NCLEX-RN Pharmacology Practice Questions:
Reproductive & Genitourinary System Exam
with Detailed Rationales |
NGN Nursing Medication Review |
ATI-Style NCLEX Prep
Question 1
Clinical Scenario A 38-year-old female client visits the family
planning clinic requesting a prescription for combined oral
contraceptives (COCs). She has a 10-year history of smoking one
pack of cigarettes per day. Her blood pressure is 138/88 mm Hg,
and her BMI is 29. She has no other significant medical history.
Question Stem Which action should the nurse take first
regarding this client’s request for combined oral
contraceptives?
A. Provide education on the proper daily timing for taking the
pill to ensure maximum efficacy. B. Discuss alternative, non-
estrogen-containing contraceptive methods due to her age and
smoking history. C. Instruct the client to take the pill with food
,to minimize gastrointestinal upset. D. Schedule the client for a
baseline mammogram before initiating the medication.
Correct Answer: B. Discuss alternative, non-estrogen-containing
contraceptive methods due to her age and smoking history.
Detailed Rationale The correct answer is B. Combined oral
contraceptives (COCs) contain estrogen, which significantly
increases the risk of thromboembolic events (e.g., deep vein
thrombosis, pulmonary embolism, stroke, and myocardial
infarction). This risk is markedly amplified in women over the
age of 35 who smoke. Therefore, COCs are contraindicated in
this demographic. The nurse’s priority is to advocate for patient
safety by discussing alternative, progestin-only, or non-
hormonal contraceptive methods (e.g., progestin-only pill,
copper IUD, or barrier methods).
Option A is incorrect because while timing is important for
progestin-only pills, the primary issue here is an absolute
contraindication to the medication class itself. Option C is
incorrect because minimizing GI upset does not address the life-
threatening cardiovascular risks associated with this
prescription. Option D is incorrect because while breast cancer
screening is important for women in this age group, it is not the
immediate priority before addressing the contraindication to
estrogen therapy. The nurse must prevent a medication error by
clarifying the prescription with the provider.
,Learning Objective
• Identify absolute contraindications for combined oral
contraceptives.
• Recognize the synergistic risk of thromboembolism in
patients over 35 who smoke.
• Prioritize patient safety by advocating for alternative
contraceptive methods when contraindications exist.
Medication Safety Focus Contraindication
Question 2
Clinical Scenario A 28-year-old client at 32 weeks of gestation is
receiving a continuous intravenous infusion of magnesium
sulfate for preterm labor. The nurse notes the client’s
respiratory rate is 10 breaths/min, deep tendon reflexes (DTRs)
are absent, and urine output has been 15 mL/hr for the past 2
hours.
Question Stem Which action should the nurse take
immediately?
A. Increase the intravenous fluid rate to 150 mL/hr. B.
Administer the next scheduled dose of nifedipine. C. Stop the
magnesium sulfate infusion and prepare to administer calcium
, gluconate. D. Obtain a stat serum magnesium level and wait for
the results before acting.
Correct Answer: C. Stop the magnesium sulfate infusion and
prepare to administer calcium gluconate.
Detailed Rationale The correct answer is C. The client is
exhibiting classic signs of magnesium sulfate toxicity, which
include respiratory depression (RR < 12 breaths/min), absent
deep tendon reflexes, and oliguria (magnesium is excreted by
the kidneys, and oliguria leads to toxic accumulation).
Magnesium sulfate is a high-alert medication. The immediate
priority nursing action is to stop the infusion to prevent further
toxicity and prepare to administer calcium gluconate, which is
the specific antidote for magnesium toxicity.
Option A is incorrect because while hydration is important, it
does not reverse the immediate life-threatening respiratory
depression. Option B is incorrect because nifedipine is a
tocolytic; administering another tocolytic would not address the
magnesium toxicity and could exacerbate hypotension. Option
D is incorrect because waiting for laboratory results delays life-
saving intervention. Clinical signs of toxicity mandate immediate
cessation of the drug and antidote preparation, regardless of
pending lab values.
Learning Objective
Reproductive & Genitourinary System Exam
with Detailed Rationales |
NGN Nursing Medication Review |
ATI-Style NCLEX Prep
Question 1
Clinical Scenario A 38-year-old female client visits the family
planning clinic requesting a prescription for combined oral
contraceptives (COCs). She has a 10-year history of smoking one
pack of cigarettes per day. Her blood pressure is 138/88 mm Hg,
and her BMI is 29. She has no other significant medical history.
Question Stem Which action should the nurse take first
regarding this client’s request for combined oral
contraceptives?
A. Provide education on the proper daily timing for taking the
pill to ensure maximum efficacy. B. Discuss alternative, non-
estrogen-containing contraceptive methods due to her age and
smoking history. C. Instruct the client to take the pill with food
,to minimize gastrointestinal upset. D. Schedule the client for a
baseline mammogram before initiating the medication.
Correct Answer: B. Discuss alternative, non-estrogen-containing
contraceptive methods due to her age and smoking history.
Detailed Rationale The correct answer is B. Combined oral
contraceptives (COCs) contain estrogen, which significantly
increases the risk of thromboembolic events (e.g., deep vein
thrombosis, pulmonary embolism, stroke, and myocardial
infarction). This risk is markedly amplified in women over the
age of 35 who smoke. Therefore, COCs are contraindicated in
this demographic. The nurse’s priority is to advocate for patient
safety by discussing alternative, progestin-only, or non-
hormonal contraceptive methods (e.g., progestin-only pill,
copper IUD, or barrier methods).
Option A is incorrect because while timing is important for
progestin-only pills, the primary issue here is an absolute
contraindication to the medication class itself. Option C is
incorrect because minimizing GI upset does not address the life-
threatening cardiovascular risks associated with this
prescription. Option D is incorrect because while breast cancer
screening is important for women in this age group, it is not the
immediate priority before addressing the contraindication to
estrogen therapy. The nurse must prevent a medication error by
clarifying the prescription with the provider.
,Learning Objective
• Identify absolute contraindications for combined oral
contraceptives.
• Recognize the synergistic risk of thromboembolism in
patients over 35 who smoke.
• Prioritize patient safety by advocating for alternative
contraceptive methods when contraindications exist.
Medication Safety Focus Contraindication
Question 2
Clinical Scenario A 28-year-old client at 32 weeks of gestation is
receiving a continuous intravenous infusion of magnesium
sulfate for preterm labor. The nurse notes the client’s
respiratory rate is 10 breaths/min, deep tendon reflexes (DTRs)
are absent, and urine output has been 15 mL/hr for the past 2
hours.
Question Stem Which action should the nurse take
immediately?
A. Increase the intravenous fluid rate to 150 mL/hr. B.
Administer the next scheduled dose of nifedipine. C. Stop the
magnesium sulfate infusion and prepare to administer calcium
, gluconate. D. Obtain a stat serum magnesium level and wait for
the results before acting.
Correct Answer: C. Stop the magnesium sulfate infusion and
prepare to administer calcium gluconate.
Detailed Rationale The correct answer is C. The client is
exhibiting classic signs of magnesium sulfate toxicity, which
include respiratory depression (RR < 12 breaths/min), absent
deep tendon reflexes, and oliguria (magnesium is excreted by
the kidneys, and oliguria leads to toxic accumulation).
Magnesium sulfate is a high-alert medication. The immediate
priority nursing action is to stop the infusion to prevent further
toxicity and prepare to administer calcium gluconate, which is
the specific antidote for magnesium toxicity.
Option A is incorrect because while hydration is important, it
does not reverse the immediate life-threatening respiratory
depression. Option B is incorrect because nifedipine is a
tocolytic; administering another tocolytic would not address the
magnesium toxicity and could exacerbate hypotension. Option
D is incorrect because waiting for laboratory results delays life-
saving intervention. Clinical signs of toxicity mandate immediate
cessation of the drug and antidote preparation, regardless of
pending lab values.
Learning Objective
