Chapter 46

A 43-year-old patient is receiving medroxyprogesterone (Depo-Provera) for treatment of dysfunctional uterine bleeding. Because of related adverse effects, which of the following may indicate a potential adverse effect?

Joint pain or pain on ambulation

A woman has decided to stop taking contraceptives so that she can become pregnant. Which information would the nurse provide?

"It may take several months for your menstrual periods to become regular." "Your risk for miscarriage is no higher because you took contraceptives."

The client receives estrogen for prostate cancer. He asks the nurse why he is receiving a female hormone. What is the best response by the nurse?

"It suppresses secretion of the androgens that make your cancer grow."

A patient has been prescribed Seasonique for contraceptive. The nurse evaluates that the patient understands the use of this medication when which statement is made?

"After I have taken pills for 84 days, I will not take pills for 7 days."

A client has been prescribed NuvaRing. What medication education should the nurse provide to this client?

"Contraceptive protection is provided for 3 weeks." "The ring uses estrogen and progestin to provide contraception."

A woman has been prescribed flibanserin (Addyi) for the treatment of sexual desire disorder. The nurse would provide which information?

"Do not drink alcohol while taking the medication." "Your pharmacy must be part of a special program to dispense this medication."

The nurse teaches the postpartum client about oxytocin (Pitocin). The nurse evaluates that learning has occurred when the client makes which statement?

"It will increase my uterine contractions."

A nurse is teaching a patient about the possible adverse effects of oral contraceptives. The nurse evaluates that the patient understands this teaching if which statement is made?

"I may experience increased acne while on oral contraceptives." "If I experience chest pain, I will call the clinic immediately." "Any blurry vision or loss of vision should be reported immediately." "If I notice swelling in my feet, hands, or face, I will notify the clinic."

A female client has been unable to conceive a child for 5 years. She asks the nurse about medications to treat her infertility. What is the best response by the nurse?

"Medications will only help if your infertility is related to an endocrine problem."

A 75-year-old woman is taking medroxyprogesterone (Provera) for treatment of inoperable metastatic uterine carcinoma. The nurse would immediately collaborate with the prescriber if the patient's family made which statement?

"Mom seems much more depressed today." "Mom is more confused today."

The nurse teaches a class on pregnancy to clients in their first trimester. The nurse evaluates that learning has occurred when the clients make which statements?

"Ovulation is caused by a surge of luteinizing hormone." "Follicle-stimulating hormone causes ovarian follicles to develop."

A patient is interested in taking levonorgestrel and estradiol (Seasonique) and asks how it is taken. Which explanation by the nurse is correct?

"Seasonique is taken for 84 days and then followed by 7 days of a lower dose contained in the same package."

A client has been taking low-dose oral contraceptives. She calls the clinic and reports that she is mid-cycle and has noticed some slight spotting. What information should the nurse provide?

"Slight spotting may occur, especially with low-dose oral contraceptives." "Monitor the bleeding and contact us again if it becomes continuous or heavy."

The client is considered infertile. The physician orders clomiphene (Clomid). The nurse teaches the client about the medication and evaluates that learning has occurred when the client makes which statement?

"This medication stimulates LH (luteinizing hormone)."

A client has been prescribed an estrogen-progestin combination oral contraceptive. How should the nurse explain the mechanism of action of this pill?

"This pill will prevent you from ovulating." "This pill makes it less likely that an embryo will implant."

A college student calls the family planning clinic and states, "I had unprotected sex, and now I am afraid I will get pregnant." The nurse would provide which information about Plan B?

"You can purchase Plan B without a prescription." "You may take two separate doses of Plan B." "Plan B will prevent ovulation and implantation."

A client has been prescribed Premarin. What medication information should the nurse provide?

"You may notice a decrease in your libido while on this medication." "If you notice pain in your abdomen that goes through to your back, be certain to notify the clinic." "Do not become pregnant while on this drug."

A client calls the clinic and tells the nurse that she has missed taking several of her contraceptive pills during the current cycle. What is the best instruction for the nurse to give the client?

"You should use an alternative form of birth control for the rest of this cycle."

A client comes to the women's center and tells the nurse she has had unprotected sex. She asks for emergency contraception. What is the best assessment question for the nurse to ask?

. "How long ago did you have unprotected sex?"

Which of the following patients would have a higher risk for adverse effects from estradiol and norethindrone (Ortho-Novum)? (Select all that apply.)

18-year-old with a history of depression A 24-year-old who smokes one pack of cigarettes per day

An adolescent client will receive Depo-Provera as a method of birth control. She asks the nurse how long the drug will be effective. What is the best response by the nurse?

3 months

The client takes Ortho-Novum for 3 months and calls the clinic to report she is having vaginal bleeding. What is the best plan by the nurse at this time?

Ask the client if she is bleeding between cycles or if this is her regular period.

The nurse completes an assessment of a patient in labor who is receiving an intravenous infusion of oxytocin. Which of the following assessments indicates the need for prompt intervention?

Contractions are sustained for 2 minutes in duration.

The client is premenopausal and asks the nurse if she should be taking hormone replacement therapy (HRT). What will the best plan by the nurse include?

Discuss alternative methods of dealing with premenopausal symptoms.

The nurse manages care for several clients receiving hormone replacement therapy (HRT). What will the priority assessment by the nurse include as related to side effects?

Pain in the calf

The nurse educator is reviewing the process of regulation of the female reproductive system. The nurse would arrange these steps in which order beginning with the initial step?

Secretion of gonadotropin-releasing hormone (GnRH) Secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Ovarian follicles mature A surge of luteinizing hormone (LH) occurs The corpus luteum is formed

A client calls the clinic and tells the nurse she has nausea and breast tenderness and is afraid she might be pregnant. She is taking oral contraceptives and has taken them exactly as prescribed. What is the best response by the nurse?

Tell the client that these symptoms can be side effects of oral contraceptives.

The client plans to use an estrogen/progestin oral contraceptive for birth control. Which client behavior would the nurse be most concerned about?

The client smokes one-half pack of cigarettes per day.

A patient has started taking clomiphene (Clomid, Serophene) after an infertility workup and asks the nurse why she is not having in-vitro fertilization. Which of the following nursing statements would be most helpful in explaining the use of clomiphene to the patient?

The patient's diagnostic work-up suggested that infrequent ovulation may be the cause for her infertility and clomiphene increases ovulation.

The client is receiving oxytocin (Pitocin) for induction of labor. Which assessment finding will most likely result in the nurse stopping the infusion?

Uterine contractions are continuous and sustained.

Progestins are secreted by the

corpus luteum.

Progestins are primarily used in the treatment of

dysfunctional uterine bleeding.

Estrogens are secreted by the

ovarian follicles.

Oxytocics are different from tocolytics in that oxytocics

stimulate uterine contractions.

The nurse explains to a client who is taking oral contraceptives that these drugs can increase risk for

thrombophlebitis

A woman consults the nurse about Plan B (levonor gestrel) after unprotected intercourse that occurred 2 days earlier. Which of the following instructions will the nurse give to this patient?

"You will take one pill of Plan B at first, followed by another pill 12 hours later."