NCLEX-RN Pharmacology Reproductive &
Genitourinary System Exam Questions with
Detailed Rationales |
20 Original NCLEX Next Generation (NGN) Practice
MCQs | Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 27-year-old woman at 41 weeks' gestation is admitted for induction
of labor. Her prenatal course has been uncomplicated. The provider
prescribes an oxytocin IV infusion. Baseline assessment reveals:
• Blood pressure: 118/72 mm Hg
• Heart rate: 86/min
• Fetal heart rate (FHR): 140/min with moderate variability
• Contractions: Every 8–10 minutes, lasting 30 seconds
Thirty minutes after the infusion begins, the nurse notes contractions
every 90 seconds lasting 100 seconds. The fetal heart tracing shows
recurrent late decelerations.
Question Stem
,Which nursing action should the nurse take first?
A. Increase the oxytocin infusion rate to strengthen labor
B. Discontinue the oxytocin infusion immediately
C. Administer prescribed IV morphine for pain
D. Encourage the client to ambulate
Correct Answer
Correct Answer: B. Discontinue the oxytocin infusion immediately
Detailed Rationale
Oxytocin stimulates uterine smooth muscle contractions by activating
oxytocin receptors, increasing intracellular calcium within myometrial
cells. While effective for labor induction, excessive uterine stimulation
(tachysystole) can reduce placental perfusion, leading to fetal hypoxia.
This client demonstrates uterine tachysystole accompanied by recurrent
late decelerations, indicating fetal compromise. The priority
intervention is to stop the oxytocin infusion immediately to decrease
uterine activity. Additional measures include repositioning the client to
the left lateral position, administering oxygen if indicated by
institutional protocol, increasing IV fluids, and notifying the provider.
Option A is incorrect because increasing oxytocin would worsen uterine
hyperstimulation and fetal distress.
Option C is incorrect because pain management does not address
impaired fetal oxygenation and may delay appropriate intervention.
Option D is incorrect because ambulation is inappropriate during fetal
distress and uterine tachysystole.
,Nurses should continuously monitor contraction frequency, duration,
resting tone, and fetal heart rate while oxytocin is administered.
Oxytocin is considered a high-alert medication because dosing errors
can result in serious maternal and fetal complications.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize uterine tachysystole caused by oxytocin.
• Prioritize nursing interventions during fetal distress.
• Describe safe monitoring requirements for oxytocin
administration.
• Apply clinical judgment when managing high-alert medications.
Medication Safety Focus: High-alert medication monitoring
Question 2
Clinical Scenario
A 69-year-old man with benign prostatic hyperplasia (BPH) is
prescribed tamsulosin. His history includes hypertension treated with
lisinopril. During discharge teaching, the nurse discusses medication
administration and safety precautions.
Question Stem
Which statement by the client indicates that further teaching is
needed?
A. "I will rise slowly from bed before standing."
, B. "I should expect my urinary stream to improve over several weeks."
C. "If I become dizzy after taking this medicine, I'll sit or lie down."
D. "I can stop taking this medication once my urinary symptoms
improve."
Correct Answer
Correct Answer: D. "I can stop taking this medication once my urinary
symptoms improve."
Detailed Rationale
Tamsulosin is a selective alpha-1 adrenergic blocker that relaxes smooth
muscle in the prostate and bladder neck, improving urine flow without
reducing prostate size. Because it provides symptomatic relief rather
than curing BPH, therapy is generally continued long term unless
directed otherwise by the healthcare provider.
Option A is correct teaching because orthostatic hypotension may
occur, particularly when therapy is initiated.
Option B is appropriate because symptom improvement may require
several days to weeks.
Option C is correct because dizziness increases fall risk, especially in
older adults.
Stopping tamsulosin abruptly may allow urinary symptoms to recur and
could increase the risk of urinary retention. The nurse should also teach
the client to take the medication consistently after the same meal each
day and to inform ophthalmologists before cataract surgery due to the
risk of intraoperative floppy iris syndrome.
Genitourinary System Exam Questions with
Detailed Rationales |
20 Original NCLEX Next Generation (NGN) Practice
MCQs | Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 27-year-old woman at 41 weeks' gestation is admitted for induction
of labor. Her prenatal course has been uncomplicated. The provider
prescribes an oxytocin IV infusion. Baseline assessment reveals:
• Blood pressure: 118/72 mm Hg
• Heart rate: 86/min
• Fetal heart rate (FHR): 140/min with moderate variability
• Contractions: Every 8–10 minutes, lasting 30 seconds
Thirty minutes after the infusion begins, the nurse notes contractions
every 90 seconds lasting 100 seconds. The fetal heart tracing shows
recurrent late decelerations.
Question Stem
,Which nursing action should the nurse take first?
A. Increase the oxytocin infusion rate to strengthen labor
B. Discontinue the oxytocin infusion immediately
C. Administer prescribed IV morphine for pain
D. Encourage the client to ambulate
Correct Answer
Correct Answer: B. Discontinue the oxytocin infusion immediately
Detailed Rationale
Oxytocin stimulates uterine smooth muscle contractions by activating
oxytocin receptors, increasing intracellular calcium within myometrial
cells. While effective for labor induction, excessive uterine stimulation
(tachysystole) can reduce placental perfusion, leading to fetal hypoxia.
This client demonstrates uterine tachysystole accompanied by recurrent
late decelerations, indicating fetal compromise. The priority
intervention is to stop the oxytocin infusion immediately to decrease
uterine activity. Additional measures include repositioning the client to
the left lateral position, administering oxygen if indicated by
institutional protocol, increasing IV fluids, and notifying the provider.
Option A is incorrect because increasing oxytocin would worsen uterine
hyperstimulation and fetal distress.
Option C is incorrect because pain management does not address
impaired fetal oxygenation and may delay appropriate intervention.
Option D is incorrect because ambulation is inappropriate during fetal
distress and uterine tachysystole.
,Nurses should continuously monitor contraction frequency, duration,
resting tone, and fetal heart rate while oxytocin is administered.
Oxytocin is considered a high-alert medication because dosing errors
can result in serious maternal and fetal complications.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize uterine tachysystole caused by oxytocin.
• Prioritize nursing interventions during fetal distress.
• Describe safe monitoring requirements for oxytocin
administration.
• Apply clinical judgment when managing high-alert medications.
Medication Safety Focus: High-alert medication monitoring
Question 2
Clinical Scenario
A 69-year-old man with benign prostatic hyperplasia (BPH) is
prescribed tamsulosin. His history includes hypertension treated with
lisinopril. During discharge teaching, the nurse discusses medication
administration and safety precautions.
Question Stem
Which statement by the client indicates that further teaching is
needed?
A. "I will rise slowly from bed before standing."
, B. "I should expect my urinary stream to improve over several weeks."
C. "If I become dizzy after taking this medicine, I'll sit or lie down."
D. "I can stop taking this medication once my urinary symptoms
improve."
Correct Answer
Correct Answer: D. "I can stop taking this medication once my urinary
symptoms improve."
Detailed Rationale
Tamsulosin is a selective alpha-1 adrenergic blocker that relaxes smooth
muscle in the prostate and bladder neck, improving urine flow without
reducing prostate size. Because it provides symptomatic relief rather
than curing BPH, therapy is generally continued long term unless
directed otherwise by the healthcare provider.
Option A is correct teaching because orthostatic hypotension may
occur, particularly when therapy is initiated.
Option B is appropriate because symptom improvement may require
several days to weeks.
Option C is correct because dizziness increases fall risk, especially in
older adults.
Stopping tamsulosin abruptly may allow urinary symptoms to recur and
could increase the risk of urinary retention. The nurse should also teach
the client to take the medication consistently after the same meal each
day and to inform ophthalmologists before cataract surgery due to the
risk of intraoperative floppy iris syndrome.
