NCLEX-RN Pharmacology Reproductive &
Genitourinary System Practice Questions with
Detailed Rationales |
20 Original NGN-Style Nursing MCQs
Question 1
Clinical Scenario
A 27-year-old primigravida at 41 weeks' gestation is admitted
for induction of labor. The provider prescribes an intravenous
oxytocin infusion. Baseline assessment reveals fetal heart rate
(FHR) 140/min with moderate variability, contractions every 8–
10 minutes, blood pressure 118/72 mm Hg, and cervical dilation
of 2 cm. Thirty minutes after the infusion rate is increased, the
nurse notes contractions occurring every 90 seconds, each
lasting 100–110 seconds. The fetal monitor shows recurrent late
decelerations with minimal variability.
Question Stem
Which action should the nurse take first?
,A. Increase the oxytocin infusion to strengthen contractions.
B. Stop the oxytocin infusion immediately.
C. Administer the prescribed analgesic for labor pain.
D. Encourage the client to begin pushing.
Correct Answer
Correct Answer: B. Stop the oxytocin infusion immediately.
Detailed Rationale
Oxytocin stimulates uterine smooth muscle by activating
oxytocin receptors, increasing intracellular calcium and
producing rhythmic contractions. Excessive stimulation may
result in uterine tachysystole (more than five contractions in 10
minutes or contractions lasting longer than 90 seconds), which
reduces uteroplacental blood flow and fetal oxygenation. This
client's prolonged, frequent contractions accompanied by
recurrent late decelerations and minimal variability indicate
fetal compromise. The priority intervention is to discontinue the
oxytocin infusion immediately to reduce uterine stimulation.
Additional interventions include repositioning the client
laterally, administering oxygen if indicated by institutional
protocol, increasing the primary IV fluid rate, and notifying the
provider while preparing for further intervention.
Option A worsens uterine hyperstimulation and increases fetal
hypoxia risk. Option C may be appropriate later but does not
,address the immediate cause of fetal distress. Option D is
inappropriate because the cervix is minimally dilated and
pushing would increase maternal and fetal stress.
Nurses should titrate oxytocin carefully using an infusion pump,
continuously monitor maternal and fetal responses, document
contraction patterns, and recognize early signs of uterine
tachysystole to prevent serious complications, including uterine
rupture and fetal hypoxia.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of oxytocin-induced uterine
tachysystole.
• Prioritize emergency nursing interventions during fetal
distress.
• Describe appropriate monitoring during oxytocin
administration.
• Explain the relationship between excessive uterine
contractions and fetal oxygenation.
Medication Safety Focus: High-alert medication
Question 2
Clinical Scenario
, A 23-year-old woman begins taking a combined oral
contraceptive containing ethinyl estradiol and norethindrone.
During a follow-up visit, she reports taking the pill daily but
states she recently started rifampin therapy for tuberculosis.
She asks whether any additional precautions are necessary
because she has remained adherent to her contraceptive
schedule.
Question Stem
Which response by the nurse is most appropriate?
A. "Continue your pills because rifampin does not affect
contraceptive effectiveness."
B. "Use a backup nonhormonal contraceptive while taking
rifampin and for the recommended period afterward."
C. "Take two contraceptive pills each day while taking rifampin."
D. "Discontinue the contraceptive until the antibiotic is
completed."
Correct Answer
Correct Answer: B. Use a backup nonhormonal contraceptive
while taking rifampin and for the recommended period
afterward.
Detailed Rationale
Genitourinary System Practice Questions with
Detailed Rationales |
20 Original NGN-Style Nursing MCQs
Question 1
Clinical Scenario
A 27-year-old primigravida at 41 weeks' gestation is admitted
for induction of labor. The provider prescribes an intravenous
oxytocin infusion. Baseline assessment reveals fetal heart rate
(FHR) 140/min with moderate variability, contractions every 8–
10 minutes, blood pressure 118/72 mm Hg, and cervical dilation
of 2 cm. Thirty minutes after the infusion rate is increased, the
nurse notes contractions occurring every 90 seconds, each
lasting 100–110 seconds. The fetal monitor shows recurrent late
decelerations with minimal variability.
Question Stem
Which action should the nurse take first?
,A. Increase the oxytocin infusion to strengthen contractions.
B. Stop the oxytocin infusion immediately.
C. Administer the prescribed analgesic for labor pain.
D. Encourage the client to begin pushing.
Correct Answer
Correct Answer: B. Stop the oxytocin infusion immediately.
Detailed Rationale
Oxytocin stimulates uterine smooth muscle by activating
oxytocin receptors, increasing intracellular calcium and
producing rhythmic contractions. Excessive stimulation may
result in uterine tachysystole (more than five contractions in 10
minutes or contractions lasting longer than 90 seconds), which
reduces uteroplacental blood flow and fetal oxygenation. This
client's prolonged, frequent contractions accompanied by
recurrent late decelerations and minimal variability indicate
fetal compromise. The priority intervention is to discontinue the
oxytocin infusion immediately to reduce uterine stimulation.
Additional interventions include repositioning the client
laterally, administering oxygen if indicated by institutional
protocol, increasing the primary IV fluid rate, and notifying the
provider while preparing for further intervention.
Option A worsens uterine hyperstimulation and increases fetal
hypoxia risk. Option C may be appropriate later but does not
,address the immediate cause of fetal distress. Option D is
inappropriate because the cervix is minimally dilated and
pushing would increase maternal and fetal stress.
Nurses should titrate oxytocin carefully using an infusion pump,
continuously monitor maternal and fetal responses, document
contraction patterns, and recognize early signs of uterine
tachysystole to prevent serious complications, including uterine
rupture and fetal hypoxia.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of oxytocin-induced uterine
tachysystole.
• Prioritize emergency nursing interventions during fetal
distress.
• Describe appropriate monitoring during oxytocin
administration.
• Explain the relationship between excessive uterine
contractions and fetal oxygenation.
Medication Safety Focus: High-alert medication
Question 2
Clinical Scenario
, A 23-year-old woman begins taking a combined oral
contraceptive containing ethinyl estradiol and norethindrone.
During a follow-up visit, she reports taking the pill daily but
states she recently started rifampin therapy for tuberculosis.
She asks whether any additional precautions are necessary
because she has remained adherent to her contraceptive
schedule.
Question Stem
Which response by the nurse is most appropriate?
A. "Continue your pills because rifampin does not affect
contraceptive effectiveness."
B. "Use a backup nonhormonal contraceptive while taking
rifampin and for the recommended period afterward."
C. "Take two contraceptive pills each day while taking rifampin."
D. "Discontinue the contraceptive until the antibiotic is
completed."
Correct Answer
Correct Answer: B. Use a backup nonhormonal contraceptive
while taking rifampin and for the recommended period
afterward.
Detailed Rationale
