NCLEX-RN Pharmacology Reproductive &
Genitourinary System Exam |
20 Original NGN Practice Questions with
Rationales |
ATI Pharmacology Made Easy Style
Question 1
Clinical Scenario
A 28-year-old G1P0 at 40 weeks gestation is receiving an IV
oxytocin infusion for labor induction. The fetal monitor shows
late decelerations, and contractions are occurring every 1.5
minutes, lasting 90 seconds each.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed PRN dose of terbutaline.
B. Decrease the oxytocin infusion rate by 50%.
C. Prepare the client for an immediate cesarean birth.
D. Turn off the oxytocin infusion.
,Correct Answer
Correct Answer: D. Turn off the oxytocin infusion.
Detailed Rationale
Uterine tachysystole is defined as more than five contractions in
a 10-minute period or contractions lasting longer than 90
seconds. When tachysystole is accompanied by nonreassuring
fetal heart rate patterns, such as late decelerations, it indicates
fetal hypoxia. The priority nursing action is to immediately turn
off the oxytocin infusion to remove the pharmacological
stimulus causing the hyperstimulation. While administering a
tocolytic like terbutaline (Option A) may be the next step if the
tachysystole does not resolve after stopping the oxytocin, it is
not the first action. Decreasing the infusion rate (Option B) is
insufficient because the medication will continue to stimulate
the uterus, and its half-life means it will remain active.
Preparing for an immediate cesarean birth (Option C) is
premature; intrauterine resuscitation measures, starting with
stopping the oxytocin, must be attempted first. This question
emphasizes the nursing process and prioritization, ensuring the
nurse addresses the root cause of the fetal distress before
escalating to surgical intervention or secondary
pharmacological treatments.
Learning Objective
, • Recognize the signs of uterine tachysystole and fetal
distress.
• Prioritize immediate nursing interventions for oxytocin-
induced hyperstimulation.
• Differentiate between primary and secondary actions
during an obstetric emergency.
Medication Safety Focus
Adverse effect / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old G2P1 at 32 weeks gestation is prescribed
terbutaline for the management of preterm labor. The nurse is
providing discharge teaching regarding the medication.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I can take this medication indefinitely to prevent early
labor."
B. "I may feel my heart racing while taking this medication."
C. "I should report any chest pain or shortness of breath
immediately."
, D. "I will monitor my blood sugar because this drug can increase
it."
Correct Answer
Correct Answer: A. "I can take this medication indefinitely to
prevent early labor."
Detailed Rationale
Terbutaline is a beta-2 adrenergic agonist used off-label as a
tocolytic. The FDA has issued a Black Box Warning against the
prolonged use of oral or injectable terbutaline for preterm labor
(beyond 48 to 72 hours) due to the risk of serious maternal
cardiovascular events, including tachycardia, pulmonary edema,
and myocardial ischemia. Therefore, the client’s belief that she
can take it indefinitely is incorrect and requires immediate
correction. Options B, C, and D are all accurate statements.
Tachycardia is a common, expected side effect of beta-agonists.
Chest pain and shortness of breath are red-flag symptoms of
pulmonary edema or cardiac ischemia that require immediate
emergency evaluation. Terbutaline also promotes
glycogenolysis, which can cause transient hyperglycemia,
making blood sugar monitoring relevant, especially for clients
with gestational diabetes.
Learning Objective
• Identify the Black Box Warning associated with prolonged
terbutaline use.
Genitourinary System Exam |
20 Original NGN Practice Questions with
Rationales |
ATI Pharmacology Made Easy Style
Question 1
Clinical Scenario
A 28-year-old G1P0 at 40 weeks gestation is receiving an IV
oxytocin infusion for labor induction. The fetal monitor shows
late decelerations, and contractions are occurring every 1.5
minutes, lasting 90 seconds each.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed PRN dose of terbutaline.
B. Decrease the oxytocin infusion rate by 50%.
C. Prepare the client for an immediate cesarean birth.
D. Turn off the oxytocin infusion.
,Correct Answer
Correct Answer: D. Turn off the oxytocin infusion.
Detailed Rationale
Uterine tachysystole is defined as more than five contractions in
a 10-minute period or contractions lasting longer than 90
seconds. When tachysystole is accompanied by nonreassuring
fetal heart rate patterns, such as late decelerations, it indicates
fetal hypoxia. The priority nursing action is to immediately turn
off the oxytocin infusion to remove the pharmacological
stimulus causing the hyperstimulation. While administering a
tocolytic like terbutaline (Option A) may be the next step if the
tachysystole does not resolve after stopping the oxytocin, it is
not the first action. Decreasing the infusion rate (Option B) is
insufficient because the medication will continue to stimulate
the uterus, and its half-life means it will remain active.
Preparing for an immediate cesarean birth (Option C) is
premature; intrauterine resuscitation measures, starting with
stopping the oxytocin, must be attempted first. This question
emphasizes the nursing process and prioritization, ensuring the
nurse addresses the root cause of the fetal distress before
escalating to surgical intervention or secondary
pharmacological treatments.
Learning Objective
, • Recognize the signs of uterine tachysystole and fetal
distress.
• Prioritize immediate nursing interventions for oxytocin-
induced hyperstimulation.
• Differentiate between primary and secondary actions
during an obstetric emergency.
Medication Safety Focus
Adverse effect / Priority nursing action
Question 2
Clinical Scenario
A 32-year-old G2P1 at 32 weeks gestation is prescribed
terbutaline for the management of preterm labor. The nurse is
providing discharge teaching regarding the medication.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I can take this medication indefinitely to prevent early
labor."
B. "I may feel my heart racing while taking this medication."
C. "I should report any chest pain or shortness of breath
immediately."
, D. "I will monitor my blood sugar because this drug can increase
it."
Correct Answer
Correct Answer: A. "I can take this medication indefinitely to
prevent early labor."
Detailed Rationale
Terbutaline is a beta-2 adrenergic agonist used off-label as a
tocolytic. The FDA has issued a Black Box Warning against the
prolonged use of oral or injectable terbutaline for preterm labor
(beyond 48 to 72 hours) due to the risk of serious maternal
cardiovascular events, including tachycardia, pulmonary edema,
and myocardial ischemia. Therefore, the client’s belief that she
can take it indefinitely is incorrect and requires immediate
correction. Options B, C, and D are all accurate statements.
Tachycardia is a common, expected side effect of beta-agonists.
Chest pain and shortness of breath are red-flag symptoms of
pulmonary edema or cardiac ischemia that require immediate
emergency evaluation. Terbutaline also promotes
glycogenolysis, which can cause transient hyperglycemia,
making blood sugar monitoring relevant, especially for clients
with gestational diabetes.
Learning Objective
• Identify the Black Box Warning associated with prolonged
terbutaline use.
