Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 5th
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Edition
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SILVESTRI TEST BANK: SAUNDERS COMPREHENSIVE REVIEW
FOR THE NCLEX-RN EXAMINATION 5th EDITION
MULTIPLE CHOICE bg
1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that the
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client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication is
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prescribed for:
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1. Pain relief bg
2. Increasing uterine contractions bg bg
3. Decreasing uterine contractions bg bg
4. Promoting fetal lung maturity bg bg bg
ANS: b g b g 1
Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to 3
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hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for pain
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relief. ―Increasing uterine contractions,‖ ―decreasing uterine contractions,‖ and ―promoting fetal lung
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maturity‖ are not actions of this medication.
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Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question.
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Remember that this medication is used for pain relief. Review the action of this medication if you had
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difficulty with this question and are unfamiliar with this medication.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding
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REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
bg Client Needs: Physiological Integrity bg bg bg
TOP: Content Area: Pharmacology bg bg
MSC: b Integrated Process: Nursing Process—Planning
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2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic
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administration following cesarean birth. If the client develops respiratory depression and requires
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naloxone (Narcan) as an antidote, the client may complain of which of the following?
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1. Increase in her pain level bg bg bg bg
2. Decrease in her pain level bg bg bg bg
3. Increase in the amount of itching from the opioid used in the epidural
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4. Decrease in the amount of itching from the opioid used in the epidural
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, ANS: b g b g 1
Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist,
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which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain
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level. Therefore ―decrease in her pain level,‖ ―increase in the amount of itching from the opioid used in
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the epidural,‖ and ―decrease in the amount of itching from the opioid used in the epidural‖ are incorrect.
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Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the
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medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an
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antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this
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question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding bg bg bg bg
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
bg Client Needs: Physiological Integrity bg bg bg
TOP: Content Area: Pharmacology bg bg
MSC: b Integrated Process: Nursing Process—Assessment
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3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the
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hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that
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the medication will do which of the following?
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1. Prevent spontaneous delivery. bg bg
2. Stop the uterine contractions.
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3. Promote maturation of the fetal lungs. bg bg bg bg bg
4. Accelerate the growth rate of the fetus. bg bg bg bg bg bg
ANS: b g b g 3
Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It
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increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory
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distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to
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allow time for the lungs of the fetus to mature.
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Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind,
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eliminate ―prevent spontaneous delivery‖ and ―stop the uterine contractions.‖ Note the strategic words
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―twenty-ninth week of gestation.‖ Specific knowledge about the medication and knowledge of the
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problems encountered by premature infants will assist in answering this question. Review the action of
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this medication if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding bg bg bg bg
REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. bg bg bg bg bg bg bg bg bg bg bg bg bg bg
Louis: Saunders.
bg OBJ: Client Needs: Physiological Integrity
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, TOP: Content Area: Pharmacology bg bg
MSC: Integrated Process: Nursing Process—Planning
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4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for
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which sign of magnesium toxicity?
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1. Proteinuria
2. Hyperactive deep tendon reflexes bg bg bg
3. Respiratory rate of 10 breaths/min bg bg bg bg
4. Serum magnesium level of 5 mEq/L bg bg bg bg bg
ANS: b g b g 3
Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium
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toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of
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deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure.
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Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can
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develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.
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Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a
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CNS depressant. Begin to answer this question by eliminating ―proteinuria‖ and ―hyperactive deep
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tendon reflexes,‖ which are signs of preeclampsia. Select between the last two options using medication
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knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this
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medication and the normal magnesium level if this question was difficult.
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PTS: 1
DIF: Level of Cognitive Ability: Analyzing bg bg bg bg
REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby. bg bg bg bg bg bg bg bg bg bg bg bg bg bg
OBJ: Client Needs: Physiological Integrity bg bg bg
TOP: Content Area: Pharmacology
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MSC: Integrated Process: Nursing Process—Assessment
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5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal
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clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how
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many weeks of gestation?
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1. 4
2. 14
3. 24
4. 34
ANS: b g b g 2
Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week of
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gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In
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, addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks after
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birth.
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Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological
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therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of
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medications and chemicals during the period of organogenesis will assist you in selecting the correct
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answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with this
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question.
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PTS: 1
DIF: Level of Cognitive Ability: Understanding bg bg bg bg
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
bg Client Needs: Physiological Integrity bg bg bg
TOP: Content Area: Pharmacology bg bg
MSC: b Integrated Process: Nursing Process—Planning
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6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a
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newborn. The nurse plans to explain to the parents that the purpose of the medication is to:
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1. Help the newborn to see more clearly.
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2. Guard against infection acquired during intrauterine life.
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3. Ensure the sterility of the conjunctiva in the newborn.
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4. Protect the newborn from contracting an eye infection during birth.
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ANS: b g b g 4
Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from
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contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results
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from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the
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United States. ―Help the newborn to see more clearly,‖ ―guard against infection acquired during
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intrauterine life,‖ and ―ensure the sterility of the conjunctiva in the newborn‖ do not describe the
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purposes of this medication.
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Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question.
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Remember erythromycin protects the newborn from contracting a conjunctival infection during birth.
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Review the purpose of this medication if you had difficulty with this question.
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PTS: 1
DIF: Level of Cognitive Ability: Applying bg bg bg bg
REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.
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OBJ:
bg Client Needs: Health Promotion and Maintenance bg bg bg bg bg
TOP: Content Area: Pharmacology bg bg
MSC: b Integrated Process: Teaching and Learning
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7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the
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newborn. Before giving the medication, the nurse explains to the client that this medication will:
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