Chapter 40: Drugs Affecting the Female Reproductive System
A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client? "Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." "It will take 10 to 12 weeks before the birth control pills will actually prevent pregnancy, so be vigilant with other contraceptives until then." "Some women get some pain in their chest or abdomen when they take oral contraceptives, but this will pass as your body gets used to them." "You need to carefully consider whether you might want to get pregnant later in your life."
An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10- to 12-week time span between the initiation of oral contraceptives use and the prevention of pregnancy.
The nurse is discussing estrogen therapy with a 52-year-old woman. What information will the nurse share with this client regarding estrogen's benefit to the cardiac system? "Estrogen therapy is only beneficial to the cardiac system if it is started before age 50." "Any dose of estrogen should not be used as a cardioprotective drug." "High-dose estrogen in women under the age of 60 will reverse the effects of aging in the heart." "Estrogen therapy has shown no benefit to the cardiac system."
Correct response: "Any dose of estrogen should not be used as a cardioprotective drug." Explanation: Though controversy exists regarding the increased risk of chronic heart disease and female cancers with the use of estrogen. Estrogen should not be used as a cardioprotective drug. Transdermal delivery systems are being explored to reduce the use of oral estradiol products and provide lower concentrations in the circulatory system.
A client has returned to the health care provider's office for follow up after receiving estrogen for symptoms of menopause. Which question should be included in the follow up? "Can you describe in detail the difference in how you are feeling today and the last visit?" "Do you think you are better than before?" "Tell me about your sexual interactions with your partner." "Do you feel that the medication is working?"
Correct response: "Can you describe in detail the difference in how you are feeling today and the last visit?" Explanation: A leading question should be asked to compare her original symptoms to the symptoms she is experiencing. The nurse would like the client to describe in detail. The nurse does not need to know about the sexual interactions. "Do you feel that the medication is working?" or "Do you think you are better than before?" are closed loop questions and do not provide insight about how the medication is working.
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." "Hot flashes and night sweats are prominent." "There is an increase in the gonadotropins." "The menstrual cycle becomes irregular."
Correct response: "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.
A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications? "Estrogen decreases the risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot." "If estrogen and progesterone are taken together, there are no increased health risks." "Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots." "Estrogen has not been proven to increase the risk of any significant medical conditions."
Correct response: "Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots." Explanation: The FDA has issued a black box warning that estrogens increase the risk for developing cancer of the uterus. The warning instructs people who take estrogens with or without progestins of the increased risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot.
On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which response by the nurse is most appropriate? "We'll have to check your bone density first, because if it's too low then it's not safe to start HRT." "HRT might be quite beneficial to you, and it carries the additional benefit of modest protection against breast cancer." "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" "Actually, most of the current research is suggesting that HRT may not be all that effective in treating the symptoms of menopause."
Correct response: "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" Explanation: Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis.
The health care provider has ordered a variety of laboratory assessments on a client who will need estrogen replacement. The follow labs are ordered: blood urea nitrogen (BUN), creatinine, and liver function tests (LFTs). What is the nurse's best statement explaining to a client the need to draw the labs? "I will get the prescriber to talk to you about the laboratory assessments ordered." "Medication adjustments are based on baseline laboratory values." "Additional labs will be ordered if these values indicate problems with your body." "The labs will identify your body's ability to filter and excrete medications."
Correct response: "The labs will identify your body's ability to filter and excrete medications." Explanation: Estrogens are used cautiously in a variety of disease processes, including liver impairment. The liver filter or metabolizes medications. The kidneys are the main organ that excretes medications. The nurse is providing a rationale to the client about drawing laboratory assessments. Medication adjustments are based on baseline laboratory values, but this does not explain why labs are needed currently. The health care provider or the nurse can discuss the laboratory assessments when they are completed. Additional labs may be ordered on a future date but teaching is focused on the need for labs currently.
A patient who has come to the emergency department after being raped is given a dose of emergency contraception at 12 AM. The nurse would instruct the patient to take another dose of the drug at which time? 6 AM 4 AM 12 PM 10 AM
Correct response: 12 PM With emergency contraception, the first dose is started within 72 hours after unprotected intercourse; then, a follow-up dose of the same dosage must be taken 12 hours after the first dose.
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? 36 hours 24 hours 48 hours 12 hours
Correct response: 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.
How long after the administration of intranasal oxytocin (Pitocin) to facilitate the letdown of milk should the nurse advise the patient to breastfeed or pump? 15 to 30 minutes 10 to 15 minutes 5 to 10 minutes 2 to 3 minutes
Correct response: 2 to 3 minutes Explanation: The nurse should advise the patient to breastfeed or pump 2 to 3 minutes after the intranasal administration of oxytocin (Pitocin).
A client diagnosed with erectile dysfunction has been advised to take sildenafil. For up to how many hours does the action of the drug persist? 4 hours 12 hours 24 hours 8 hours
Correct response: 4 hours Explanation: The action of sildenafil persists for 4 hours. The duration of the drug is from 30 minutes to 4 hours before sexual activity. Medical attention should be sought for erections sustained for more than 4 hours. The action of the drug does not persist for 8, 12, or 24 hours.
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? Asthma Adrenal disease Active pelvic inflammatory disease Hypertension
Correct response: 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.
The nurse is teaching a patient who is taking raloxifene about possible adverse effects. Which of the following would the nurse be least likely to include? Amenorrhea Hot flashes GI upset Edema
Correct response: Amenorrhea Explanation: Vaginal bleeding is associated with raloxifene. Hot flashes are associated with raloxifene. Edema is associated with raloxifene. GI upset is associated with raloxifene.
Which classification of medication is used to treat overactive bladder syndrome? Antispasmodics Antiepileptics Antigens Antidiuretics
Correct response: Antispasmodics Explanation: Antispasmodics are cholinergic blocking drugs that inhibit bladder contractions and delay the urge to void in overactive bladder syndrome. Antigens are inflammatory agents that produce a mediated response by a foreign substance. Antiepileptics are used for seizures. Antidiuretics are used to slow down urine production in the kidneys.
The nurse is completing a history on a client who is new to the women's clinic. What information is most important for the nurse to obtain if the client is to be prescribed estrogens? (Select all that apply.) If the client's grandfather had lung cancer Family history of a brain attack If the client had any multifetal pregnancies When was the client's last menstrual period Any symptoms of cardiovascular disease
Correct response: Any symptoms of cardiovascular disease Family history of a brain attack When was the client's last menstrual period Explanation: Prior to the use of estrogen therapy, the nurse must know if the client has any symptoms of cardiovascular disease such as heart attack or thrombophlebitis because estrogen use is contraindicated in these conditions. It is also contraindicated in pregnancy and is used with caution in a client who has a family history of stroke.
After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.) Pulse Blood glucose Blood pressure Respiratory rate Temperature
Correct response: Blood pressure Pulse Respiratory rate Explanation: After an injection of oxytocin (Pitocin), during ongoing assessment the nurse monitors the client's blood pressure, pulse, and respiratory rate.
The nurse's ongoing assessment of outpatient clients receiving estrogen, progestin, or combination products should include what assessments? (Select all that apply.) Therapeutic effects Temperature Pulse Respiratory rate Blood pressure
Correct response: Blood pressure Respiratory rate Pluse Therapeutic effects Explanation: The nurse's ongoing assessment of outpatient clients receiving estrogen, progestin, or combination products should include blood pressure, pulse, respiratory rate, weight, and questioning about adverse effects and therapeutic effects.
The nurse is caring for a client who has cancer and who until recently took estrogen. The nurse knows that estrogen may have increased the risk of development of which types of cancer? (Select all that apply.) Brain cancer Melanoma Lung cancer Breast cancer Endometrial cancer
Correct response: Breast cancer Endometrial cancer Explanation: Estrogen use has been associated with the development of breast and endometrial cancer.
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.) Administer oxytocin intranasally. Encourage the client to force fluids. Measure the client's output hourly. Increase the client's maintenance IV. Discontinue the oxytocin infusion.
Correct response: 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.
The client informs the nurse that she had unprotected intercourse last night. The client is considering requesting emergency postcoital contraception. The nurse's best response is: Emergency contraception is not effective if started later than 12 hours after exposure. Emergency contraception is most effective if started within 24 hours and no later than 72 hours after exposure. Emergency contraception is most effective if started within 8 hours and no later than 24 hours after exposure. Emergency contraception is most effective if started 72 hours after exposure.
Correct response: Emergency contraception is most effective if started within 24 hours and no later than 72 hours after exposure. Explanation: Plan B (levonorgestrel) is the only emergency contraceptive on the market used to avoid pregnancy after unprotected sexual intercourse. It should be used only as a backup method and is not for routine birth control. Emergency contraception is most effective if started within 24 hours and no later than 72 hours after exposure. The drug is believed to act mainly by inhibiting ovulation; the drug may also have an effect on fertilization and implantation.
What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen? Cardiac valve dysfunction Diabetes mellitus Parkinson disease Endometrial cancer
Correct response: Endometrial cancer 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 patient is prescribed estradiol in a vaginal ring form. The nurse would instruct the patient to insert a new vaginal ring at which frequency? Monthly Weekly Daily Every 3 months
Correct response: Every 3 months Explanation: The vaginal ring formulation of estradiol is applied once every 3 months.
Which would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a client taking estrogen? Headaches Amenorrhea Cholestatic jaundice Breast tenderness
Correct response: Headaches Explanation: Pain in the groin, headaches, dizziness, & chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone.
A patient is using an oral contraceptive combination that includes drospirenone. The nurse would assess the patient for: Hyperkalemia Abdominal pain Headache Irritation
Correct response: 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.
A patient is using an oral contraceptive combination that includes drospirenone. The nurse would assess the patient for: Irritation Headache Abdominal pain Hyperkalemia
Correct response: 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.
A patient is receiving oxytocin intravenously. The nurse would expect this drug to begin acting within which time frame? 5 to 8 minutes 3 to 5 minutes Immediately 8 to 11 minutes
Correct response: Immediately Explanation: Oxytocin IV has an immediate onset of action
A male patient is receiving therapy to stimulate spermatogenesis. Which agent would most likely be used? Menotropins Follitropin beta Ganirelix Chorionic gonadotropin
Correct response: Menotropins Explanation: Menotropins are used to stimulate spermatogenesis in men. Chorionic gonadotropin is used to stimulate ovulation in women. Ganirelix is used to inhibit premature LH surges in women receiving ovarian hyperstimulation for infertility. Follitropin beta is used to stimulate follicular development.
The nurse is assessing a client who states that she has been taking a lot of black cohosh to deal with her menopausal symptoms. What assessment findings would indicate that the client is experiencing black cohosh toxicity? (Select all that apply.) Impaired vision Diaphoresis Edema Headache Nausea
Correct response: Nausea Impaired vision Headache Explanation: Symptoms of black cohosh toxicity include dizziness, headache, nausea, impaired vision, and vomiting. Edema and diaphoresis would not indicate black cohosh toxicity.
A postmenopausal woman is receiving raloxifene as part of a treatment plan for osteoporosis. The nurse would instruct the patient that this drug is administered by which route? Transdermal Intravaginal Oral Intramuscular
Correct response: Oral Raloxifene is administered only by the oral route.
A client is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route? Intravaginal Intravenous Subcutaneous Oral
Correct response: Oral Explanation: Conjugated estrogens are administered orally.
Estropipate is sometimes administered to postmenopausal women to prevent which condition? Uterine cancer Osteoporosis Endometriosis Dysfunctional uterine bleeding
Correct response: Osteoporosis Explanation: Estropipate and other estrogens are sometimes prescribed to postmenopausal women to prevent or treat osteoporosis associated with hormone deficiency. However, given the potentially significant risks associated with hormone replacement therapy, this use is not currently considered a first-line treatment.
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? Weight gain Pain in one leg Breast tenderness Abnormal menstrual bleeding
Correct response: 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.
Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes which information? (Select all that apply.) Previous obstetric problems Parity Type of labor Abortions Stillbirths
Correct response: Parity Stillbirths Abortions Previous obstetric problems Type of labor Explanation: Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, and live-birth infant abnormalities.
When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins? Epilepsy Migraine headaches Asthma Pelvic inflammatory disease
Correct response: 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 patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately? Abdominal bloating Dizziness Shortness of breath Weight gain
Correct response: Shortness of breath Explanation: Estrogens are associated with the development of thrombi and emboli. Reports of shortness of breath may indicate a possible pulmonary embolism necessitating emergency treatment. Abdominal bloating, weight gain, and dizziness are common adverse effects of estrogen therapy that should be reported, but it is not necessary to report them immediately.
A 63-year-old client taking estrogen and progestin for several years has recently been changed to estrogen alone. What medical event would prompt such a change in treatment? weight gain development of hypertension persistent nausea hysterectomy
Correct response: hysterectomy Explanation: Women who have an intact uterus should take both estrogen and progestin; the progestin component prevents endometrial cancer, an adverse effect of estrogen-only therapy. Posthysterectomy, clients should take estrogen-only medications. None of the other options would require a treatment change.
When caring for a postpartum patient who is receiving oxytocin intranasally, the nurse understands what is the action of oxytocin? Controls antepartum bleeding Anti-stimulating properties on the uterus Stimulates the milk ejection reflex Has a diuretic effect
Correct response: 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 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. HRT was found to cause mood disturbances in many of the women who used it long term. HRT was found to be a significant risk factor for bone fractures and osteoporosis. The risks of chronic obstructive pulmonary disease were found to be significantly higher in women taking HRT.
Correct response: 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.
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 client's blood pressure is 109/68. The client's pulse is 90. The fetal heart rate is between 136 and 159. The uterine contractions are occurring every 90 seconds.
Correct response: 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.
When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis? Chloasma Gastrointestinal upset Edema of the feet Thromboembolism
Correct response: Thromboembolism Explanation: The nursing diagnosis of impaired tissue perfusion is related to thromboembolism, which is a complication of estrogen replacement therapy. A nurse may note other female-hormone-related adverse reactions such as edema of the feet due to excess fluid volume, or gastrointestinal upset, which manifests as nausea, vomiting, abdominal cramps and bloating. Chloasma is a dermatologic reaction due to female hormones, which results in excessive pigmentation of the skin.
When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis? Thromboembolism Edema of the feet Gastrointestinal upset Chloasma
Correct response: Thromboembolism Explanation: The nursing diagnosis of impaired tissue perfusion is related to thromboembolism, which is a complication of estrogen replacement therapy. A nurse may note other female-hormone-related adverse reactions such as edema of the feet due to excess fluid volume, or gastrointestinal upset, which manifests as nausea, vomiting, abdominal cramps and bloating. Chloasma is a dermatologic reaction due to female hormones, which results in excessive pigmentation of the skin.
Medroxyprogesterone acetate is indicated for the treatment of women with what disorder? Ovarian cancer Uterine bleeding Fibromyalgia Cervical cancer
Correct response: 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 menopausal client, prescribed estrogen and progesterone, asks why she should take two different medications. Which explanation best addresses the client's question? Taking both medications together will make her periods lighter and of shorter duration. When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer. The client needs both estrogen and progesterone to stop menopausal hot flashes. The client should speak with her health care provider concerning the need for both prescriptions.
Correct response: When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer. Explanation: During menopause, estrogens are prescribed to relieve symptoms of estrogen deficiency and to prevent or treat osteoporosis. When estrogen is prescribed for women with an intact uterus, a progestin is also given to prevent unwanted thickening of the lining of the uterus and to decrease the risk of cancer of the uterus, a possible result of using estrogen alone. Both drug therapies are commonly referred to as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT). None of the other options accurately describe the reason for the prescription of both medications
A client has been diagnosed with benign prostatic hypertrophy. Which group of medications are used to treat this disorder? cholinergic agents beta adrenergic blockers alpha adrenergic blockers calcium channel blockers
Correct response: 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 63-year-old client taking estrogen and progestin for several years has recently been changed to estrogen alone. What medical event would prompt such a change in treatment? hysterectomy development of hypertension persistent nausea weight gain
Correct response: hysterectomy Explanation: Women who have an intact uterus should take both estrogen and progestin; the progestin component prevents endometrial cancer, an adverse effect of estrogen-only therapy. Posthysterectomy, clients should take estrogen-only medications. None of the other options would require a treatment change.
The nurse is discussing proper use of oral contraceptives with a client. The nurse should instruct the client to immediately contact a health care provider if she: experiences nausea. misses a dose of the medication. experiences breast tenderness. misses a menstrual period.
Correct response: misses a menstrual period. Explanation: If a client taking oral contraceptives misses a menstrual period, she should contact a health care provider to be evaluated for pregnancy. Continuing to take the medication while pregnant can cause fetal damage. Breast tenderness and nausea are common adverse effects of the hormones in the contraceptives, but they are unlikely to cause harm. If the client misses a dose of an oral contraceptive, she should take the next dose as soon as possible; it may be appropriate to take two doses in the same day if this occurs.
A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would likely identify this as which condition? stress incontinence neurogenic bladder overactive bladder syndrome urge incontinence
Correct response: overactive bladder syndrome Explanation: Overactive bladder syndrome involves conditions of urgency, frequency, and nocturia, with or without incontinence. Stress incontinence involves losing urine without meaning to during physical activity. Urge incontinence involves the strong, sudden need to void due to bladder spasms or contractions. Neurogenic bladder refers to impaired bladder function caused by a nervous system abnormality.
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? corpus luteum adrenal gland posterior pituitary gland uterus
Correct response: 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 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 St. John's wort ginger tea tree
Correct response: 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 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. knowledge of sexual health. risk factors for adverse effects. current health status.
Correct response: 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.
A 31-year-old pregnant woman has been prescribed administration of a tocolytic drug. During which period is a tocolytic drug usually administered? Pre-term labor Antepartum Second stage of labor Postpartum
Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of pre-term labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. In the postpartum period and during the second stage of normal labor, the tocolytics are not of any importance.
When caring for a postpartum patient who is receiving oxytocin intranasally, the nurse understands what is the action of oxytocin? Has a diuretic effect Stimulates the milk ejection reflex Anti-stimulating properties on the uterus Controls antepartum bleeding
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 female client tells the nurse that she has been experiencing a strong and sudden desire to urinate and often cannot make it to the bathroom. The client also tells the nurse that she has to urinate all day and "many times" at night. The nurse suspects: vaginal prolapse. enlarged prostate. overactive bladder. cystitis.
Symptoms of an overactive bladder include urinary urgency or a strong and sudden desire to urinate, frequent urination throughout the day and night, and urge incontinence. Cystitis is an infection. Enlarged prostrate would occur in a male client. A vaginal prolapse would occur in a female client but does not affect the ability to urinate.
A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication? Reduction of breast tissue Nausea Weight loss Cessation of bleeding and/or spotting
Taking combination oral contraceptives is commonly accompanied by nausea. The nurse should tell the client to anticipate this adverse effect. Breakthrough bleeding or spotting is likely with the medication. The nurse would be incorrect to inform the client that bleeding with cease completely. More commonly, clients taking oral contraceptives experience mild to moderate weight gain, not loss. Breast swelling and tenderness is common with this medication, not a reduction in breast tissue.
A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's best statement? "It decreases the desire to have sexual relations." "It stimulates the bladder to increase the urge to urinate." "It prevents the conversion of testosterone into the androgen DHT." "It works by relaxing the smooth muscle of the prostate and the bladder neck."
Terazosin is an alpha adrenergic blocker and works by relaxing the smooth muscle of the prostate and the bladder neck. By blocking norepinephrine, the muscles relax, and this allows urine to flow to the bladder. Terazosin does not prevent the conversion of testosterone or stimulates the bladder to void. Terazosin does not affect the desire for sexual relations.
Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect? polydipsia water intoxication dehydration hypotension
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 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 Beginning an exercise regime Beginning taking a loop diuretic to aid weight loss Beginning daily aspirin therapy
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.
