NCLEX-RN Pharmacology Practice Questions:
Reproductive & Genitourinary System |
20 Original NGN-Style MCQs with Detailed
Rationales, Medication Safety & Clinical
Judgment
Question 1
Clinical Scenario
A 28-year-old female client (G1P0) at 34 weeks of gestation is
admitted to the labor and delivery unit with preterm labor. The
primary healthcare provider orders intravenous magnesium
sulfate to suppress uterine contractions. The nurse initiates the
infusion per facility protocol. Two hours after starting the
infusion, the client's vital signs are: BP 118/74 mmHg, HR 82
bpm, RR 10 breaths/min, and SPO2 96% on room air. The deep
tendon reflexes (DTRs) are 0 (absent), and urine output over the
past hour was 18 mL.
Question Stem
Which priority action should the nurse take first?
,Options
A. Decrease the magnesium sulfate rate by 50%
B. Stop the magnesium sulfate infusion immediately
C. Administer calcium gluconate 1 g intravenously over 10
minutes
D. Notify the primary healthcare provider of the urinary output
Correct Answer
Correct Answer: B. Stop the magnesium sulfate infusion
immediately
Detailed Rationale
Magnesium sulfate is a high-alert medication used for tocolysis
in preterm labor and neuroprotection/seizure prevention in
preeclampsia. Its therapeutic serum level is 4 to 7 mEq/L. Signs
of magnesium toxicity follow a predictable clinical sequence:
loss of deep tendon reflexes (8–10 mEq/L), respiratory
depression (10–12 mEq/L), oliguria, and cardiac arrest (>12–15
mEq/L). The client exhibits clear signs of severe magnesium
toxicity, including hyporeflexia (0 DTRs), respiratory depression
(RR 10/min), and oliguria (<30 mL/hr).
The immediate, first priority nursing action when toxicity is
suspected is to stop the magnesium sulfate infusion to prevent
further drug accumulation and life-threatening respiratory or
,cardiac arrest. While calcium gluconate is the antidote for
magnesium toxicity and must be administered, stopping the
toxin source comes first. Decreasing the rate by 50% is
inappropriate because the client is actively toxic. Notifying the
provider is necessary, but only after stopping the infusion and
ensuring client safety.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the clinical signs and symptoms of magnesium
sulfate toxicity.
• Prioritize nursing actions when caring for a client exhibiting
severe drug toxicity.
• Identify the antidote for magnesium sulfate overdose and
its administration guidelines.
Medication Safety Focus
High-alert medication / Antidote administration
Question 2
Clinical Scenario
A 68-year-old male client with a history of benign prostatic
hyperplasia (BPH) and hypertension presents to the outpatient
clinic complaining of persistent urinary hesitancy and weak
stream. His current daily medications include amlodipine 5 mg
, orally and lisinopril 10 mg orally. The healthcare provider
prescribes tamsulosin 0.4 mg orally once daily.
Question Stem
Which instruction should the nurse emphasize when teaching
the client about starting tamsulosin?
Options
A. "Take this medication on an empty stomach 1 hour before
breakfast."
B. "Change positions slowly when rising from a sitting or lying
position."
C. "Crush the capsule and mix it with applesauce if you have
difficulty swallowing."
D. "Decrease your fluid intake in the evening to prevent
excessive dizziness."
Correct Answer
Correct Answer: B. "Change positions slowly when rising from a
sitting or lying position."
Detailed Rationale
Tamsulosin is a selective alpha-1 adrenergic antagonist that
relaxes smooth muscle in the prostate neck and bladder outlet,
improving urinary flow in BPH. Although tamsulosin is selective
for alpha-1A receptors in the prostate, it still carries a risk of
Reproductive & Genitourinary System |
20 Original NGN-Style MCQs with Detailed
Rationales, Medication Safety & Clinical
Judgment
Question 1
Clinical Scenario
A 28-year-old female client (G1P0) at 34 weeks of gestation is
admitted to the labor and delivery unit with preterm labor. The
primary healthcare provider orders intravenous magnesium
sulfate to suppress uterine contractions. The nurse initiates the
infusion per facility protocol. Two hours after starting the
infusion, the client's vital signs are: BP 118/74 mmHg, HR 82
bpm, RR 10 breaths/min, and SPO2 96% on room air. The deep
tendon reflexes (DTRs) are 0 (absent), and urine output over the
past hour was 18 mL.
Question Stem
Which priority action should the nurse take first?
,Options
A. Decrease the magnesium sulfate rate by 50%
B. Stop the magnesium sulfate infusion immediately
C. Administer calcium gluconate 1 g intravenously over 10
minutes
D. Notify the primary healthcare provider of the urinary output
Correct Answer
Correct Answer: B. Stop the magnesium sulfate infusion
immediately
Detailed Rationale
Magnesium sulfate is a high-alert medication used for tocolysis
in preterm labor and neuroprotection/seizure prevention in
preeclampsia. Its therapeutic serum level is 4 to 7 mEq/L. Signs
of magnesium toxicity follow a predictable clinical sequence:
loss of deep tendon reflexes (8–10 mEq/L), respiratory
depression (10–12 mEq/L), oliguria, and cardiac arrest (>12–15
mEq/L). The client exhibits clear signs of severe magnesium
toxicity, including hyporeflexia (0 DTRs), respiratory depression
(RR 10/min), and oliguria (<30 mL/hr).
The immediate, first priority nursing action when toxicity is
suspected is to stop the magnesium sulfate infusion to prevent
further drug accumulation and life-threatening respiratory or
,cardiac arrest. While calcium gluconate is the antidote for
magnesium toxicity and must be administered, stopping the
toxin source comes first. Decreasing the rate by 50% is
inappropriate because the client is actively toxic. Notifying the
provider is necessary, but only after stopping the infusion and
ensuring client safety.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the clinical signs and symptoms of magnesium
sulfate toxicity.
• Prioritize nursing actions when caring for a client exhibiting
severe drug toxicity.
• Identify the antidote for magnesium sulfate overdose and
its administration guidelines.
Medication Safety Focus
High-alert medication / Antidote administration
Question 2
Clinical Scenario
A 68-year-old male client with a history of benign prostatic
hyperplasia (BPH) and hypertension presents to the outpatient
clinic complaining of persistent urinary hesitancy and weak
stream. His current daily medications include amlodipine 5 mg
, orally and lisinopril 10 mg orally. The healthcare provider
prescribes tamsulosin 0.4 mg orally once daily.
Question Stem
Which instruction should the nurse emphasize when teaching
the client about starting tamsulosin?
Options
A. "Take this medication on an empty stomach 1 hour before
breakfast."
B. "Change positions slowly when rising from a sitting or lying
position."
C. "Crush the capsule and mix it with applesauce if you have
difficulty swallowing."
D. "Decrease your fluid intake in the evening to prevent
excessive dizziness."
Correct Answer
Correct Answer: B. "Change positions slowly when rising from a
sitting or lying position."
Detailed Rationale
Tamsulosin is a selective alpha-1 adrenergic antagonist that
relaxes smooth muscle in the prostate neck and bladder outlet,
improving urinary flow in BPH. Although tamsulosin is selective
for alpha-1A receptors in the prostate, it still carries a risk of
