NCLEX-RN Pharmacology Reproductive &
Genitourinary System Practice Questions with
Detailed Rationales |
20 Original NGN-Style Nursing Exam Prep MCQs
Question 1
Clinical Scenario
A 28-year-old G1P0 client at 41 weeks gestation is receiving an
IV oxytocin infusion for labor induction. The fetal monitor
displays late decelerations, and the tocodynamometer shows
contractions occurring every 1.5 minutes and lasting 90
seconds. The client's blood pressure is 130/80 mm Hg, and her
heart rate is 95/min.
Question Stem
Which action should the nurse take first?
A. Administer subcutaneous terbutaline as a rescue tocolytic.
B. Increase the primary IV fluid infusion rate to 250 mL/hr.
C. Discontinue the oxytocin infusion immediately.
D. Apply oxygen via a non-rebreather face mask at 10 L/min.
,Correct Answer
Correct Answer: C. Discontinue the oxytocin infusion
immediately.
Detailed Rationale
The clinical scenario describes uterine tachysystole
(contractions more frequent than 5 in 10 minutes or lasting
longer than 90 seconds) accompanied by non-reassuring fetal
heart rate patterns (late decelerations). The priority nursing
action is to remove the cause of the tachysystole by
immediately discontinuing the oxytocin infusion. Oxytocin has a
very short half-life (approximately 1 to 6 minutes), making
cessation the fastest and most effective initial intervention to
improve uteroplacental perfusion. After stopping the oxytocin,
the nurse should implement intrauterine resuscitation
measures, which include turning the client to a lateral position,
administering oxygen via face mask at 8 to 10 L/min, increasing
the rate of the primary IV fluid infusion, and notifying the
provider. If the tachysystole does not resolve, the provider may
prescribe a tocolytic agent such as terbutaline to relax the
uterus. Increasing the IV fluid rate or applying oxygen are
important subsequent steps, but they do not address the root
cause as effectively as stopping the offending agent.
Administering terbutaline is not the first independent nursing
action; it requires a provider's prescription and is reserved for
,cases where discontinuing oxytocin and positional changes are
insufficient.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs of uterine tachysystole and non-
reassuring fetal heart rate patterns.
• Prioritize nursing interventions for oxytocin-induced uterine
hyperstimulation.
• Differentiate between independent nursing actions and
provider-prescribed interventions during fetal distress.
Medication Safety Focus
High-alert medication / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old P1 client is 2 hours postpartum following a
spontaneous vaginal delivery. The nurse assesses a boggy
uterus and heavy vaginal bleeding. The client's blood pressure is
158/95 mm Hg, and her heart rate is 110/min. The provider
prescribes methylergonovine 0.2 mg IM.
Question Stem
Which action should the nurse take?
, A. Administer the medication deep intramuscularly as
prescribed.
B. Assess the client's deep tendon reflexes before
administration.
C. Hold the medication and notify the provider.
D. Request a prescription for intravenous administration of the
medication.
Correct Answer
Correct Answer: C. Hold the medication and notify the provider.
Detailed Rationale
Methylergonovine is an ergot alkaloid used to treat postpartum
hemorrhage caused by uterine atony. It works by causing
sustained smooth muscle contraction in the uterus. However, it
also causes systemic vasoconstriction, making hypertension an
absolute contraindication. The client’s blood pressure of 158/95
mm Hg indicates hypertensive status, and administering
methylergonovine could precipitate a hypertensive crisis,
stroke, or myocardial infarction. The nurse’s priority action is to
recognize this contraindication, hold the medication, and notify
the provider to request an alternative uterotonic agent, such as
oxytocin, carboprost (if no asthma), or misoprostol. Assessing
deep tendon reflexes (Option B) is relevant for magnesium
sulfate toxicity, not methylergonovine. Administering the
medication IM (Option A) ignores the critical safety
Genitourinary System Practice Questions with
Detailed Rationales |
20 Original NGN-Style Nursing Exam Prep MCQs
Question 1
Clinical Scenario
A 28-year-old G1P0 client at 41 weeks gestation is receiving an
IV oxytocin infusion for labor induction. The fetal monitor
displays late decelerations, and the tocodynamometer shows
contractions occurring every 1.5 minutes and lasting 90
seconds. The client's blood pressure is 130/80 mm Hg, and her
heart rate is 95/min.
Question Stem
Which action should the nurse take first?
A. Administer subcutaneous terbutaline as a rescue tocolytic.
B. Increase the primary IV fluid infusion rate to 250 mL/hr.
C. Discontinue the oxytocin infusion immediately.
D. Apply oxygen via a non-rebreather face mask at 10 L/min.
,Correct Answer
Correct Answer: C. Discontinue the oxytocin infusion
immediately.
Detailed Rationale
The clinical scenario describes uterine tachysystole
(contractions more frequent than 5 in 10 minutes or lasting
longer than 90 seconds) accompanied by non-reassuring fetal
heart rate patterns (late decelerations). The priority nursing
action is to remove the cause of the tachysystole by
immediately discontinuing the oxytocin infusion. Oxytocin has a
very short half-life (approximately 1 to 6 minutes), making
cessation the fastest and most effective initial intervention to
improve uteroplacental perfusion. After stopping the oxytocin,
the nurse should implement intrauterine resuscitation
measures, which include turning the client to a lateral position,
administering oxygen via face mask at 8 to 10 L/min, increasing
the rate of the primary IV fluid infusion, and notifying the
provider. If the tachysystole does not resolve, the provider may
prescribe a tocolytic agent such as terbutaline to relax the
uterus. Increasing the IV fluid rate or applying oxygen are
important subsequent steps, but they do not address the root
cause as effectively as stopping the offending agent.
Administering terbutaline is not the first independent nursing
action; it requires a provider's prescription and is reserved for
,cases where discontinuing oxytocin and positional changes are
insufficient.
Learning Objective
After completing this question, the learner should be able to:
• Recognize the signs of uterine tachysystole and non-
reassuring fetal heart rate patterns.
• Prioritize nursing interventions for oxytocin-induced uterine
hyperstimulation.
• Differentiate between independent nursing actions and
provider-prescribed interventions during fetal distress.
Medication Safety Focus
High-alert medication / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old P1 client is 2 hours postpartum following a
spontaneous vaginal delivery. The nurse assesses a boggy
uterus and heavy vaginal bleeding. The client's blood pressure is
158/95 mm Hg, and her heart rate is 110/min. The provider
prescribes methylergonovine 0.2 mg IM.
Question Stem
Which action should the nurse take?
, A. Administer the medication deep intramuscularly as
prescribed.
B. Assess the client's deep tendon reflexes before
administration.
C. Hold the medication and notify the provider.
D. Request a prescription for intravenous administration of the
medication.
Correct Answer
Correct Answer: C. Hold the medication and notify the provider.
Detailed Rationale
Methylergonovine is an ergot alkaloid used to treat postpartum
hemorrhage caused by uterine atony. It works by causing
sustained smooth muscle contraction in the uterus. However, it
also causes systemic vasoconstriction, making hypertension an
absolute contraindication. The client’s blood pressure of 158/95
mm Hg indicates hypertensive status, and administering
methylergonovine could precipitate a hypertensive crisis,
stroke, or myocardial infarction. The nurse’s priority action is to
recognize this contraindication, hold the medication, and notify
the provider to request an alternative uterotonic agent, such as
oxytocin, carboprost (if no asthma), or misoprostol. Assessing
deep tendon reflexes (Option B) is relevant for magnesium
sulfate toxicity, not methylergonovine. Administering the
medication IM (Option A) ignores the critical safety
