NCLEX-RN Pharmacology Reproductive &
Genitourinary System Exam |
20 Original NGN Practice Questions with
Detailed Rationales
Question 1
Clinical Scenario
A 28-year-old client, G1P0, at 40 weeks of gestation is receiving
a continuous IV oxytocin infusion for labor induction. The fetal
heart rate is 110 beats/min with moderate variability. The nurse
notes that the client is having contractions every 1.5 minutes,
each lasting 90 seconds.
Question Stem
Which action should the nurse take first?
A. Apply oxygen at 10 L/min via a nonrebreather mask.
B. Increase the IV maintenance fluid rate to 250 mL/hr.
C. Stop the oxytocin infusion immediately.
D. Administer terbutaline 0.25 mg subcutaneously as
prescribed.
,Correct Answer
C. Stop the oxytocin infusion immediately.
Detailed Rationale
The client is experiencing uterine tachysystole, defined as more
than 5 contractions in a 10-minute period or contractions
lasting longer than 90 seconds. This compromises
uteroplacental perfusion and can lead to fetal hypoxia. The
priority nursing action is to remove the causative agent by
stopping the oxytocin infusion immediately. While applying
oxygen, increasing IV fluids, and administering terbutaline (a
tocolytic) are all appropriate, evidence-based interventions for
tachysystole with nonreassuring fetal heart rate patterns, they
are secondary to eliminating the source of the excessive
stimulation. Clinical reasoning dictates that the nurse must first
halt the offending agent before initiating supportive or rescue
measures. Once the infusion is stopped, the nurse should
reposition the client, administer oxygen, and notify the
healthcare provider.
Learning Objective
• Recognize the clinical signs of uterine tachysystole during
labor induction.
• Prioritize nursing interventions for tachysystole to restore
uteroplacental perfusion.
, • Differentiate between primary and secondary nursing
actions in obstetric emergencies.
Medication Safety Focus
Priority nursing action / Adverse effect management
Question 2
Clinical Scenario
A 68-year-old male client with a history of benign prostatic
hyperplasia (BPH) is being discharged with a new prescription
for tamsulosin 0.4 mg daily.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I should rise slowly from a sitting or lying position."
B. "I will take this medication in the morning with breakfast."
C. "I can stop taking this medication once my urinary stream
improves."
D. "I will report any instances of increased blood pressure to my
provider."
Correct Answer
A. "I should rise slowly from a sitting or lying position."
Detailed Rationale
Tamsulosin is an alpha-1 adrenergic blocker that relaxes smooth
, muscle in the bladder neck and prostate to improve urinary
flow. A primary adverse effect is first-dose orthostatic
hypotension, which significantly increases the risk of falls,
especially in older adults. Rising slowly allows the
cardiovascular system time to compensate for positional
changes. The medication is typically recommended to be taken
30 minutes after the same meal each day (often dinner or
bedtime) to minimize this risk, making option B incorrect.
Option C is incorrect because BPH medications must be taken
continuously to maintain symptom relief; abrupt cessation will
cause symptoms to return. Option D is incorrect because
tamsulosin may lower blood pressure, not increase it.
Learning Objective
• Identify the mechanism of action and common adverse
effects of alpha-1 blockers.
• Educate patients on fall prevention strategies related to
orthostatic hypotension.
• Emphasize the importance of medication adherence for
chronic symptom management.
Medication Safety Focus
Patient education / Fall prevention
Question 3
Genitourinary System Exam |
20 Original NGN Practice Questions with
Detailed Rationales
Question 1
Clinical Scenario
A 28-year-old client, G1P0, at 40 weeks of gestation is receiving
a continuous IV oxytocin infusion for labor induction. The fetal
heart rate is 110 beats/min with moderate variability. The nurse
notes that the client is having contractions every 1.5 minutes,
each lasting 90 seconds.
Question Stem
Which action should the nurse take first?
A. Apply oxygen at 10 L/min via a nonrebreather mask.
B. Increase the IV maintenance fluid rate to 250 mL/hr.
C. Stop the oxytocin infusion immediately.
D. Administer terbutaline 0.25 mg subcutaneously as
prescribed.
,Correct Answer
C. Stop the oxytocin infusion immediately.
Detailed Rationale
The client is experiencing uterine tachysystole, defined as more
than 5 contractions in a 10-minute period or contractions
lasting longer than 90 seconds. This compromises
uteroplacental perfusion and can lead to fetal hypoxia. The
priority nursing action is to remove the causative agent by
stopping the oxytocin infusion immediately. While applying
oxygen, increasing IV fluids, and administering terbutaline (a
tocolytic) are all appropriate, evidence-based interventions for
tachysystole with nonreassuring fetal heart rate patterns, they
are secondary to eliminating the source of the excessive
stimulation. Clinical reasoning dictates that the nurse must first
halt the offending agent before initiating supportive or rescue
measures. Once the infusion is stopped, the nurse should
reposition the client, administer oxygen, and notify the
healthcare provider.
Learning Objective
• Recognize the clinical signs of uterine tachysystole during
labor induction.
• Prioritize nursing interventions for tachysystole to restore
uteroplacental perfusion.
, • Differentiate between primary and secondary nursing
actions in obstetric emergencies.
Medication Safety Focus
Priority nursing action / Adverse effect management
Question 2
Clinical Scenario
A 68-year-old male client with a history of benign prostatic
hyperplasia (BPH) is being discharged with a new prescription
for tamsulosin 0.4 mg daily.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
A. "I should rise slowly from a sitting or lying position."
B. "I will take this medication in the morning with breakfast."
C. "I can stop taking this medication once my urinary stream
improves."
D. "I will report any instances of increased blood pressure to my
provider."
Correct Answer
A. "I should rise slowly from a sitting or lying position."
Detailed Rationale
Tamsulosin is an alpha-1 adrenergic blocker that relaxes smooth
, muscle in the bladder neck and prostate to improve urinary
flow. A primary adverse effect is first-dose orthostatic
hypotension, which significantly increases the risk of falls,
especially in older adults. Rising slowly allows the
cardiovascular system time to compensate for positional
changes. The medication is typically recommended to be taken
30 minutes after the same meal each day (often dinner or
bedtime) to minimize this risk, making option B incorrect.
Option C is incorrect because BPH medications must be taken
continuously to maintain symptom relief; abrupt cessation will
cause symptoms to return. Option D is incorrect because
tamsulosin may lower blood pressure, not increase it.
Learning Objective
• Identify the mechanism of action and common adverse
effects of alpha-1 blockers.
• Educate patients on fall prevention strategies related to
orthostatic hypotension.
• Emphasize the importance of medication adherence for
chronic symptom management.
Medication Safety Focus
Patient education / Fall prevention
Question 3
