Chapter 40: Drugs Affecting the Female Reproductive System

A nurse is taking care of a woman receiving an abortifacient. The nurse is aware that the most serious adverse effect is:

vaginal bleeding. Explanation: All of the options are adverse effects of abortifacients. However, the most serious adverse effect would be vaginal bleeding, which could indicate a perforated uterus or uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken by the nurse.

The contractions of a client who is receiving tocolytic therapy stop at 4 pm. The nurse would expect to continue to administer the drug infusion for at least which time frame?

12 hours Explanation: After contractions cease, the drug dosage is tapered to the lowest effective dose by decreasing the drug infusion rate at regular intervals prescribed by the primary health care provider. The infusion continues for at least 12 hours after uterine contractions cease. The time frames of greater than 12 hours are excessive and inappropriate.

After teaching a group of students about abortifacients, the instructor determines that the teaching was successful when students identify which condition as a contraindication to their use?

Active pelvic inflammatory disease Explanation: Active PID is a contraindication to the use of abortifacients because the infection could be exacerbated by the drug. Abortifacients are used cautiously in patients with asthma. Abortifacients are used cautiously in patients with hypertension. Abortifacients are used cautiously in patients with adrenal disease.

A nurse administers methylergonovine (Methergine) to a client immediately after delivery of a normal, healthy baby boy. The nurse will advise her that she may experience which common adverse effect of the drug?

An increase in blood pressure Explanation: Methylergonovine is given orally three or four times a day beginning immediately postpartum for a maximum of 1 week. Hypertension, sometimes with seizures or headache, is the most common adverse effect. Tingling of the extremities and numbness are signs of acute overdose. Diarrhea is not associated with the use of the drug.

The nurse is aware that estrogen is used without progestin for hormone replacement therapy in what circumstance?

If the client has had her uterus removed Explanation: Estrogen may be used alone if the woman has had her uterus removed. The use of estrogen without progesterone in women who have an intact uterus can increase the risk of endometrial cancer. Estrogen therapy is contraindicated in clients who have had thrombophlebitis or breast cancer.

After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.)

Blood pressure Pulse Respiratory rate Correct response: Incorrect response: Your selection: Explanation: After an injection of oxytocin (Pitocin), during ongoing assessment the nurse monitors the client's blood pressure, pulse, and respiratory rate.

Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect?

water intoxication Explanation: Water intoxication is an adverse effect caused by all uterine stimulants because of their antidiuretic effect. Dehydration occurs when the body does not have enough fluid to sustain homeostasis. Hypotension can result in pregnancy with uterine rupture and loss of circulating blood volume. Polydipsia is seen in diabetes as well as pregnancy-induced diabetes.

A group of nursing students are reviewing information about oxytocin for labor induction. The students demonstrate understanding of this drug, identifying which as the maximum dose for induction?

10 units/min Explanation: When used for labor induction, the dose is individualized but does not exceed 10 units/min. More than 10 units/min can lead to uterine rupture. Oxytocin can be given at 10 units/min as prescribed by the health care provider and adjusted to enhance labor contractions.

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the health care provider?

Pain in one leg Explanation: Pain in one leg could indicate a thrombus formation. Common side effects of progesterone are abnormal menstrual bleeding, including spotting; breast tenderness; and weight gain.

Pitocin is given to prevent what condition?

Postpartum bleeding Explanation: After delivery, Pitocin is the drug of choice for prevention or control of postpartum uterine bleeding. The drug reduces uterine bleeding by contracting uterine muscle. It also plays a role in letdown of breast milk to the nipples during lactation.

The nurse is caring for a patient who is beginning hormone replacement therapy. Which goal is appropriate to include in the patient's plan of care?

The patient will take drugs accurately and for the length of time prescribed. Explanation: Goals for patients for patients to achieve while receiving hormone therapy include taking drugs accurately and for the prescribed length of time. Educating the patient and assisting in securing follow-up care are nursing interventions.

A client asks the nurse about a word they heard from the health care provider. The word was "andropause". The client asks what that is. Which is the nurse's best response?

"A gradual change, related to age, that occurs in the testes." Explanation: Andropause occurs in men and the changes occur gradually. Aging changes in the male reproductive system occur primarily in the testes. Like the ovary, testicular tissue diminishes; what is different between the sexes is that the male sex hormone levels of testosterone remain relatively constant. Andropause is not a medication but a condition that occurs in the body.

A client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time?

3 months Explanation: Medroxyprogesterone, a synthetic progestin used in the treatment of abnormal uterine bleeding and secondary amenorrhea, is also used as a contraceptive. This drug is given IM every 3 months. Longer than this time frame the medication is not effective for contraception.

When explaining the potentially harmful effects of anabolic steroid abuse, the nurse should stress which related fact?

Abuse of anabolic steroids can result in addiction. Explanation: Anabolic steroid abuse is associated with a wide variety of harmful effects, including addiction. The drugs increase muscle strength and size. Health care professionals do not facilitate the use of anabolic steroids for performance-enhancing purposes.

A client taking hormonal contraceptives will soon turn 35 years of age. She is moderately obese and has smoked for 15 years. Which action should the nurse encourage the client to take to best minimize risk for complications associated with contraception use?

Beginning smoking cessation Explanation: Women older than 35 years of age who smoke cigarettes are at greater risk for thromboembolic disorders. The client should be instructed on smoking cessation. The client should not begin an exercise regime unless prescribed by her health care provider. The client should not begin daily aspirin therapy unless prescribed by her health care provider. The client should not begin daily aspirin or diuretic therapy unless prescribed by her health care provider.

The nurse is discussing the use of Depo-Provera with a 17-year-old female who desires birth control. The nurse recognizes that this medication is used in this client for what reason?

Birth control for 3 months Explanation: Depo-Provera is often used in teenagers because it is given by injection and provides effective birth control for 3 months from the first injection.

A patient is receiving treatment for infertility and is receiving a drug that stimulates ovulation. Which drug would this most likely be?

Chorionic gonadotropin Explanation: Chorionic gonadotropin is used to stimulate ovulation. Cetrorelix inhibits premature LH surges in women undergoing controlled ovarian stimulation. Follitropin alfa is injected to stimulate follicular development. Follitropin beta is used to stimulate follicular development.

What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen?

Endometrial cancer Explanation: Warnings associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, and thromboembolic disease, and hypercalcemia in those with breast cancer and bone metastases.

A 16-year-old is prescribed estrogen therapy for hypogonadism. During therapy, what will the nurse monitor the client closely for?

Normal sexual development and growth Explanation: When a prepubescent girl is given estrogen to treat lack of the same hormone, the nurse should monitor for growth throughout therapy to prevent premature closing of the epiphyses and also evaluate for normal sexual development with therapy. Other complications and disorders are mostly to be found in postmenopausal women who are given estrogen.

A patient is using an oral contraceptive combination that includes drospirenone. The nurse would assess the patient for:

Hyperkalemia Explanation: Drospirenone used in combination contraceptives has antimineralocorticoid activity and can block aldosterone, leading to increased potassium levels. Irritation is associated with transdermal or vaginal use. Headache is associated with vaginal gel use. Abdominal pain may be due to intrauterine system administration.

When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process?

Interviewing the patient and observing for therapeutic and adverse effects Explanation: The evaluation should include interviewing the patient and observing for therapeutic and adverse drug effects. Although the other options describe important teaching guidelines for patients on estrogen or progestin therapy, they are not part of the evaluation process.

After teaching a group of students about the use of estrogens, the instructor determines that additional teaching is needed when the students identify which as a contraindication?

Metabolic bone disease Explanation: Estrogens should be used cautiously in patients with metabolic bone disease because of the bone conserving effects of estrogen, which could exacerbate the disease. Thromboembolic disorders contraindicate the use of estrogen. Idiopathic vaginal bleeding is a contraindication for the use of estrogens. Breast cancer is a contraindication for the use of estrogens.

A client is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route?

Oral Explanation: Conjugated estrogens are administered orally.

A postmenopausal woman is administered estradiol for the purpose of preventing which condition?

Osteoporosis Explanation: Conjugated estrogens are used to prevent osteoporosis in postmenopausal women. Conjugated estrogens are not administered in postmenopausal women to treat endometriosis, amenorrhea, or uterine cancer.

A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?

The risks of stroke and breast cancer are unacceptably high in women taking HRT. Explanation: Studies have demonstrated no evidence for HRT in secondary prevention of heart disease and showed increased rates of CHD, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer, which outweigh the benefits of decreased risk of fracture and colon cancer. Mood disturbances and COPD were not significant factors.

A 7 months' pregnant woman is experiencing contractions. She is admitted to the hospital in preterm labor. What will be prescribed to stop the labor?

Tocolytics Explanation: Tocolytics are uterine relaxants that are used to stop labor contractions that occur before the completion of the 37th week of gestation. Oxytocics are uterine stimulants used to initiate or augment a contractile pattern of labor. On the other hand, prostaglandins prepare the uterus for labor and delivery by ripening the cervix. Finally, estrogen may have a role in the creation of additional oxytocin receptors.

When considering serious adverse effects, oral contraceptive use would most likely be contraindicated in which client?

a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day Explanation: Oral contraception contains estrogen as an active ingredient. The most serious adverse effect of estrogen use is the increased risk of thromboembolic conditions. Thromboembolic disorders are most likely to occur in women older than 35 years of age who take oral contraceptives and smoke cigarettes, postmenopausal women taking long-term estrogen and progestin therapy, and men or women who receive large doses of estrogens for cancer treatment. None of the other clients have unusually high risks for thromboembolic conditions.

A client is prescribed methylergonovine. The nurse reviews the client's medical record for possible contraindications to the use of this drug. Which, if found, would the nurse identify as being a contraindication to the prescribed drug?

hypertension Explanation: The use of methylergonovine is contraindicated in clients with hypertension. Terbutaline should not be used in women with heart disease, hyperthyroid, or poorly controlled diabetes. Clients with asthma can have exacerbations of the asthma if taking aspirin, NSAIDs, beta blockers, and ACE inhibitors. Treatment with bile acid-binding resins in hypercholesterolemic clients is contraindicated in the presence of hypertriglyceridemia.

A nurse is explaining the drug oxytocin to a client. When describing this drug, the nurse notes that oxytocin is an endogenous hormone produced by which?

posterior pituitary gland Explanation: Oxytocin is an endogenous hormone produced by the posterior pituitary gland. The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. The uterus is part of the female reproductive system where the fetus grows until term; it does not produce hormones, but oxytocin stimulates the smooth muscle to contract. The corpus luteum is a temporary endocrine structure in female ovaries that is involved in the production of relatively high levels of progesterone, moderate levels of estradiol and inhibin A.

A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the client's request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the client's:

vigilant adherence to the drug regimen. Explanation: It is necessary to assess each client's need and desire for contraception, as well as her willingness to comply with the prescribed regimen. Compliance is essential for effective contraception. Health status, knowledge, and risk factors are all valid focuses for health education, but these do not primarily determine success of therapy.

Which are true in regards to oxytocin? (Select all that apply.)

Oxytocin has uterine-stimulating properties. Oxytocin has vasopressor effects. Oxytocin stimulates milk ejection. Explanation: Oxytocin is a hormone secreted by the posterior pituitary gland that has uterine-stimulating properties, antidiuretic effects, vasopressor effects, and stimulates milk ejection.

A client with an extensive history of using herbal remedies asks the nurse if there is an herbal supplement for the diagnosis of BPH. Which supplement does the nurse provide information on for the treatment of BPH?

saw palmetto Explanation: Saw palmetto is used to relieve the symptoms of BPH, which include urinary frequency, decreased flow of urine, and nocturia. Tea tree is used for a variety of ailments and also has antioxidant properties. Ginger is used for nausea. St. John's wort is used for depression.

A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include:

uterine tachysystole. Explanation: Adverse effects of oxytocin are dose related and take two forms—maternal and fetal. The most common maternal adverse effects are nausea, vomiting, uterine tachysystole, and cardiac arrhythmias. Less common but potentially fatal are severe water intoxication and hyponatremia.

Which statements indicate that a client understands the need for a follow-up after the initial injection of medroxyprogesterone?

"I know that this injection lasts for 3 months." Explanation: Long-acting progestin contraceptive preparations such as the intramuscular depot medroxyprogesterone last 3 months per injection; intrauterine progesterone lasts 1 year; and levonorgestrel subcutaneous implants last 5 years.

A client has been diagnosed with benign prostatic hypertrophy. Which group of medications are used to treat this disorder?

alpha adrenergic blockers Explanation: The most widely used drugs to treat BPH are the alpha adrenergic blockers. Beta blockers are used for cardiac disorders. Calcium channel blockers are used in hypertension. Cholinergic agents are used in a variety of disorders but not BPH.

A nurse is caring for a 25-year-old clinic client who is starting on birth control pills. What statement by the client indicates that she needs further teaching?

"I will exercise more if I experience chest or leg pain." Explanation: Chest or leg pain may be indicative of a thrombus, and medical care should be sought immediately. The other options are correct statements but do not address the question asked.

A client alerts the nurse that they have been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective?

"Estrogen and progesterone diminish." Explanation: During menopause, estrogen and progesterone diminish causing the menstrual cycle to become more irregular and then stops altogether. Symptoms of the decrease in estrogen and progesterone are hot flashes, night sweats, vaginal dryness, and sleep problems. There is not an increase of gonadotropins during menopause.

Which client who is taking progesterone would a nurse monitor most carefully for potential adverse effects?

A 32-year-old woman with epilepsy Explanation: Progesterone therapy may result in fluid retention. Clients with pathologies that may be adversely affected by fluid retention, such as epilepsy, migraines, asthma, cardiac dysfunction, and renal dysfunction, need to be given progesterone with extra caution. Clients with hypotension, those who are HIV-positive, and clients who have hepatitis would not require as careful monitoring directly related to progesterone therapy as the client with epilepsy.

Oral contraceptive use would be contraindicated for which client?

A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day Explanation: Because of their widespread effects on body tissues and reported adverse reactions, estrogens, progestins, and hormonal contraceptives are contraindicated in thrombotic disorders, known or suspected cancers of breast or genital tissues, undiagnosed vaginal or uterine bleeding, fibroid tumors of the uterus, family history of breast or reproductive system cancers, active liver disease or impaired liver function, history of cerebrovascular disease, coronary artery disease, hypertension, or conditions predisposing to these disease processes and women older than 35 years of age who smoke cigarettes.

The nurse is preparing to give a 25-year-old female client an injection of carboprost. What would be most important for the nurse to do?

Assess for contraindications or cautions. Explanation: Abortifacients should not be used with any known allergy to abortifacients or prostaglandins to avoid hypersensitivity reactions, after 20 weeks from the last menstrual period which would be too late into the pregnancy for an abortion, or with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Assessing vital signs would be important and so would drawing up the medication and injecting within 5 minutes, but they are not the most important nursing actions. It would be inappropriate to try to talk the mother out of taking the drug.

A couple comes to the fertility clinic to get information about treatment for their infertility. What would be included in the information this couple receives regarding adverse effects?

Birth defects Explanation: A major adverse effect of fertility drugs is multiple births and birth defects. Adverse effects of fertility medications do not include peripheral edema, cardiovascular events, or renal failure.

The nurse's ongoing assessment of outpatient clients receiving estrogen, progestin, or combination products should include what assessments? (Select all that apply.)

Blood pressure Pulse Respiratory rate Therapeutic effects

A 34-year-old woman has presented to the clinic for the first time, and the nurse learns that she has been taking medroxyprogesterone for the past 13 years. This aspect of the woman's medical history should prompt what assessment?

Bone density testing Explanation: There is a black box warning regarding the use of medroxyprogesterone that relates to its being associated with the loss of stored calcium from bones, which increases the risk of broken bones and osteoporosis, especially after menopause. There is a greater risk of bone loss with long-term use. Consequently, bone density testing may be warranted. There is no particular indication for this client to undergo stress testing, renal ultrasound, or triglyceride testing.

The nurse is scheduled to administer an oral contraceptive to a client admitted with type 2 diabetes. What is the priority teaching that would be provided regarding this medication?

Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg. Explanation: The priority for teaching in the situation is that the major adverse effect of taking oral contraceptives is the possibility for developing venous thromboembolism, a life-threatening emergency that must be reported to the primary care provider (PCP) right away. The nurse must teach the client on the signs and symptoms of a deep venous thrombosis: leg pain, redness, and edema. The client could also develop a pulmonary embolus with sudden dyspnea, and chest pain. The other teaching points are not as high of a priority because they consist of how to take the medication to decrease the possible side effect of nausea, which usually decreases with taking the medication for a few months. Also, it is important to take the medication the same time of day to help remember to take it. Instructions about what to do if a dose is skipped is important to prevent pregnancy by instructing the client to use another form of contraception until the first week of the next cycle of the oral contraceptive. It is important for a client to report an elevated blood glucose level, so the PCP may consider what may be the cause for the increase and decide if an increase in the oral antidiabetic medications is necessary.

A group of students are reviewing the various fertility drugs that are available. The students demonstrate understanding when they identify which drug as being administered orally?

Clomiphene Explanation: Clomiphene is administered orally. Cetrorelix, follitropin alfa, and ganirelix are administered parenterally.

What nursing interventions are most important if the nurse has concerns that the client is developing fluid overload while receiving oxytocin? (Select all that apply.)

Discontinue the oxytocin infusion. Measure the client's output hourly. Explanation: If the nurse observes any signs of fluid overload, the nurse should discontinue the oxytocin infusion but let the primary IV line run at the rate ordered until the health care provider examines the client. The nurse should continue to monitor the client's input and output frequently. The client's oral fluids should be limited because this can contribute to water intoxication. The client should not receive any more oxytocin until the health care provider gives the approval. Intranasal oxytocin is only used to assist in milk letdown with breast feeding.

A nurse is preparing to teach a client about the estrogen therapy that has been prescribed. The nurse will point out which adverse reaction(s) to the client that will need to be reported to the health care provider? Select all that apply.

Migraines Changes in libido Breast tenderness Explanation: Adverse reactions associated with estrogens include headache, including migraines; breakthrough bleeding (not decreased), spotting, or changes in menstrual flow; changes in libido; weight gain or loss; breast pain, enlargement, and tenderness; and nausea and vomiting but not constipation

The nurse is teaching a patient about etonogestrel, which the patient is receiving as a subdermal implant. The nurse informs the patient that the implant will need to be removed at which time?

In 3 years Explanation: Etonogestrel subdermal implant may be left in place for up to 3 years and then it must be removed. Another implant could be placed at that time.

A client is prescribed tamoxifen for vaginal atrophy and menopausal symptoms. The client asks the nurse how this drug works. What is the nurse's best response?

It blocks estrogen effects in different tissues in the body. Explanation: Tamoxifen is a selective estrogen receptor modulator drug. SERMS potentiate or block estrogen effects in different tissues and aid in hormonal treatment of postmenopausal symptoms. Tamoxifen is used to treat breast cancer, not ovarian cancer. Tamoxifen can be used for osteoporosis prevention but this is not indicated in the client's history. Tamoxifen does not activate estrogen receptors in the breasts.

A 22-year-old woman is in the clinic to end an early pregnancy. She takes three tablets of mifepristone (Mifeprex). Two days after she takes the medication, she returns to the clinic to see if she is still pregnant or if the medical abortion is complete. It is determined that she is still pregnant. The nurse will administer which drug?

Misoprostol Explanation: After taking mifepristone, if the medical abortion is not complete in 3 days, the patient will take two tablets of misoprostol. Misoprostol is a synthetic prostaglandin E1 analogue. Although it is used to prevent gastric ulcers resulting from the use of nonsteroidal anti-inflammatory drugs, it is also known to have abortifacient properties, by producing uterine contractions. Alendronate, raloxifene, and etidronate are drugs given for osteoporosis.

The nurse is caring for a 23-year-old female client who is on estrogen therapy. What intervention would be appropriate in a care plan for this client?

Monitor liver function periodically. Explanation: Appropriate interventions for clients taking estrogen therapy include to monitor liver function periodically for the client on long-term therapy, to evaluate liver function and ensure discontinuation of drug at any sign of hepatic dysfunction. The nurse should help post-menopausal women plan for adequate calcium and vitamin D in the diet and adequate weight-bearing exercise to maintain bone strength and prevent osteoporosis; assist clients in obtaining follow-up health care when indicated; and provide client teaching for drug therapy. The client should not combine medications unless ordered. The client in the scenario is not old enough to be concerned about calcium and vitamin D in the diet connected with osteoporosis. The nurse would provide client teaching for anything to prevent osteomyelitis because nothing in the scenario says the client has osteomyelitis.

A 32-year-old pregnant woman has been prescribed an IV infusion of oxytocin to induce labor. Which intervention should the nurse implement before starting the IV infusion of oxytocin for the patient?

Obtain an obstetric and general health history. Explanation: Before starting an IV infusion of oxytocin to induce labor, the nurse should obtain a complete obstetric history (e.g., parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live-birth infant abnormalities) and a general health history. Patient should not have water before labor, as the oxytocin may lead to water intoxication. The nurse should examine for any signs of water intoxication or fluid overload as a sign of an adverse reaction to the drug and need not assess this before administration of the medication. Placing the patient in an upright position is advised when oxytocin is administered intranasally to facilitate the letdown of milk for breastfeeding.

When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins?

Pelvic inflammatory disease Explanation: Progestins are contraindicated in patients with pelvic inflammatory disease because progestins affect the vasculature of the uterus. Cautious use is necessary for women with migraine headaches, asthma, and epilepsy due to possible exacerbation of these conditions with the use of progestins.

A client has been prescribed a transdermal patch of estrogen. Which adverse effect should be included in the teaching plan about the medication?

Redness at the application site Explanation: Redness and irritation at the application site is an adverse reaction with the transdermal system. The client is receiving a transdermal patch, not an injection. Irritation of the oral pharynx would occur with an oral medication. Edema and rhinitis of the nose can occur with nasal medications or rhinitis.

When caring for a postpartum patient who is receiving oxytocin intranasally, the nurse understands what is the action of oxytocin?

Stimulates the milk ejection reflex Explanation: Oxytocin, when administered intranasally, stimulates the milk ejection (milk letdown) reflex. Oxytocin has uterine-stimulating properties, not antistimulating properties, on the uterus. Tocolytics have an antistimulating effect on the uterus. Oxytocin has an antidiuretic effect, which might lead to a danger of excessive fluid volume (water intoxication), and not a diuretic effect. Oxytocin is given IM during the third stage of labor to produce uterine contractions and control postpartum, and not antepartum bleeding and hemorrhage.

A patient is to receive lutropin alfa. The nurse would expect to administer this agent by which route?

Subcutaneous Explanation: Lutropin alfa is a fertility drug that is administered subcutaneously with follitropin alfa.

While monitoring a woman who is receiving IV oxytocin for induction of labor, what event would cause the nurse to contact the health care provider immediately?

The uterine contractions are occurring every 90 seconds. Explanation: The health care provider should be notified immediately if there is a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions that last more than 60 seconds; and contractions occurring more frequently than every 2-3 minutes. The client's blood pressure and pulse are within normal limits and the fetal heart rate is within normal limits.

Which statement should the nurse share with a client to best describe the rationale for using a 28-day oral contraceptive pack?

This will assist clients to comply with their medication regimen, making it less likely to forget taking their pill every day. Explanation: Dispensers with 28 tablets contain 7 inactive or placebo tablets of a third color. Several combination products and alternative dosage forms are available to help individualize treatment and promote adherence. None of the other options present accurate statements regarding oral contraception packs.

Medroxyprogesterone acetate is indicated for the treatment of women with what disorder?

Uterine bleeding Explanation: Health care providers use progestins to suppress ovarian function in dysmenorrhea, endometriosis, endometrial cancer, and uterine bleeding. Progestins are not normally used to treat cervical cancer, ovarian cancer, and fibromyalgia.

A client is receiving estrogen therapy. The nurse would assess the client for which as an adverse reaction? Select all that apply.

abdominal bloating breakthrough bleeding breast pain Explanation: Abdominal bloating, breakthrough bleeding, and breast pain are adverse reactions associated with estrogens. Mental depression and insomnia are associated with progestins.

When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment?

blood pressure Explanation: Oral contraceptives can result in increased blood pressure. Regular monitoring is consequently indicated. It is not normally necessary to assess skin integrity or respiration. These drugs have adverse effects influencing the cardiovascular system, but such effects are unlikely to result in alterations in rate and rhythm.

A nurse is caring for a client who is receiving magnesium. The nurse would be alert for which finding?

depressed reflexes Explanation: Magnesium affects the neuromuscular system, so the nurse would assess mentation, cranial nerve function, and deep tendon reflexes. Depressed reflexes would be a cause for concern. Vasoconstriction can occur when methylergonovine is administered to a client who is a heavy smoker. The calcium channel blocker (nifedipine) and the beta2-adrenergic drug (terbutaline) are used to delay the delivery process for 24 to 48 hours. Sweating, hypotension, depressed reflexes, and flaccid paralysis are other adverse reactions associated with IV administration.

The nurse monitors a patient receiving oxytocin for water intoxication based on the understanding that this condition is the result of:

release of antidiuretic hormone. Explanation: Oxytocin can cause severe water intoxication, which is thought to occur because of related effects of antidiuretic hormone, which may be released in response to oxytocin activity. Oxytocin does stimulate neuroreceptor sites but this is not the reason for the development of water intoxication. Ergonovine and methylergonovine can produce ergotism. Blockage of estrogen receptor sites occurs with estrogen receptor modulators.