Pharm 154 Prep U Practice Quiz 1 & 2

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?"

A client has been given a prescription for sildenafil (Viagra) for treatment of erectile dysfunction. The nurse will instruct the client to take this medication at what time prior to the onset of sexual intercourse?

30 minutes

A client diagnosed with erectile dysfunction has been advised to take Viagra. For up to how many hours does the action of the drug persist?

4 hours

A client at the clinic reports amenorrhea and has participated in competitive bodybuilding for years. She tested positive for pregnancy. After obtaining a health history, the nurse finds the client has healthy eating habits, regular exercise, herbal supplement use, and alcohol avoidance. What client education should follow?

Anabolic steroid use is contraindicated in pregnancy.

Which classification of medication is used to treat overactive bladder syndrome?

Antidiuretics

A female client began an infusion of oxytocin 2 hours ago and the nurse has been conducting regular assessments on her as well as monitoring the fetal heart rate closely. The nurse should prioritize which potential nursing diagnosis in the organization of the client's immediate care?

Excess fluid volume

Dinoprostone can be used to terminate a pregnancy after 20 weeks.

False

A pregnant patient has been receiving an infusion of oxytocin for the past several hours. For the past 20 minutes, the patient's contractions have been lasting in excess of 2 to 3 minutes each and there is less than 1 minute between most contractions. As well, there have been significant decelerations in fetal heart rate. The nurse has recognized the clinical characteristics of tachysystole and informed the physician, seeking an order to discontinue the oxytocin. The physician, however, wants to persist with the oxytocin infusion because the patient is "making good progress". How should the nurse best respond?

Go up the hospital chain of command to obtain assistance

An 8-year-old boy is being administered testosterone injections for treatment of hypogonadism. What should be measured every 6 months?

Hand and wrist epiphyseal growth plates

Medroxyprogesterone is an effective form of birth control. Long-term use can cause what serious adverse effect?

Headaches

Pitocin is given to prevent what condition?

Postpartum bleeding

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

alpha adrenergic blockers

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:

misses a menstrual period.

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. 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.

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

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." 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.

Which statement indicates that the client understands the follow-up needed after an injection of Depo-Provera?

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

After teaching a client who is prescribed sildenafil about using the drug, the nurse determines that the teaching was successful when the client states:

"I need to take the pill about an hour before any sexual stimulation."

A male clent has been diagnosed with impotence and is started on a regimen of androgens. Which statement by the client indicates that he has understood the teaching?

"If my skin appears yellow or my urine turns dark, I will contact my health care provider."

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?

"It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" 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.

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." 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 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?

"The labs will identify your body's ability to filter and excrete medications." 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.

During client teaching, a young woman asks the nurse, "If I get pregnant on the 'pill' should I continue to take it?" What is the nurse's best response?

"The pill can be harmful to the female fetus."

A client calls the women's health clinic and tells the nurse that she went to the dentist for an abscessed tooth. The dentist put her on an antibiotic, and the client wants to know if it will cause problems with her prescribed oral contraceptives. What is the nurse's best response?

"Use alternate means of birth control until you are finished with the antibiotic."

A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him:

"You might find that your face becomes flushed or you get a headache after you take Viagra."

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?

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.

Conjugated estrogen therapy would be most appropriate for which one of these clients?

A 25-year-old female with primary ovarian failure

The nurse is aware that oral contraceptives are effective but associated with potential health risks that must be carefully considered. Which client has the highest risk of experiencing the adverse effects of oral contraceptive use?

A 38-year-old diabetic woman who smokes one-and-a-half packs of cigarettes daily.

Oral contraceptive use would be contraindicated by what in a client's medical history?

A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day Because of their widespread effects on body tissues and reported adverse reactions, estrogens, progestins, and hormonal contraceptives are contraindicated in thrombolic 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.

A 24-year-old female athlete is using high doses of anabolic steroids to enhance her performance. She may be at risk for which condition?

Acne

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

The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil?

Antidysrhythmics

A new client calls on the phone requesting a prescription for contraceptives, which she has been taking for 2 years. She has not been seen in more than a year and is unable to come into the clinic until next month. She insists she is doing fine on this medication and must have her prescription now. The nurse's best response would be:

Before the drugs are prescribed, a complete medical history, physical examination, pap test, urinalysis, and weight and blood pressure measurements are recommended. Because estrogens, progestins, and hormonal contraceptives are often taken for years and may cause adverse reactions, patients taking these drugs need continued supervision by a health care provider. Before the drugs are prescribed, a complete medical history is taken; a physical examination including breast and pelvic examinations and a Pap test; urinalysis; and weight and blood pressure measurements are recommended. These examinations should be repeated at least annually as long as the patient is taking the drugs.

A client has begun treatment for penile erectile dysfunction. What explanation should the nurse provide regarding the primary effect a prescribed phosphodiesterase type 5 inhibitor will have on this condition?

Blood flow to the penis will be improved

A young male patient, age 14, has been prescribed testosterone for delayed onset of puberty. Follow-up care includes a visit to the clinic at least every 6 months for ongoing assessment. It will be most important for the nurse to monitor:

Bone growth

Carter, age 13, is prescribed testosterone for delayed onset of puberty. What is a priority when monitoring the prepubescent?

Bone growth

A female client has been prescribed estrogen therapy. Which will the nurse advise the client is a common adverse effect of estrogen therapy?

Breakthrough bleeding

The nurse is scheduled to administer an oral contraceptive to a client admitted with adult onset 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.

A female client asks the nurse about the use of progestins. The nurse shares with the client that clients who take this medication are at an increased risk for what serious adverse effect?

Cardiovascular complications

The nurse is reviewing the history of a client who is to receive testosterone. Which of the following would alert the nurse to the need for close monitoring of the client?

Cardiovascular disease

Mark, age 42, is prescribed sildenafil for the treatment of pulmonary hypertension. The nurse caring for Mark would explain that sildenafil works by what mechanism?

Causing vasodilation in the pulmonary vascular bed

A nurse is caring for a patient with advanced breast cancer who is receiving androgen therapy. Which sign might alert the nurse to the possibility of liver toxicity?

Clinical jaundice

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.

A client is receiving androgen therapy. Which would cause the nurse the greatest concern?

Elevated liver enzyme levels

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?

Endometrial cancer Breast cancer

The nurse is aware that older men are more prone to urinary tract infections because of what physiologic change related to aging?

Enlargement of the prostate Many older men have enlarged prostate glands that compress the urethra and reduce the flow of urine, which makes men more susceptible to urinary tract infection. Reduction in renal function, loss of muscle tone in the pelvic structures, and involuntary contractions of the bladder do not lead to increased urinary tract infections in older men.

A client is menopausal and has been given a prescription for estrogen. She asks the nurse what some of the risks are in taking this medication. The nurse's best response is:

Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots. The FDA has issued a BLACK BOX WARNING that estrogens increase the risk for developing cancer of the uterus. The warning instructs individuals who take estrogens with or without progestins of the increased risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot.

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?

Every 3 months When using the vaginal ring, the client should insert the ring and keep it in place for 3 weeks and then remove it on the same day of the week it was inserted. The ring can be expelled accidentally, such as with straining on defecation of removing a tampon. Typically, bleeding occurs once the ring is removed. The ring should be discarded after each use.

The nurse must complete which assessments prior to starting an IV infusion of oxytocin for induction of labor?

Fetal heart rate Client blood pressure Client respiratory rate

The nurse will monitor a woman receiving oxytocin for what abnormal finding in the fetal assessment?

Fetal heart rate of 84 bpm

A client who is taking an estrogen reports swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority?

Fluid volume excess

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 Pain in the groin, headaches, dizziness, and 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.

The nurse is aware that intranasal oxytocin is used for what reason?

Help with milk letdown in breastfeeding

When teaching a group of high school students about using anabolic steroids, the nurse would include information that these drugs are classified as which class of controlled substances?

III

A 9 year old child has been prescribed testosterone. What information should the nurse provide the client's parents regarding the continuation of the therapy?

If signs of early puberty are identified the therapy should be stopped

A patient is receiving oxytocin intravenously. The nurse would expect this drug to begin acting within which time frame?

Immediately

A client with a history of benign prostatic hypertrophy (BPH) is seeking androgenic medication treatment for penile erectile dysfunction. What information should the nurse provide the client regarding this therapy?

It increases the risk for prostate cancer

A woman who has been prescribed high doses of anabolic steroids should be instructed on which effects?

Masculinization

A 38-year-old female client has just visited the health care provider and has received a prescription for birth control pills. The client calls the nurse and states that she doesn't need birth control pills because she had voluntary sterilization after her third child. The nurse explains that birth control pills may be used for what other reason?

Menstrual disorders

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 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.

A nurse is reviewing the medication history of a client. The nurse understands that a PDE5 inhibitor would be inappropriate for a client taking:

Nitroglycerin

After teaching a patient who is prescribed estradiol vaginal cream, the nurse determines that the patient has understood the instructions when she states that she will administer the medication at which frequency?

Once a day Intravaginal estradiol is administered every day.

Estropipate is sometimes administered to postmenopausal women to prevent which condition?

Osteoporosis 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.

A female client is 38 weeks' pregnant. The nurse is aware what hormone is responsible for the induction of labor?

Oxytocin

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

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

Pelvic inflammatory disease

The nurse knows that for a client who still has her ovaries intact, estrogen must be paired with what other drug when used to treat menopausal symptoms?

Progestins When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, progestins must also be used to decrease the risk of endometrial cancer. Antispasmodics are used to treat issues of the bladder. Androgen hormone inhibitors are used to treat benign prostatic hypertrophy. Aromatase inhibitors are used to treat breast cancer.

A client who is taking estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse suspects the client is experiencing what adverse reaction related to estrogen therapy?

Pulmonary embolism

The nurse is preparing to apply testosterone gel (Androgel) to a male client who has a low testosterone level. What is the nurse's top priority action before administering this medication?

Put on gloves.

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

Respiratory rate Blood pressure Pulse

A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which potential nursing diagnosis?

Risk for Injury related to loss of vision or thrombotic events

A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately?

Shortness of breath 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.

A group of students are reviewing the drugs available for treating penile erectile dysfunction. The students demonstrate understanding when they identify which drug as a PDE5 inhibitor?

Sildenafil

A woman is diagnosed with pulmonary hypertension. The nurse explains the drug prescribed and the patient states, "That's a drug that used to treat erectile dysfunction." Which drug would this most likely be?

Sildenafil

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

A client is using a transdermal system for androgen administration. Which drug would the client most likely be using?

Testosterone

Which would the nurse expect to administer as a depot injection?

Testosterone

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 occuring every 90 seconds. 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.

Headache and flushing are adverse effects associated with PDE 5 inhibitors.

True

A patient who is taking oral contraceptives develops an upper respiratory infection for which a tetracycline is ordered. Which instruction would be most important for the nurse to include?

Using an alternative means of contraception while taking the tetracycline

The nurse limits the amount of oral fluids given to a client receiving oxytocin for induction of labor. This is done to prevent what serious complication?

Water intoxication

The health care provider has ordered oxytocin to be administered via IV pump and titrated until a client's contractions are every 3 minutes. The nurse caring for the client is aware that oxytocin can cause dangerous effects to the CNS, musculoskeletal, and cardiovascular systems of the client. What is the cause of these adverse effects?

Water intoxication Oxytocin increases the water permeability of the nephron, which causes more water retention than sodium reabsorption and, in turn, leads to water intoxication. Symptoms of water intoxication primarily affect the CNS and musculoskeletal systems. Oxytocin infusions, when given to a client with autism or Asperger's disorder, result in a significant reduction in repetitive behaviors. Tachysystole and abnormal atrioventricular rhythms are not the cause of adverse effects.

A client is going through menopause. She informs you that her health care provider has prescribed estrogen and progesterone. She asks why she should take two medications. The nurse's best response is:

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

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 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.

Anabolic steroid use causes an increase in muscular work capacity, which is what makes these agents popular as performance-enhancing drugs. They are dangerous specifically to teens because they:

can damage the heart, liver, and kidneys.

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for:

cardiovascular complications. Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen.

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

endometrial cancer

Androgens may be prescribed to women to treat conditions related to the effects of the female sex hormones. Danazol is prescribed to prevent or treat fibrocystic breast disease and:

endometriosis.

A nurse is caring for a female client who states she has a 28-day cycle. Which two hormones are influential in the female fertility cycle?

estrogen and progesterone

A client is prescribed oxytocin to stimulate the milk ejection reflex. The nurse would expect this drug to be administered by which route?

intranasally

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?

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

oral

After teaching a woman who is receiving estrogen hormonal therapy about substances to avoid, the nurse determines that additional teaching is needed when the patient cites:

orange juice

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

osteoporosis 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 nurse is preparing to administer a drug in the antepartal period to induce a pregnant woman's labor contractions. Which medication would the nurse most likely administer?

oxytocin

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 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 is diagnosed with dysmenorrhea. Which oral medication will be prescribed that has the ability to provide physiological actions on the neuroendocrine control of ovarian function?

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

A 24-year-old woman has come to the clinic with an infection and has been prescribed penicillin. The nursing assessment reveals that she is taking oral contraceptives. The nurse will instruct her to:

use an additional form of birth control while taking penicillin.

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

water intoxication