Ch. 52- Women's Health (mine)

The nurse is teaching students about applying a transdermal estradiol patch. Which statement made by a student suggests effective learning? "Rotate the patch every 2 weeks." "Rotate the patch at the same time each day." "Apply the patch to the breast area for better absorption." "Apply the patch to the lower abdomen for better absorption."

"Apply the patch to the lower abdomen for better absorption." If the estradiol transdermal patch is given, it is to be applied as ordered, which is usually one patch applied once or twice weekly to the lower abdomen and not to the breast and chest areas. The patch is not rotated unless prescribed by the primary health care provider and is changed once or twice each week, not daily or bi-weekly. p. 784

Which statement indicates that the patient understands the benefit of continuous administration of progestin with an estrogen regimen? "The progestin in the regimen will help prevent ovarian cancer." "Endometrial cancer risk can be reduced by adding progestin." "The progestin in the regimen will help prevent breast cancer." "Vaginal cancer is prevented by adding progestin to the regimen."

"Endometrial cancer risk can be reduced by adding progestin."

Which statement indicates that the patient understands the benefit of continuous administration of progestin with an estrogen regimen? This regimen prevents ovarian cancer." "This regimen will prevent breast cancer." "Vaginal cancer is prevented with this regimen." "Endometrial cancer risk can be reduced with this regimen."

"Endometrial cancer risk can be reduced with this regimen." Endometrial cancer risk is decreased with this regimen. Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia. It does not prevent ovarian, vaginal or breast cancer from occurring. p. 765

A teenage patient is asking the nurse to explain how birth control pills work. What is the nurse's best response? "Estrogen in the pills keeps you from ovulating." "Just take the pills, or you'll get pregnant." "The pills keep you from having a period." "The pills kill sperm."

"Estrogen in the pills keeps you from ovulating."

Which statement should the nurse use to instruct a patient about the use of NuvaRing transvaginal contraception? Use a new NuvaRing every week." "Place the NuvaRing over the cervix." "Remove the NuvaRing during intercourse." "Reinsert the NuvaRing within 3 hours if it slips out."

"Reinsert the NuvaRing within 3 hours if it slips out." The nurse should instruct a patient to reinsert the vaginal ring within 3 hours if it slips out. Failure to do so would increase the risk for pregnancy. A patient should use the same vaginal ring for 3 weeks, and then use a new ring after the withdrawal of menses. Because the absorption of steroid hormones occurs because of the close proximity of the ring to vaginal mucosa, the vaginal ring should not be placed over the cervix, but placed into the middle or upper third of the vagina. The vaginal ring remains in place during intercourse.

Which statement should the nurse use to instruct a patient about the use of the Ortho-Evra transdermal patch? "Use one patch for 3 weeks." "Place the patch near the breasts." "Rotate the placement site of the patch." "Report the occurrence of withdrawal bleeding."

"Rotate the placement site of the patch." The nurse should instruct a patient to rotate the placement site of the Ortho-Evra transdermal patch to avoid skin irritation. The patch should be changed weekly for a period of 3 weeks, and then not worn for 1 week. The nurse should ask a patient to avoid placing the patch near the breasts, because the patch contains an estrogen component, which may increase the risk of breast cancer if the added supplementation of estrogen is in close proximity to the breasts. There is no need for a patient to report withdrawal bleeding, because it would be a normal finding.

A patient with menopausal symptoms is seeking hormonal replacement therapy. During the assessment, the nurse finds that the patient has a history of endometrial cancer. Which is the most important information for this patient? "The therapy may cause thromboembolic events." "You may need to stop smoking during the therapy." "The treatment is likely to cause endometrial cancer." "The treatment should be started as soon as possible."

"The treatment is likely to cause endometrial cancer." In patients with a history of endometrial cancer, estrogen therapy raises the possibility of recurrence of cancer. Hence, the nurse informs the patient about it so that she is aware of the risks associated with the therapy. The treatment is not started as soon as possible, but may be prevented. The progesterone therapy causes thromboembolic events as an adverse effect in some patients. The nurse may advise the patient to stop smoking if she starts the therapy.

A patient taking the oral contraceptive Ortho Tri-Cyclen has developed an infection and is prescribed tetracycline. What information is essential for the nurse to teach the patient? "Stop the Ortho Tri-Cyclen while on this medication." "Do not drink grapefruit juice while on these medications." "Take these two medications with milk to prevent stomach upset." "Use an additional form of contraception while on these medications."

"Use an additional form of contraception while on these medications." Antibiotics interact with oral contraceptives and decrease their effectiveness. An additional form of contraception is needed while taking tetracycline. p. 769

What are the routes for administering combined hormone contraception (CHC) products? Select all that apply. 1 Oral 2 Transvaginal 3 Transdermal 4 Intramuscular 5 Subcutaneous

1, 2, 3 Combined hormone contraception (CHC) products are available for administration via oral, transvaginal, and transdermal routes. The oral route requires daily intake, whereas CHC products are absorbed by the gastrointestinal tract and metabolized by the liver. The transvaginal route involves the use of a vaginal ring, which releases ethinyl estradiol (EE) and etonogestrel internally. The transdermal route involves the use of the Ortho-Evra patch, which delivers ethinyl estradiol (EE) and norelgestromin through a transdermal system. There are no CHC products currently available to be administered via the intramuscular or subcutaneous route.

A postpartum woman who is breastfeeding says she wants to go on birth control. The physician decides a progestin-only pill is the best choice. What will the nurse include in the patient teaching? Select all that apply. 1 There are no placebos in the pack. 2 There is a three-hour window for dosing. 3 The patient should stop breastfeeding. 4 The patient may experience increased libido. 5 Increased irregular bleeding is possible.

1, 2, 5 Progestin-only pills have no placebos in the pack; the patient takes the same dose continuously. There is a three-hour window for dosing, and if the dose is missed, a back-up method of birth control should be used for 48 hours due to a lack of estrogen. Bleeding may become increased or irregular. The progestin-only pill is the only pill used in breastfeeding women. Libido is decreased with progestin-only pills.

Which are mechanisms of action of the progestin-only oral contraceptive pill (minipill)? Select all that apply 1 Alteration of the cervical mucus 2 Absence of withdrawal bleeding 3 Interference with the endometrial lining 4 Prevention of a luteinizing hormone (LH) surge 5 Increased fallopian tube peristalsis

1, 3, 4 The minipill alters the cervical mucus to a thick and viscous consistency to block sperm penetration. It also changes the endometrial lining to interfere with implantation of the ovum. In addition, the minipill prevents the surge in LH in approximately 50% of cycles, thereby inhibiting ovulation so that pregnancy does not occur. The minipill causes decreased, not increased, peristalsis in the fallopian tubes, impairing transport of the ovum. Continuous daily use of the minipill leads to an absence in withdrawal bleeding, but this is a dosing effect, not a contraceptive mechanism of action.

The nurse is assessing a 38-year-old patient who uses a combined hormone contraception (CHC) product. The nurse finds that the patient is a frequent smoker. Which assessment parameter is of highest priority in this case? Medical history Occupational detail Blood pressure readings Use of dietary supplements

Blood pressure readings Smoking increases the risk for hypertension in patients who are over 35 years old and who take CHC products; therefore, the nurse should assess the patient's blood pressure in this case. Smoking also increases the risk of endothelial damage, which is a precursor to developing deep vein thrombosis. Assessing the patient's use of dietary supplements or medical history is not a priority in this case, because it is more important to understand the immediate risks to the patient. Assessing the patient's occupational details will help to understand stress factors, which are secondary in this case. pg. 770-771

A perimenopausal woman is experiencing vaginal dryness and hot flashes, especially at night. She asks her physician for help in treating these symptoms. What regimen does the nurse expect will be prescribed? Conjugated equine estrogens with synthetic progestin Progestin-only therapy Ethinyl estradiol Clonidine

Conjugated equine estrogens with synthetic progestin The most commonly prescribed regimen for menopausal symptoms are conjugated equines estrogens with a certain level of synthetic progestin added. Progestin-only therapy is not effective, as it is primarily the estrogen that is depleted in a menopausal woman. Ethinyl estradiol is not as frequently prescribed as the equine-sourced version. Clonidine can be used for the vasomotor symptoms, but it is not a first-line therapy.

Which treatment for dysfunctional uterine bleeding (DUB) is always used in combination with other drugs? Estrogen Progestin Nonsteroidal antiinflammatory drugs (NSAIDs) Gonadotropin-releasing hormone (GnRH) agonists

Estrogen Estrogen is never used alone to treat DUB because the risk of endometrial cancer rises dramatically. Progestin is often used alone, especially in low-dose birth control pills. NSAIDs treat the pain associated with cramping that accompanies DUB but do not treat the underlying cause of the bleeding. GnRH agonists may be used specifically to treat endometriosis, not DUB. p. 776

A female patient with strep throat is taking amoxicillin with clavulanate (Augmentin) to treat the infection. Because the patient also takes an oral contraceptive (OC), the nurse will instruct the patient to use a different method of birth control for how long? During the entire period the patient is taking the antibiotic For at least 1 month during and after starting the antibiotic Until three throat cultures have been negative for the pathogen For at least 6 weeks, starting at the end of the antibiotic regimen

For at least 1 month during and after starting the antibiotic Because antibiotics, especially penicillin and cephalosporins, can impair the action of OCs, the nurse instructs the patient to use another method of birth control for at least 1 month during and after starting the antibiotic. The effect of OCs is reduced when antibiotic therapy is started. Hence, using birth control at the end of the antibiotic regimen is not effective. If three throat cultures are negative for the pathogen, it indicates a need to stop the antibiotic therapy, not to resume the use of birth control. pp. 763, 769

The nurse administers medroxyprogesterone (Provera) to a patient who has diabetes. Which test reports will the nurse need to evaluate to prevent any complications in the patient? Select all that apply. Glucose Urinalysis Liver function Cognitive function Complete blood count

Glucose Liver function Medroxyprogesterone may cause liver dysfunction, which can manifest as jaundice in patients. Hence, it is necessary to evaluate the liver function test. The drug may also decrease glucose tolerance in diabetic patients, so the nurse needs to assess the patient's glucose levels so that the antidiabetic drug dosage can be adjusted. Urinalysis and complete blood count are important only if there is any indication of infection. Cognitive function is assessed in women who undergo combination estrogen-progestin therapy because there is an increased risk of developing dementia.

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? Male condom Spermicidal agent Intrauterine device Cervical diaphragm

Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease because they provide the most barrier protection. A spermicidal agent kills sperm. An intrauterine device is placed in the uterus. A cervical diaphragm is not as effective as condoms.

Which medication is suitable therapy for oral contraception in women who cannot take estrogen? Megestrol (Megace) Estropipate (Ortho-Est) Estrone (Estrone Aqueous) Medroxyprogesterone (Provera)

Medroxyprogesterone (Provera) Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers. Estropipate and Estrone are synthetic estrogens. p. 776

Which drug has abortificient properties and is avoided in pregnant women? Sulindac (Clinoril) Misoprostol (Cytotec) Indomethacin (Indocin) Diclofenac sodium (Voltaren)

Misoprostol (Cytotec) Misoprostol is a synthetic prostaglandin E1 analogue and has abortificient properties. It is prescribed with nonsteroidal antiinflammatory drugs to prevent gastrointestinal ulcers. Sulindac, indomethacin, and diclofenac sodium are nonsteroidal antiinflammatory drugs. These are acetic acid derivatives and do not have abortifacient properties.

A patient taking clomiphene citrate to increase ovulation becomes pregnant. What potential side effect might she experience? Gestational diabetes Breast tenderness Multiple gestation Subsequent infertility

Multiple gestation Clomiphene citrate causes an increase in ovulation, which then increases the chances that the woman will have more than one fertilized egg, resulting in a multiple gestation/birth. Gestational diabetes is not known to be an adverse effect of this drug. Breast tenderness is more likely to occur because of pregnancy than the drug. The use of clomiphene is not associated with subsequent infertility. p. 779

What is an adverse effect associated with estrogen therapy? Nausea Dry skin Weight loss Higher-pitched voice

Nausea The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma, not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy.

A 70-year-old patient is prescribed alendronate (Fosamax) for osteoporosis. The patient is unable to sit or stand upright for more than a few minutes. Which is the most important nursing action in this case? Obtain a prescription for a change of drug. Assess if the patient can swallow the medicine. Ask the patient to lie down after taking the drug. Administer a large quantity of fluids with the drug.

Obtain a prescription for a change of drug. Oral doses of alendronate (Fosamax) may get lodged in the esophagus and cause esophageal burns. In order to prevent this, the nurse gives the drug with a full glass of water and asks the patient to stand upright for 30 minutes. If the patient is not able to stand or sit upright, the nurse needs to inform the primary health care provider for a change of drug. Administering large quantities of fluids will not help the patient swallow the drug if the patient does not sit upright. The patient is asked to stand upright and not lie down after taking the drug. It is more important to assess if the patient can sit or stand after taking the drug, rather than assessing the patient's swallowing ability.

Which statement about progestin is accurate? Progestin is only used for contraception. All progesterones are synthetic. Progestin is a derivative of testosterone. There is only one type of progestin.

Progestin is a derivative of testosterone. Progestins are derivatives of testosterone. As such, it is used for contraception but also to balance out the effects of estrogen. Progesterones can be both natural or synthetic. There are eight different types of progestin used in oral contraceptives.

Which has the greatest potential to increase the risk of thromboembolic phenomena in a patient taking norethindrone and ethinyl estradiol (Loestrin)? Sedentary lifestyle Smoking heavily every day Consumption of saturated fats Increased body mass index (BMI)

Smoking Heavily Every Day Women taking oral contraceptives are at increased risk of thromboembolic events if they smoke heavily or have a history of thromboembolism; this higher risk is partially due to an increase in circulating levels of clotting factors. Consumption of saturated fats is likely to increase the risk of a thromboembolic event in a patient who takes an oral contraceptive, but not as much as smoking. Increased BMI and sedentary living elevate the risk of several health problems and can contribute to the development of thromboemboli, but that risk is secondary to the risk resulting from concurrent smoking and use of oral contraceptives.

In an assessment session, a patient tells the nurse that she became pregnant after using the contraceptive pills regularly. The nurse finds that the patient uses a Sunday start method for using contraception. Which other assessment finding could be a likely cause of the patient's pregnancy? The patient is older than 35. The patient smokes excessively. The patient usually takes the pills an hour late. The patient did not use a backup contraception method.

The patient did not use a backup contraception method. A backup method of contraception is needed when a patient uses a Sunday start method, which is when a patient begins taking a contraceptive on the Sunday after the first day of menstruation, because the patient can start the contraception later than the fifth day of the menstrual cycle. A second contraception method will ensure protection until the first method reaches its peak level of contraceptive effectiveness. Excessive smoking is likely to increase the risk for cardiovascular problems in a patient, but not pregnancy. Age does not affect the effectiveness of the contraception method. A patient should take the contraception daily within a three-hour window each day for effectiveness. pg.768

A patient who uses a vaginal ring tells the nurse, "My vaginal ring had dislodged, but I reinserted it within 6 hours. I also took a backup oral contraceptive pill for 2 days." What can the nurse conclude from this information? The patient is at a risk for pregnancy. The patient may develop an infection. The patient cannot use the vaginal ring. The patient will not have withdrawal menses.

The patient is at a risk for pregnancy. The vaginal ring should be reinserted within 3 hours, not 6; therefore, in this case, the patient would be at risk of pregnancy and should use a backup contraception for 7 days. Vaginal infection is a side effect of the vaginal ring and does not occur if the vaginal ring is dislodged. A patient uses a vaginal ring for three weeks and has withdrawal menses in the fourth week. If a patient can reinsert the vaginal ring after dislodgment, it indicates that the patient is able to use the vaginal ring effectively.

A postmenopausal patient is being treated with bisphosphonate medication for osteopenia. A few months later, the patient complains of severe pain in the upper thigh. Why is this cause for alarm? The patient may have rhabdomyolysis. The patient may have a femur fracture. The patient may have a deep vein thrombosis (DVT). The patient may have tendonitis.

The patient may have a femur fracture. A rare but serious complication of bisphosphonate therapy is the potential for femur fractures. Rhabdomyolysis is a breakdown of skeletal muscle and not a known side effect of bisphosphonate drugs. DVT is a known side effects of raloxifene, which is a selective estrogen receptor modulator, not a bisphosphonate. Tendonitis is not a known adverse reaction nor a cause for alarm.

A 57-year-old patient who has osteoporosis after menopause is prescribed 1500 mg of calcium per day and 2000 IU per day of vitamin D for 3 months. After these 3 months, the nurse finds little improvement in the patient's condition. Which assessment finding could be a cause of the patient's condition? The patient takes sedatives at bedtime. The patient performs low-impact aerobics. The patient smokes and consumes alcohol. The patient's intake of ascorbic acid (vitamin C) is low.

The patient smokes and consumes alcohol. Smoking interferes with the absorption of vitamin D and alcohol consumption interferes with the absorption of calcium; therefore, a patient's condition will not improve if the patient smokes and drinks alcohol while taking calcium and vitamin supplements. Low-impact aerobics help increase muscle mass and strengthen the bones. An increase or decrease in the intake of ascorbic acid (vitamin C) will not affect a patient who has osteoporosis after menopause, because this supplement does not help restore bone health in the patient. The use of sedatives will increase a patient's risk for falls, but will not interfere with calcium and vitamin D absorption.

A patient who is postmenopausal is taking estradiol (Estrasorb) for estrogen therapy. The nurse notes that the medical reports identify the patient as having an intact uterus. Which further assessment is a priority based on this information? The patient's x-ray reports The patient's calcium intake The use of a progestin tablet The use of vitamin supplements

The use of a progestin tablet A postmenopausal patient who has an intact uterus should have progestin therapy along with the estrogen therapy. Progestin helps to protect the uterine endometrium from hyperplasia. Assessing the patient's calcium intake or x-ray reports would be a priority if the patient had osteoporosis. The use of vitamin supplements is not a priority in this case, because it does not concern the patient's uterine status.

Which problem in a patient's history would contraindicate the administration of estrogen? Weight gain Hypertension Dysmenorrhea Thrombophlebitis

Thrombophlebitis Contraindications for estrogen administration include known drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or a history of such a disorder. It is not contraindicated in patients with hypertension, dysmenorrhea, or weight gain.

What is the purpose of giving estrogen therapy cyclically or with progestins? To treat breast cancer To treat ovarian cancer To prevent endometrial cancer To reduce the chances of vaginal cancer

To prevent endometrial cancer To reduce the risk of endometrial hyperplasia or cancer, the concurrent use of a progestin for 10 to 14 days of the cycle is recommended for women with an intact uterus. Estrogens are administered to prevent complications due to ovarian failure and not to treat ovarian cancer. Estrogen therapy raises recurrence risk if administered to patients with breast cancer. Vaginal cancer is treated with surgery or chemotherapy.

What information will the nurse include when teaching about cancer risks in postmenopausal women? Estrogen monotherapy increases the risk of breast cancer. Monotherapy with a progestin increases breast cancer risk. Unopposed estrogen increases the risk of endometrial cancer. Estradiol with progestin increases the risk of endometrial cancer.

Unopposed estrogen increases the risk of endometrial cancer. The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. Estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes.