planning ss ss ss
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid
ss ss s s ss ss ss ss ss ss s s s s ss s s ss ss
analgesic administration following cesarean birth. If the client develops respiratory
ss ss ss ss ss ss ss ss ss ss
depression and requires naloxone (Narcan) as an antidote, the client may complain of which
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
of the following?
ss ss ss
1. Increase in her pain level ss ss ss ss
2. Decrease in her pain level ss ss ss ss
3. Increase in the amount of itching from the opioid used in the epidural
ss ss ss ss ss ss ss ss ss ss ss ss
4. Decrease in the amount of itching from the opioid used in the epidural
ss ss ss ss ss ss ss ss ss ss ss ss
, ANS: 1
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
ss ss ss ss ss ss ss ss ss ss ss ss ss
which reverses the effects of opioids. If it is given, the client may complain of an increase in her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
pain level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the
ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
opioid used in the epidural,‖ and ―decrease in the amount of itching from the opioid used in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
epidural‖ are incorrect.
ss ss ss
Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
an antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
this question was difficult.
ss s s ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. ss ss ss ss ss ss ss ss ss
Louis: Saunders. OBJ:
ss Client Needs: Physiological Integrity
ss ss ss ss ss
TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Assessment ss ss ss
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse
ss ss ss ss ss ss ss ss ss ss ss ss ss
understands that the medication will do which of the following?
ss ss ss ss ss ss ss ss ss ss
1. Prevent spontaneous delivery. ss ss
2. Stop the uterine contractions.
ss ss ss
3. Promote maturation of the fetal lungs. ss ss ss ss ss
4. Accelerate the growth rate of the fetus. ss ss ss ss ss ss
ANS: 3
Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
ss ss ss ss ss ss ss ss ss ss
increases the surfactant level and lung maturity in the fetus, which reduces the incidence of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
of betamethasone to allow time for the lungs of the fetus to mature.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the
ss ss ss ss ss ss ss ss ss ss ss ss
strategic words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and
ss ss ss ss ss ss ss ss ss ss ss ss
knowledge of the problems encountered by premature infants will assist in answering this question.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Review the action of this medication if this question was difficult.
ss ss s s ss ss ss ss ss ss ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: McKinney, E., James, S., Murray, S., &Ashwill, J. (2009). Maternal-child nursing (3rd ed.). ss ss ss ss ss ss s ss ss ss ss ss ss
St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
ss ss ss ss ss ss
, TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Planning ss ss ss
4. Aclient with preeclampsia is receiving magnesium sulfate. The nurse assesses the client
ss ss ss ss ss ss ss ss ss ss ss
closely for which sign of magnesium toxicity?
ss ss ss ss ss ss ss
1. Proteinuria
2. Hyperactive deep tendon reflexes ss ss ss
3. Respiratory rate of 10 breaths/min ss ss ss ss
4. Serum magnesium level of 5 mEq/L ss ss ss ss ss
ANS: 3
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
ss ss ss ss ss ss ss ss ss ss ss ss
magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
s s ss ss ss ss ss ss ss ss ss ss ss
depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
rate and blood pressure.
ss s s ss ss
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
ss ss ss ss ss ss ss ss ss ss ss ss ss
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is
ss ss ss ss ss ss ss ss ss ss ss ss ss
a CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive
ss ss ss ss ss ss ss ss ss ss ss ss ss
deep tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication knowledge and recalling that the therapeutic serum levels of magnesium are
s s ss ss ss ss ss ss ss ss ss ss ss
4 to 7 mEq/L. Review this medication and the normal magnesium level if this question was
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
difficult.
ss
PTS: 1
DIF: Level of CognitiveAbility: Analyzing ss ss s s
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: ss ss ss ss ss ss ss ss ss ss ss ss ss
Mosby.
ss
OBJ: Client Needs: Physiological Integrity ss ss ss
TOP: Content Area: Pharmacology
ss s s ss ss
MSC: Integrated Process: Nursing Process—Assessment ss ss ss
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus
s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
has reached how many weeks of gestation?
ss ss ss ss ss ss ss
1. 4
2. 14
3. 24
4. 34
ANS: 2
Rationale: The pregnant women with HIV infection will be prescribed oralAZT in the fourteenth
ss ss ss ss ss ss ss ss ss ss s ss ss ss
week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication. In
ss s s
ss s ss ss ss ss ss
Edition
ss
Pharmacology
ss Test Bank ss
MULTIPLE CHOICE ss
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse understands
ss s s ss ss ss ss ss ss ss ss ss ss ss ss
that this medication is prescribed for:
ss ss ss ss ss ss
1. Pain relief ss
2. Increasing uterine contractions ss ss
3. Decreasing uterine contractions ss ss
4. Promoting fetal lung maturity ss ss ss
ANS: 1
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be
ss ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
prescribed for pain relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and
ss ss ss ss ss ss ss ss ss ss ss
―promoting fetal lung maturity‖ are not actions of this medication.
ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this
ss ss ss ss ss ss ss ss ss ss ss ss ss
question. Remember that this medication is used for pain relief. Review the action of this
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication if you had difficulty with this question and are unfamiliar with this medication.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St.
ss ss ss ss ss ss ss ss ss
Louis: Saunders. OBJ:
ss Client Needs: Physiological Integrity
ss ss ss ss ss
TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Planning ss ss ss
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid
ss ss s s ss ss ss ss ss ss s s s s ss s s ss ss
analgesic administration following cesarean birth. If the client develops respiratory
ss ss ss ss ss ss ss ss ss ss
depression and requires naloxone (Narcan) as an antidote, the client may complain of which
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
of the following?
ss ss ss
1. Increase in her pain level ss ss ss ss
2. Decrease in her pain level ss ss ss ss
3. Increase in the amount of itching from the opioid used in the epidural
ss ss ss ss ss ss ss ss ss ss ss ss
4. Decrease in the amount of itching from the opioid used in the epidural
ss ss ss ss ss ss ss ss ss ss ss ss
, ANS: 1
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
ss ss ss ss ss ss ss ss ss ss ss ss ss
which reverses the effects of opioids. If it is given, the client may complain of an increase in her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
pain level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the
ss s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
opioid used in the epidural,‖ and ―decrease in the amount of itching from the opioid used in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
epidural‖ are incorrect.
ss ss ss
Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
an antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
this question was difficult.
ss s s ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. ss ss ss ss ss ss ss ss ss
Louis: Saunders. OBJ:
ss Client Needs: Physiological Integrity
ss ss ss ss ss
TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Assessment ss ss ss
3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse
ss ss ss ss ss ss ss ss ss ss ss ss ss
understands that the medication will do which of the following?
ss ss ss ss ss ss ss ss ss ss
1. Prevent spontaneous delivery. ss ss
2. Stop the uterine contractions.
ss ss ss
3. Promote maturation of the fetal lungs. ss ss ss ss ss
4. Accelerate the growth rate of the fetus. ss ss ss ss ss ss
ANS: 3
Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
ss ss ss ss ss ss ss ss ss ss
increases the surfactant level and lung maturity in the fetus, which reduces the incidence of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
of betamethasone to allow time for the lungs of the fetus to mature.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mind, eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the
ss ss ss ss ss ss ss ss ss ss ss ss
strategic words ―twenty-ninth week of gestation.‖ Specific knowledge about the medication and
ss ss ss ss ss ss ss ss ss ss ss ss
knowledge of the problems encountered by premature infants will assist in answering this question.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Review the action of this medication if this question was difficult.
ss ss s s ss ss ss ss ss ss ss ss
PTS: 1
DIF: Level of CognitiveAbility: Understanding ss ss s ss
REF: McKinney, E., James, S., Murray, S., &Ashwill, J. (2009). Maternal-child nursing (3rd ed.). ss ss ss ss ss ss s ss ss ss ss ss ss
St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
ss ss ss ss ss ss
, TOP: ContentArea: Pharmacology s ss
MSC: Integrated Process: Nursing Process—Planning ss ss ss
4. Aclient with preeclampsia is receiving magnesium sulfate. The nurse assesses the client
ss ss ss ss ss ss ss ss ss ss ss
closely for which sign of magnesium toxicity?
ss ss ss ss ss ss ss
1. Proteinuria
2. Hyperactive deep tendon reflexes ss ss ss
3. Respiratory rate of 10 breaths/min ss ss ss ss
4. Serum magnesium level of 5 mEq/L ss ss ss ss ss
ANS: 3
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of
ss ss ss ss ss ss ss ss ss ss ss ss
magnesium toxicity relate to central nervous system (CNS) depression and include respiratory
s s ss ss ss ss ss ss ss ss ss ss ss
depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
rate and blood pressure.
ss s s ss ss
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
ss ss ss ss ss ss ss ss ss ss ss ss ss
develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is
ss ss ss ss ss ss ss ss ss ss ss ss ss
a CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive
ss ss ss ss ss ss ss ss ss ss ss ss ss
deep tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication knowledge and recalling that the therapeutic serum levels of magnesium are
s s ss ss ss ss ss ss ss ss ss ss ss
4 to 7 mEq/L. Review this medication and the normal magnesium level if this question was
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
difficult.
ss
PTS: 1
DIF: Level of CognitiveAbility: Analyzing ss ss s s
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: ss ss ss ss ss ss ss ss ss ss ss ss ss
Mosby.
ss
OBJ: Client Needs: Physiological Integrity ss ss ss
TOP: Content Area: Pharmacology
ss s s ss ss
MSC: Integrated Process: Nursing Process—Assessment ss ss ss
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus
s s ss ss ss ss ss ss ss ss ss ss ss ss ss ss
has reached how many weeks of gestation?
ss ss ss ss ss ss ss
1. 4
2. 14
3. 24
4. 34
ANS: 2
Rationale: The pregnant women with HIV infection will be prescribed oralAZT in the fourteenth
ss ss ss ss ss ss ss ss ss ss s ss ss ss
week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
medication. In
ss s s
