Abrams Chapter 7 - NCLEX
The nurse is assessing a client who has been prescribed contraception that contains the progestin drospirenone. What laboratory value should the nurse prioritize? A. Hemoglobin and hematocrit B. White blood cell differential C. Serum potassium D. Serum sodium
C. Serum potassium Contraceptives that contain the progestin drospirenone can increase serum potassium levels. Potassium monitoring may thus be indicated. Sodium, red cell, and white cell indices are not normally affected.
The effect of which drug class is not affected by a simultaneous prescription for an oral contraceptive? A. Corticosteroids B. Sulfonylurea antidiabetic drugs C. Benzodiazepines D. Anticonvulsants
A. Corticosteroids Corticosteroids are not affected by oral contraception use. Oral contraceptives decrease the effects of some benzodiazepines (e.g., lorazepam, oxazepam, temazepam), anticonvulsants, sulfonylurea antidiabetic drugs, and warfarin. If one of these drugs is taken concurrently with an oral contraceptive, increased dosage may be needed for therapeutic effects.
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? A. Hysterectomy B. Persistent nausea C. Weight gain D. Development of hypertension
A. Hysterectomy Clients 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.
A new client telephones the clinic requesting a renewal prescription for contraceptives she has been taking for 4 years. It has been more than a year since her last health care visit, but she is unable to present to the clinic until next month. The client A. ''Before estrogen-based drugs are prescribed, you must see the health care provider to get an order for a mammogram.'' B. ''Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.'' C. ''If you have a physical within the past 2 years, I can get your medication refilled.'' D. ''Since you are doing well on this regimen, I'll arrange to get the prescription filled for a month to last until your clinic appointment.''
B. ''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, clients taking these drugs need continued supervision by a health care provider. Before the drugs are prescribed, a complete medical history, 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 if the client is taking the drugs.
A client experiencing menopause informs the nurse that the primary health care provider has prescribed estrogen and progesterone. The client asks the nurse why she should take two medications. What is the nurse's best response? A. ''You need both estrogen and progesterone to stop the hot flashes.'' B. ''Using estrogen alone can increase the risk of endometrial cancer.'' C. ''Taking both of the medications together will make your periods lighter and of shorter duration.'' D. ''You should speak to your health care provider because you do not need to take both prescriptions.''
B. ''Using estrogen alone can increase the risk of endometrial cancer.'' 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).
What statement by the client who has been prescribed a combination contraceptive several months ago indicates a need for health education? A. ''I've been checking my blood pressure at the drug store from time to time since I started on the pill.'' B. ''I've learned that the pill is almost 100% effective if you take it on schedule.'' C. ''It's good to know that the pill protects against some sexually transmitted infections.'' D. ''My friend says she takes the pill for problems with her period, not to avoid getting pregnant.''
C. ''It's good to know that the pill protects against some sexually transmitted infections.'' Oral contraceptives provide no protection against STIs. Effectiveness approaches 100%, and blood pressure monitoring is appropriate and necessary. Health care providers also use oral contraceptive preparations to treat menstrual disorders.
Oral contraceptive use would be contraindicated for which client? A. A 40-year-old client who has a family history of hypofunction of the pituitary gland B. A 45-year-old client who has a family history of pancreatic cancer C. A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day D. A 50-year-old client who is taking a cholesterol-lowering medication
C. 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 thrombotic disorders, known or suspected cancers of breast or genital tissues, undiagnosed vaginal or uterine bleeding, fibroid tumors of the uterus, family history of breast or reproductive system cancers, active liver disease or impaired liver function, history of cerebrovascular disease, coronary artery disease, hypertension, or conditions predisposing to these disease processes and women older than 35 years of age who smoke cigarettes.
A client who is menopausal has been given a prescription for estrogen. The client asks the nurse what some of the risks are in taking this medication. What is the nurse's best response? A. ''Estrogen decreases the risk of dementia and myocardial infarctions.'' B. ''Estrogen has not been proven to increase the risk of any medical condition.'' C. ''As long as estrogen and progesterone are taken together, there are no increased health risks.'' D. ''Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.''
D. ''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.
What assessment question is most appropriate when assessing a 58-year-old client for therapeutic effects of prescribed estrogen therapy? A. ''How long do you think you would like to continue with this drug?'' B. ''Have you stopped having menstrual bleeding since you started taking estrogen?'' C. ''How would you describe your energy levels since starting treatment?'' D. ''Have you been having as many hot flashes and night sweats lately?''
D. ''Have you been having as many hot flashes and night sweats lately?'' Treatment of menopausal symptoms is the most likely goal of estrogen therapy in a client who is 58 years old. Hot flashes and night sweats are among the most common symptoms of menopause. As such, assessing menstrual bleeding and energy levels is not a priority. Asking the client how long she would like to continue the drug does not address specific therapeutic effects.
A client who has been prescribed an oral contraceptive asks the nurse to explain why the medication is dispensed in a 28-day pack. What rationale will the nurse provide? A. ''It allows for a longer time between periods.'' B. ''This is a less expensive form of birth control method compared to those that contain placebo tablets.'' C. ''It allows for a rest of ovarian function between periods.'' D. ''It makes it less likely you will forget to take a pill every day.''
D. ''It makes it less likely you will forget to take a pill every day.' Dispensers with 28 tablets contain 7 inactive or placebo tablets of a different color than the active tablets. Because the inclusion of the placebo allows the client to take a pill every day, the action becomes routine, which makes forgetting doses less likely. Several combination products and alternative dosage forms are available to help individualize treatment and promote adherence. None of the other options are true statements.
The nurse is providing education for a client who will receive an injection of medroxyprogesterone. Which statement indicates that the client understands the teaching? A. ''This injection is good for 1 year at most.'' B. ''This injection protects against only some sexually transmitted infections.'' C. ''I will need to return in 6 months for another injection.'' D. ''This injection lasts for 3 months.''
D. ''This injection lasts for 3 months.'' Long-acting progestin contraceptive preparations such as the intramuscular depot medroxyprogesterone last for 3 months per injection; intrauterine progesterone lasts for 1 year; and levonorgestrel subcutaneous implants last for 5 years. The injection does not provide any protection against STIs.
The nurse is providing education to a client who will receive medication therapy for atrophic vaginitis. What information will the nurse include? A. ''Nonsteroidal synthetic preparations are the standard treatment for this condition.'' B. ''If you are not allergic to vibramycin, you will be prescribed an oral dose every 6 hours for 14 days.'' C. ''Your health care provider will prescribe miconazole topically daily for 1 week.'' D. ''You will be prescribed an estrogen preparation to help prevent osteoporosis.''
D. ''You will be prescribed an estrogen preparation to help prevent osteoporosis.'' Estrogens are prescribed to relieve symptoms of estrogen deficiency (e.g., atrophic vaginitis and vasomotor instability, which produces ''hot flashes'' or ''hot flushes'') and to prevent or treat osteoporosis. Such use is usually called estrogen replacement therapy (ERT). None of the other statements are relevant to the treatment of atrophic vaginitis.
When providing follow-up care for a client who has been prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment? A. Heart rate and rhythm B. Chest auscultation C. Skin integrity D. Blood pressure
D. Blood pressure Oral contraceptives can result in increased blood pressure. Regular monitoring is consequently indicated. It is not normally necessary to assess skin integrity or respiration. These drugs have adverse effects influencing the cardiovascular system, but such effects are unlikely to result in alterations in heart rate and rhythm.
A monophasic oral contraceptive is described as having which composition? A. Primarily follicle-stimulating hormone B. Fixed amounts of estrogen and varied amounts of progestin C. Three different doses of estrogen and progestin D. Fixed amounts of both estrogen and progestin components
D. Fixed amounts of both estrogen and progestin components Three different types of hormonal contraceptives are common: monophasic contraceptives, which contain fixed amounts of both estrogen and progestin components; biphasics, which contain fixed amounts of estrogen and varied amounts of progestin; and triphasics, which contain three different doses of estrogen and progestin. Primarily follicle-stimulating hormone is not found in such contraceptives.
A nurse teaching a 57-year-old client about the factors that must be considered around the use of hormone replacement therapy (HRT) should discuss what increased risk associated with the therapy? A. Bronchiectasis B. Malignant hyperthermia C. Crohn's disease D. Venous thromboembolism
D. Venous thromboembolism Studies have demonstrated no evidence for HRT in secondary prevention of heart disease and showed increased rates of coronary heart disease, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer. HRT does not increase the risk for bronchiectasis, malignant hyperthermia, or Crohn's disease.