Final Exam: Women's Health Drugs

Progestins may be used to treat which conditions? (Select all that apply.) A. Endometrial hyperplasia B. Dysfunctional uterine bleeding C. Endometriosis D. Breast cancer E. Amenorrhea

Correct answeR: A B C E Progestins are used for contraception (see Chapter 62) and to counteract endometrial hyperplasia that could be caused by unopposed estrogen during HT. Other uses include dysfunctional uterine bleeding, amenorrhea, endometriosis, and support of pregnancy in women with corpus luteum deficiency. Progestins are contraindicated in carcinoma of the breast.

A patient tells the nurse, "I use a foam contraceptive by applying it 2 hours before having sex, and I have not gotten pregnant." What is the nurse's best response? A. "Foam contraceptives should be applied no more than 1 hour before intercourse." B. "You have chosen the most effective over-the-counter contraceptive." C. "The active ingredients in foam contraceptives also kill potentially harmful bacteria." D. Combine the foam with a contraceptive jelly to make it even more effective."

Correct answer: A Foams are a type of spermicide and kill sperm by destroying the cell membrane; they are only moderately effective. Foams are immediately effective, but they should not be used more than 1 hour before coitus. Women who use foam contraceptives should not douche for at least 6 hours after intercourse. Foams do not eradicate harmful bacteria and are more effective when combined with a diaphragm or condom, not contraceptive jelly.

The nurse is aware that which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins? A. Monophasic B. Biphasic C. Triphasic D. Quadriphasic

Correct answer: A In a monophasic regimen, the daily doses of estrogen and progestin remain constant throughout the cycle of use. In the other regimens, either the estrogen, the progestin, or both change as the cycle progresses. The biphasic, triphasic, and quadriphasic schedules reflect efforts to more closely simulate ovarian production of estrogens and progestins.

A nurse obtains a health history from a patient who is scheduled to take a combination OC. Which factor in the patient's history should the nurse recognize as a contraindication to this treatment? A. Breast cancer B. Colon polyps C. Tuberculosis D. Endometriosis

Correct answer: A OCs do not have a known risk of cancer—except for promoting breast cancer growth. OCs do not increase the risk for breast cancer for most women. For women who have the BRCA1 gene mutation, they promote the growth of existing breast cancer and should be avoided. OCs are not contraindicated with a history of colon polyps, tuberculosis, or endometriosis.

Which patient may be given progestin therapy during pregnancy? A. A woman who is 8 weeks pregnant and diagnosed with corpus luteum deficiency syndrome B. A woman pregnant with triplets during her first pregnancy C. A woman experiencing severe nausea and vomiting during pregnancy D. A woman who is trying to achieve pregnancy through planned intercourse

Correct answer: A Progestins are used to support an early pregnancy in women with corpus luteum deficiency syndrome and in women undergoing in vitro fertilization (IVF). Progestin therapy is also used for prematurity prevention. One progestin—hydroxyprogesterone acetate [Makena]—is approved for preventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. It is not used for nausea or for pregnancy achievement through planned intercourse.

A patient who takes an angiotensin-converting enzyme (ACE) medication is scheduled to begin taking the Yaz oral contraceptive (OC). Which laboratory results should the nurse monitor during the first cycle of use? A. Potassium level B. Sodium level C. Glucose level D. Creatinine level

Correct answer: A Yaz OC combines ethinyl estradiol and a compound called drospirenone, which has antialdosterone actions. Drospirenone is an analog of spironolactone, a potassium-sparing diuretic. For women who take medications such as ACE inhibitors that can elevate the serum potassium level, these levels should be monitored during the first cycle of Yaz. It is not necessary to monitor levels of sodium, glucose, or creatinine when taking Yaz.

The nurse is teaching a patient about depot medroxyprogesterone acetate [Depo-Provera] injection. The nurse explains that this medication prevents pregnancy by which actions? (Select all that apply.) A. Preventing follicular maturation Correct B. Thickening the cervical mucus Correct C. Destroying the sperm cell membrane D. Causing a thinning of the endometrium E. Blocking the sperm from the cervix

Correct answer: A B D Depot medroxyprogesterone acetate (DMPA), injected IM or subQ, protects against pregnancy for 3 months or longer by inhibiting secretion of gonadotropins. The drug thereby inhibits follicular maturation and ovulation, thickens the cervical mucus, and causes thinning of the endometrium, making implantation unlikely. Spermicidal medications destroy the sperm cell membrane. Barriers block the sperm from the cervix.

The Women's Health Initiative (WHI) landmark trial data led to which recommendations about hormone replacement therapy? (Select all that apply.) A. There are benefits to using HRT short term to reduce vasomotor symptoms. B. Postmenopausal women should avoid smoking, exercise regularly, and control hypertension. C. Estrogen/progestin therapy (EPT) is preferred as the primary treatment to prevent loss of bone mass. D. Estrogen and progesterone should be used only to prevent cardiovascular events. E. Treatment with HRT for longer than 5 years increases the risk for pulmonary embolus and stroke.

Correct answer: A B E The WHI trial has yielded the most current, statistically valid data on the benefits and risks of HRT. The use of HRT short term to reduce vasomotor symptoms generally outweighs the risks if the dose is kept low for the shortest time needed. HRT should not be used to prevent cardiovascular disease; postmenopausal women should avoid smoking, perform regular exercise, and manage hypertension and diabetes with medications as needed. There are preferred alternative therapies to HRT to preserve bone mass. The major risks of HRT taken for longer than 5 years are myocardial infarction, dementia, stroke, deep vein thrombosis, and breast cancer.

Which beneficial metabolic effects does estrogen have in nonreproductive tissues? (Select all that apply.) A. It promotes and suppresses coagulation. B. It improves glomerular filtration rates. C. It reduces low-density lipoproteins (LDLs). D. It suppresses bone resorption. E. It reduces fat deposits in the liver.

Correct answer: A C D Estrogens have a positive effect on bone mass, blocking bone resorption. It also has favorable effects on cholesterol levels in that LDL levels are reduced, and the levels of high-density lipoprotein (HDL) are elevated. Estrogens promote coagulation by increasing factors II, VII, and others; they also suppress coagulation, increasing the activity of factors that promote the breakdown of fibrin. Estrogens do not improve the glomerular filtration rate or reduce fatty deposits in the liver.

A nurse is teaching a postmenopausal patient taking estrogen/progestin therapy (EPT) about breast self-examination (BSE). Which of these instructions should the nurse give? A. "There are no risks for breast cancer, so BSE is not necessary." B. "Do your breast self-examination the first day of each month." C. "Examine your breasts by looking at them in the mirror." D. "Feel each breast while lying on the opposite side."

Correct answer: B All women should perform regular breast self-examinations, preferably 1 week after the menstrual cycle ends. It is especially important for postmenopausal women taking a progestin combined with an estrogen, because this treatment is associated with an increased risk of breast cancer. Recent data suggest that estrogen alone does not increase the risk of breast cancer. For postmenopausal women without monthly cycles, the breasts should be examined once a month on the same day; the first day of the month is suggested.

Which therapeutic effect is the purpose of a progestin medication in menopausal hormone therapy (HT)? A. To reduce urogenital atrophy B. To suppress endometrial proliferation C. To relieve vasomotor symptoms D. To prevent adverse cardiac events

Correct answer: B Progestin is prescribed in HT to provide a counterbalance to estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer. However, it is omitted in women who do not have a uterus. Progestins appear to increase the risk of adverse cardiac events. Estrogens relieve the vasomotor symptoms of menopause and prevent urogenital atrophy (manifesting as vaginal dryness and itching).

The nurse is providing teaching regarding Duavee (conjugated estrogens/bazedoxifene). Which statement by the patient indicates that the teaching was effective? A. "I know I am at an additional risk for increased growth of my uterus lining." B. "I understand that the combination product should help protect me from the side effects of the estrogen." Correct C. "I will have to set an alarm to take my medication four times per day." D. "I am prepared to take this medication for the rest of my life."

Correct answer: C Duavee is the first drug to combine estrogen with an estrogen agonist/antagonist (bazedoxifene). The bazedoxifene component of Duavee reduces the risk of excessive growth of the lining of the uterus that can occur with the estrogen component. The dose is one tablet orally twice daily for the prevention of vasomotor symptoms and osteoporosis in postmenopausal women with a uterus. Contraindications to taking Duavee are the same as for other estrogen-containing products, and as with other products, this drug should be used for the shortest duration possible.

During the follicular phase of the menstrual cycle, estrogen has which effects on the female reproductive organs? A. Maturation of a corpus luteum B. Ripening of an ovarian follicle C. Proliferation of the endometrium D. Monthly menstrual bleeding

Correct answer: C During the first half of the menstrual cycle, called the follicular phase, estrogen released from maturing ovarian follicles causes the endometrial lining to proliferate. Follicle-stimulating hormone (FSH) acts on the developing ovarian follicles, causing them to ripen and release estrogens in the first half of the cycle. Luteinizing hormone (LH) levels rise at midcycle, causing rupture of the follicle, which evolves into a corpus luteum. At the end of the cycle, without fertilization, the corpus luteum atrophies, leading to menstrual bleeding as the endometrial lining is shed.

The nurse is aware that the primary use for misoprostol [Cytotec] is what? A. Regulation of menstrual cycle B. Prevention of pregnancy C. Induction of abortion D. Sterilization

Correct answer: C Misoprostol [Cytotec] is a prostaglandin used for induction of abortion, cervical ripening, and induction of labor. It is not used to regulate the menstrual cycle, to prevent pregnancy, or for sterilization.

Which factor should a nurse recognize as one that would increase the risk of thromboembolic phenomena arising from OC use? A. Alcohol consumption B. Asthma C. Smoking D. Noncompliance

Correct answer: C OCs are absolutely contraindicated in smokers older than age 35 because of the risk of thromboembolic phenomena. Additional risk factors include hypertension, cerebrovascular disease, coronary artery disease, myocardial infarction, and surgery in which postoperative thrombosis might be suspected. Asthma and noncompliance do not increase the risk of thromboembolic events.

A nurse should recognize which adverse effect in a patient taking a progestin-only OC? A. Back pain B. Thick, sticky cervical mucus C. Irregular vaginal bleeding D. Elevated blood pressure

Correct answer: C Progestin-only OCs contain no estrogen and are more likely to cause irregular vaginal or breakthrough bleeding. Thrombotic events from combination OCs are due to both the progestin and the estrogen, not just the estrogen, as previously believed. Progestin-only OCs prevent pregnancy by causing the production of a thick, sticky cervical mucus. Blood pressure is not affected by progestin-only OCs, as it is by estrogen.

What is the primary difference between the selective estrogen receptor modulators tamoxifen and raloxifene? A. Raloxifene does not protect against breast cancer. B. Raloxifene does not produce hot flashes. C. Raloxifene does not increase the risk for uterine cancer. D. Raloxifene does not increase the risk for thromboembolism.

Correct answer: C Raloxifene is very similar to tamoxifen. The principal difference is that raloxifene does not activate estrogen receptors in the endometrium and hence does not pose a risk of uterine cancer. Like tamoxifen, raloxifene protects against breast cancer and osteoporosis, promotes thromboembolism, and induces hot flushes. Raloxifene is approved only for prevention and treatment of osteoporosis, and for prevention of breast cancer in high-risk women.

Which statement is true about the NuvaRing? A. It is implanted in the arm by a healthcare provider. B. It is a progestin-only device. C. It prevents pregnancy by acting as a barrier. D. It is removed for 1 week each month.

Correct answer: D NuvaRing is a hormonal contraceptive device designed for vaginal insertion. Like combination OCs, the ring contains an estrogen/progestin combination that prevents pregnancy largely by suppressing ovulation. Insertion is done by the user. One ring is inserted once each month, left in place for 3 weeks, and then removed; a new ring is inserted 1 week later. During the ring-free week, withdrawal bleeding occurs.

A patient takes fluoxetine [Prozac] for premenstrual disorder (PMD). Which priority assessment allows the nurse to evaluate the effectiveness of this treatment? A. Decreased craving for carbohydrates B. Reduction in breast tenderness C. Less abdominal bloating D. Reports of mood improvement

Correct answer: D Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are considered first-line therapy for the psychologic symptoms of PMD. They are most effective for reducing the affective symptoms (mood improvement) of PMD; however, they also can reduce physical symptoms, such as breast tenderness, bloating, and headaches.

Which statement is true about the Ortho Evra transdermal contraceptive patch? A. It is applied in the vaginal area. B. It is a progestin-only device. C. It prevents pregnancy by acting as a barrier. D. It is removed for 1 week each month.

Correct answer: D The Ortho Evra transdermal contraceptive patch has the same mechanism as combination OCs. Application of the patch, which is 1.75 inches square (about the size of a matchbook), is done once a week for 3 weeks, followed by 1 week off (to permit normal menstruation). Patches are applied to the lower abdomen, buttocks, upper outer arm, or upper torso (front or back)—but not to the breasts, or skin that is red, cut, or irritated.