NCLEX-RN Pharmacology Reproductive &
Genitourinary System Exam Questions with
Rationales |
20 Original NGN Practice MCQs
Question 1
Clinical Scenario
A 28-year-old patient at 39 weeks gestation is receiving an
intravenous oxytocin infusion for labor induction. The fetal
monitor shows contractions occurring every 1.5 minutes, lasting
90 seconds, with a resting tone of 30 mm Hg. The fetal heart
rate tracing demonstrates recurrent late decelerations.
Question Stem
Which action should the nurse take first?
Options
A. Increase the maintenance IV fluid rate to 250 mL/hr.
B. Discontinue the oxytocin infusion immediately.
C. Administer terbutaline 0.25 mg subcutaneously.
D. Notify the healthcare provider of the fetal heart rate pattern.
,Correct Answer
Correct Answer: B. Discontinue the oxytocin infusion
immediately.
Detailed Rationale
The clinical scenario describes uterine tachysystole
(contractions more frequent than every 2 minutes)
accompanied by nonreassuring fetal heart rate patterns (late
decelerations). The priority nursing action is to immediately
discontinue the oxytocin infusion to reduce uterine activity and
improve placental perfusion. While turning the patient to a
lateral position, increasing IV fluids, and administering oxygen
are appropriate subsequent interventions, removing the
causative agent of hyperstimulation is the definitive first step.
Administering terbutaline (Option C) may be ordered if
discontinuing oxytocin and position changes do not resolve the
tachysystole, but it is not the initial independent action.
Notifying the provider (Option D) is necessary but should occur
after the nurse has initiated the immediate safety intervention
of stopping the harmful continuous infusion. Clinical judgment
dictates that the nurse must act independently to stop the
infusion before seeking further orders. Monitoring parameters
include contraction frequency, duration, resting tone, and
continuous fetal heart rate monitoring.
Learning Objective
, • Recognize the signs of uterine tachysystole and fetal
distress.
• Prioritize independent nursing interventions for oxytocin-
induced hyperstimulation.
• Apply clinical judgment in intrapartum medication safety.
Medication Safety Focus
Adverse effect / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old patient with severe preeclampsia is receiving a
continuous intravenous magnesium sulfate infusion. During the
hourly assessment, the nurse notes the patient’s respiratory
rate is 10 breaths per minute, deep tendon reflexes (DTRs) are
absent, and urine output has been 15 mL over the past hour.
Question Stem
Which medication should the nurse anticipate administering?
Options
A. Calcium gluconate
B. Naloxone
C. Flumazenil
D. Protamine sulfate
, Correct Answer
Correct Answer: A. Calcium gluconate
Detailed Rationale
The patient is exhibiting classic signs of magnesium sulfate
toxicity, which include a respiratory rate less than 12 breaths
per minute, absent deep tendon reflexes (DTRs), and decreased
urine output (less than 30 mL/hr). Magnesium is excreted by
the kidneys, and oliguria can lead to toxic accumulation of the
drug. The priority intervention is to administer the antidote,
calcium gluconate, which directly antagonizes the
neuromuscular and cardiac depressant effects of magnesium.
Naloxone (Option B) is the antidote for opioid toxicity.
Flumazenil (Option C) is the antidote for benzodiazepine
toxicity. Protamine sulfate (Option D) is the antidote for
heparin. Nursing considerations for magnesium sulfate therapy
include continuous monitoring of respiratory rate, DTRs, and
urine output, as well as ensuring calcium gluconate is readily
available at the bedside. This question emphasizes medication
safety and the recognition of life-threatening adverse effects
requiring immediate pharmacological intervention.
Learning Objective
• Identify the clinical manifestations of magnesium sulfate
toxicity.
• Select the appropriate antidote for magnesium toxicity.
Genitourinary System Exam Questions with
Rationales |
20 Original NGN Practice MCQs
Question 1
Clinical Scenario
A 28-year-old patient at 39 weeks gestation is receiving an
intravenous oxytocin infusion for labor induction. The fetal
monitor shows contractions occurring every 1.5 minutes, lasting
90 seconds, with a resting tone of 30 mm Hg. The fetal heart
rate tracing demonstrates recurrent late decelerations.
Question Stem
Which action should the nurse take first?
Options
A. Increase the maintenance IV fluid rate to 250 mL/hr.
B. Discontinue the oxytocin infusion immediately.
C. Administer terbutaline 0.25 mg subcutaneously.
D. Notify the healthcare provider of the fetal heart rate pattern.
,Correct Answer
Correct Answer: B. Discontinue the oxytocin infusion
immediately.
Detailed Rationale
The clinical scenario describes uterine tachysystole
(contractions more frequent than every 2 minutes)
accompanied by nonreassuring fetal heart rate patterns (late
decelerations). The priority nursing action is to immediately
discontinue the oxytocin infusion to reduce uterine activity and
improve placental perfusion. While turning the patient to a
lateral position, increasing IV fluids, and administering oxygen
are appropriate subsequent interventions, removing the
causative agent of hyperstimulation is the definitive first step.
Administering terbutaline (Option C) may be ordered if
discontinuing oxytocin and position changes do not resolve the
tachysystole, but it is not the initial independent action.
Notifying the provider (Option D) is necessary but should occur
after the nurse has initiated the immediate safety intervention
of stopping the harmful continuous infusion. Clinical judgment
dictates that the nurse must act independently to stop the
infusion before seeking further orders. Monitoring parameters
include contraction frequency, duration, resting tone, and
continuous fetal heart rate monitoring.
Learning Objective
, • Recognize the signs of uterine tachysystole and fetal
distress.
• Prioritize independent nursing interventions for oxytocin-
induced hyperstimulation.
• Apply clinical judgment in intrapartum medication safety.
Medication Safety Focus
Adverse effect / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old patient with severe preeclampsia is receiving a
continuous intravenous magnesium sulfate infusion. During the
hourly assessment, the nurse notes the patient’s respiratory
rate is 10 breaths per minute, deep tendon reflexes (DTRs) are
absent, and urine output has been 15 mL over the past hour.
Question Stem
Which medication should the nurse anticipate administering?
Options
A. Calcium gluconate
B. Naloxone
C. Flumazenil
D. Protamine sulfate
, Correct Answer
Correct Answer: A. Calcium gluconate
Detailed Rationale
The patient is exhibiting classic signs of magnesium sulfate
toxicity, which include a respiratory rate less than 12 breaths
per minute, absent deep tendon reflexes (DTRs), and decreased
urine output (less than 30 mL/hr). Magnesium is excreted by
the kidneys, and oliguria can lead to toxic accumulation of the
drug. The priority intervention is to administer the antidote,
calcium gluconate, which directly antagonizes the
neuromuscular and cardiac depressant effects of magnesium.
Naloxone (Option B) is the antidote for opioid toxicity.
Flumazenil (Option C) is the antidote for benzodiazepine
toxicity. Protamine sulfate (Option D) is the antidote for
heparin. Nursing considerations for magnesium sulfate therapy
include continuous monitoring of respiratory rate, DTRs, and
urine output, as well as ensuring calcium gluconate is readily
available at the bedside. This question emphasizes medication
safety and the recognition of life-threatening adverse effects
requiring immediate pharmacological intervention.
Learning Objective
• Identify the clinical manifestations of magnesium sulfate
toxicity.
• Select the appropriate antidote for magnesium toxicity.
