, Silvestri: Saunders Comprehensive Review for the NCLEX- z! z! z! z! z! z!
RN® Examination, 6th Edition z! z! z!
Pharmacology z!
Test Bank z!
MULTIPLE CHOICE z!
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that t
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
he client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication i
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
s prescribed for:
z! z!
1. Pain relief z!
2. Increasing uterine contractions z! z!
3. Decreasing uterine contractions z! z!
4. Promoting fetal lung maturity z! z! z!
ANS: 1 z!z!
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for p
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and “promoting fetal lun
z! z! z! z! z! z! z! z! z! z! z!
g maturity” are not actions of this medication.
z! z! z! z! z! z! z!
Test-
Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question. Re
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
member that this medication is used for pain relief. Review the action of this medication if you had diffic
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ulty with this question and are unfamiliar with this medication.
z! z! z! z! z! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF:
Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
z! z! z! z! z! z! z! z! z! z! z! z!
OBJ: Client Needs: Physiological Integrity z! z! z!
TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Planning
z ! z! z! z!
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
administration following cesarean birth. If the client develops respiratory depression and requires
z! z! z! z! z! z! z! z! z! z! z! z!
naloxone (Narcan) as an antidote, the client may complain of which of the following?
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
1. Increase in her pain level z! z! z! z!
2. Decrease in her pain level z! z! z! z!
3. Increase in the amount of itching from the opioid used in the epidural
z! z! z! z! z! z! z! z! z! z! z! z!
4. Decrease in the amount of itching from the opioid used in the epidural
z! z! z! z! z! z! z! z! z! z! z! z!
, ANS: 1 z!z!
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist, wh
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ich reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
Therefore “decrease in her pain level,” “increase in the amount of itching from the opioid used in the ep
! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
idural,” and “decrease in the amount of itching from the opioid used in the epidural” are incorrect.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the medica
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
tions used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an antidote f
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
or an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this question wa
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
s difficult.
z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF:
Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
z! z! z! z! z! z! z! z! z! z! z! z!
OBJ: Client Needs: Physiological Integrity z! z! z!
TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Assessment
z ! z! z! z!
3. A client experiencing preterm labor at the twenty-
z! z! z! z! z! z! z!
ninth week of gestation has been admitted to the hospital. The client has a prescription to receive betam
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ethasone (Celestone). The nurse understands that the medication will do which of the following?
z! z! z! z! z! z! z! z! z! z! z! z! z!
1. Prevent spontaneous delivery. z! z!
2. Stop the uterine contractions. z! z! z!
3. Promote maturation of the fetal lungs. z! z! z! z! z!
4. Accelerate the growth rate of the fetus. z! z! z! z! z! z!
ANS: 3 z!z!
Rationale: Betamethasone (Celestone) is classified as an anti-
z! z! z! z! z! z! z!
inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which r
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
educes the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours aft
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
er administration of betamethasone to allow time for the lungs of the fetus to mature.
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eli
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
minate “prevent spontaneous delivery” and “stop the uterine contractions.” Note the strategic words “tw
z! z! z! z! z! z! z! z! z! z! z! z! z!
enty-
ninth week of gestation.” Specific knowledge about the medication and knowledge of the problems enco
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
untered by premature infants will assist in answering this question. Review the action of this medication
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
if this question was difficult.
! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal- z! z! z! z! z! z! z! z! z! z!
child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
z! z! z! z! z! z! z! z! z!
, TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Planning
z ! z! z! z!
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
which sign of magnesium toxicity?
z! z! z! z!
1. Proteinuria
2. Hyperactive deep tendon reflexes z! z! z!
3. Respiratory rate of 10 breaths/min z! z! z! z!
4. Serum magnesium level of 5 mEq/L z! z! z! z! z!
ANS: 3 z!z!
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of de
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can deve
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
lop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a CNS d
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
epressant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep tendon refle
z! z! z! z! z! z! z! z! z! z! z! z! z!
xes,” which are signs of preeclampsia. Select between the last two options using medication knowledge a
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
nd recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this medication a
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
nd the normal magnesium level if this question was difficult.
z! z! z! z! z! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Analyzing z! z! z! z!
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby. z! z! z! z! z! z! z! z! z! z! z! z! z! z!
OBJ:
Client Needs: Physiological Integrity TOP: z! z! z! z!
Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Assessment
z ! z! z! z!
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
many weeks of gestation?
! z! z! z!
1. 4
2. 14
3. 24
4. 34
ANS: 2 z!z!
Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
RN® Examination, 6th Edition z! z! z!
Pharmacology z!
Test Bank z!
MULTIPLE CHOICE z!
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that t
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
he client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication i
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
s prescribed for:
z! z!
1. Pain relief z!
2. Increasing uterine contractions z! z!
3. Decreasing uterine contractions z! z!
4. Promoting fetal lung maturity z! z! z!
ANS: 1 z!z!
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for p
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and “promoting fetal lun
z! z! z! z! z! z! z! z! z! z! z!
g maturity” are not actions of this medication.
z! z! z! z! z! z! z!
Test-
Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question. Re
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
member that this medication is used for pain relief. Review the action of this medication if you had diffic
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ulty with this question and are unfamiliar with this medication.
z! z! z! z! z! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF:
Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
z! z! z! z! z! z! z! z! z! z! z! z!
OBJ: Client Needs: Physiological Integrity z! z! z!
TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Planning
z ! z! z! z!
2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
administration following cesarean birth. If the client develops respiratory depression and requires
z! z! z! z! z! z! z! z! z! z! z! z!
naloxone (Narcan) as an antidote, the client may complain of which of the following?
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
1. Increase in her pain level z! z! z! z!
2. Decrease in her pain level z! z! z! z!
3. Increase in the amount of itching from the opioid used in the epidural
z! z! z! z! z! z! z! z! z! z! z! z!
4. Decrease in the amount of itching from the opioid used in the epidural
z! z! z! z! z! z! z! z! z! z! z! z!
, ANS: 1 z!z!
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist, wh
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ich reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
Therefore “decrease in her pain level,” “increase in the amount of itching from the opioid used in the ep
! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
idural,” and “decrease in the amount of itching from the opioid used in the epidural” are incorrect.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the medica
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
tions used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an antidote f
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
or an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this question wa
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
s difficult.
z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF:
Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
z! z! z! z! z! z! z! z! z! z! z! z!
OBJ: Client Needs: Physiological Integrity z! z! z!
TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Assessment
z ! z! z! z!
3. A client experiencing preterm labor at the twenty-
z! z! z! z! z! z! z!
ninth week of gestation has been admitted to the hospital. The client has a prescription to receive betam
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ethasone (Celestone). The nurse understands that the medication will do which of the following?
z! z! z! z! z! z! z! z! z! z! z! z! z!
1. Prevent spontaneous delivery. z! z!
2. Stop the uterine contractions. z! z! z!
3. Promote maturation of the fetal lungs. z! z! z! z! z!
4. Accelerate the growth rate of the fetus. z! z! z! z! z! z!
ANS: 3 z!z!
Rationale: Betamethasone (Celestone) is classified as an anti-
z! z! z! z! z! z! z!
inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which r
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
educes the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours aft
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
er administration of betamethasone to allow time for the lungs of the fetus to mature.
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eli
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
minate “prevent spontaneous delivery” and “stop the uterine contractions.” Note the strategic words “tw
z! z! z! z! z! z! z! z! z! z! z! z! z!
enty-
ninth week of gestation.” Specific knowledge about the medication and knowledge of the problems enco
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
untered by premature infants will assist in answering this question. Review the action of this medication
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
if this question was difficult.
! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Understanding z! z! z! z!
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal- z! z! z! z! z! z! z! z! z! z!
child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity
z! z! z! z! z! z! z! z! z!
, TOP: Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Planning
z ! z! z! z!
4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
which sign of magnesium toxicity?
z! z! z! z!
1. Proteinuria
2. Hyperactive deep tendon reflexes z! z! z!
3. Respiratory rate of 10 breaths/min z! z! z! z!
4. Serum magnesium level of 5 mEq/L z! z! z! z! z!
ANS: 3 z!z!
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of de
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
ep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can deve
z! z! z! z! z! z! z! z! z! z! z! z! z! z!
lop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
z! z! z! z! z! z! z! z! z! z! z! z!
Test-
Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a CNS d
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
epressant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep tendon refle
z! z! z! z! z! z! z! z! z! z! z! z! z!
xes,” which are signs of preeclampsia. Select between the last two options using medication knowledge a
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
nd recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this medication a
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
nd the normal magnesium level if this question was difficult.
z! z! z! z! z! z! z! z! z!
PTS: 1
DIF: Level of Cognitive Ability: Analyzing z! z! z! z!
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby. z! z! z! z! z! z! z! z! z! z! z! z! z! z!
OBJ:
Client Needs: Physiological Integrity TOP: z! z! z! z!
Content Area: Pharmacology z! z!
MSC: Integrated Process: Nursing Process—Assessment
z ! z! z! z!
5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z
many weeks of gestation?
! z! z! z!
1. 4
2. 14
3. 24
4. 34
ANS: 2 z!z!
Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z! z!
