DRUGS AFFECTING THE M/F REPRODUCTIVE SYSTEM
The nurse is caring for a patient with cryptorchidism who is 28 years old and taking testosterone to treat his condition. What statement by this patient would lead the nurse to believe that he has understood the teaching provided about the drug? A. "My body hair may increase." B. "My sexual desire may increase." C. "My voice may become higher." D) "My skin may become clear and soft."
A Feedback: Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and testicular atrophy. Testosterone does not make the skin clear and soft, it does not make the voice higher, and the testicular atrophy is more likely to decrease rather than increase libido.
When fluoxymesterone (Androxy) is administered to a 14-year-old boy for hypogonadism, what is the expected result? A) Enlarged sex organs B) Decreased skin thickness C) Increased protein metabolism D) Increased sperm production
A Feedback: In prepubertal boys, administration of male sex hormone-like drugs will stimulate development of masculine characteristics and cause development of the male sexual organs. Production of sperm will occur when the boy enters puberty. These drugs are not administered to decrease skin thickness or increase protein metabolism.
A patient is prescribed oxymetholone (Anadrol-50) for treatment of angioedema. The nurse knows the patient has type 2 diabetes and will instruct the patient that the combination of oxymetholone with antidiabetic agents may lead to what? A) Hyperglycemia B) Hypoglycemia C) Jaundice D) Urinary retention
B Feedback: Because of its effects on the liver, oxymetholone (Anadrol-50) may interact with antidiabetic agents to decrease their metabolism and increase their effectiveness, leading to hypoglycemia. The dosage of the antidiabetic agents should be reduced and the patient monitored closely. It would not lead to hyperglycemia, jaundice, and urinary retention.
The patient is prescribed sildenafil 25 mg PO one hour before sexual intercourse is planned. The patient returns for follow-up care and says that 25 mg did not produce an erection so he increased the dosage. How much of an increase would be enough to concern a nurse? A) 50 mg B) 75 mg C) 100 mg D) 25 mg
C Feedback: Normal dosage range is 25 to 100 mg so the nurse should not be concerned unless the dosage exceeded 100 mg.
When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered? A) Long-term B) Short-term C) Continuous D) Intermittent
D Feedback: Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy.
The nurse is caring for an infertile couple who will take chorionic gonadotropin to become pregnant. How would the nurse describe the actions of this drug? A) Affecting follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release B) Stimulating follicular development C) Stimulating maturation of ova D) Stimulating multiple follicle development
A Chorionic gonadotropin is used to stimulate ovulation by acting like gonadotropin-releasing hormone (GnRH) and affecting FSH and LH release. It does not stimulate follicular development, maturation of the ova, or multiple follicle development.
A female athlete is using high doses of anabolic steroids to enhance her performance. The nurse warns this patient that such use of anabolic steroids is likely to result in what? A) Masculinization B) Immobility of joints C) Obesity D) Hypotension
A Feedback: Adverse effects in women include masculinization effects, hirsutism, and deepening of the voice. A woman using anabolic steroids would not expect it to result in joint immobility, obesity, or hypotension.
A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse? A) Smoking a pack of cigarettes a day B) Gaining 10 pounds in the last 3 months C) Craving sugar D) Spending less time exercising
A Feedback: All these options are poor health habits and will impact the patient's health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 pounds, a craving for sugar, and a decrease in exercise would not be as immediate a concern although the nurse should address these issues.
A nurse is caring for an adolescent with hypogonadism who has been prescribed fluoxymesterone (Androxy) for replacement. What adverse effect of this drug will the nurse alert the patient to that could result in self-esteem concerns? A) Acne B) Dizziness C) Insomnia D) Fatigue
A Feedback: All these options are possible adverse effects of the drug. However, for the adolescent, acne is the only one that could cause image concerns, which could lead to low self-esteem. Dizziness, insomnia, and fatigue would not cause self-esteem concerns.
The nurse learns a patient receiving a new prescription for oxandrolone takes a lipid-lowering medication daily. What will the nurse tell the patient about this drug interaction? A) Lipid-lowering drug becomes much less effective. B) Increased risk of oxandrolone toxicity with this combination of drugs C) Increased risk of liver damage with this combination of drugs D) Oxandrolone becomes less effective with this combination of drugs.
A Feedback: Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid-lowering agents. Lipid-lowering medications do not impact anabolic steroids and there is no increased risk for toxicity of either drug.
What is the priority assessment for the 23-year-old female patient who is on estrogen therapy? A) Monitor liver function periodically for the patient on long-term therapy. B) Assess for contraindications to drug therapy. C) Help plan a diet rich in calcium and vitamin D. D) Provide patient teaching for diet therapy to prevent osteomyelitis.
A Feedback: Assessing liver function is important for the patient on long-term estrogen therapy. Teaching is an intervention and not an assessment. The patient should be assessed for contraindications before administering the medication initially.
A child in renal failure is taking androgens to promote red blood cell production and is seen in the clinic every other month. What adverse drug effect would the nurse monitor for with this child? A) Epiphyseal closure B) Acne C) Skin color D) Weight gain
A Feedback: Because of the effects of androgens on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. The other options are also adverse effects and require monitoring but are not as serious as premature epiphyseal closure.
When the nurse learns the male patient takes conjugated estrogens, the nurse questions the patient about what disorder? A) Prostate cancer B) Breast cancer C) Osteoporosis D) Andropause
A Feedback: Conjugated estrogen is most commonly taken by men to treat prostate cancer because the estrogen competes with testosterone for binding sites. Although men do get breast cancer and osteoporosis, they would not be treated with estrogen for these disorders. Andropause is caused by a reduction in testosterone so they would get a male hormone replacement and not estrogen.
The nurse attributes what assessment finding to the use of androgens by the male patient? A. Testicular atrophy B. Increased fertility C. Increased urination D. Hoarseness
A Feedback: In adult men, adverse effects include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido. Increased fertility, increased urination, and hoarseness would not be expected assessment findings.
A 16-year-old boy is diagnosed with delayed onset of puberty and the physician has ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the patient? A) Discuss changes that will occur in his body. B) Have patient fast before injection. C) Have patient reduce protein intake. D) Decrease exercise while on this hormonal treatment.
A Feedback: It is important for this patient to understand what will happen and the changes he will see to reduce the anxiety that could occur if he didn't understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the patient fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.
A 69-year-old man is prescribed testosterone. The patient is found to have hypertension and a history of congestive failure after assessment by the nurse. What is this patient at increased risk for? A. Fluid retention B. Impotence C. Liver failure D. Kidney failure
A Feedback: Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but since that is not indicated by the question, this would be a lower risk than fluid retention.
The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The patient is on a low-residue diet for colitis. What factor in the patient's history may contraindicate the use of birth control pills? A) Migraine headaches B) Age C) Asthma D) Colitis
A Feedback: Progestins should be used with caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.
For what reason might the nurse administer sildenafil to a woman? A) Pulmonary arterial hypertension B) Sexual dysfunction C) Breast cancer D) Endometriosis
A Feedback: Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women.
A 68-year-old male patient tells the nurse that he has been unable to get an erection for the past 6 months and he guesses his sex life is over. The provider orders diagnostic testing to determine whether sildenafil (Viagra) is appropriate for the patient. What is the most correct nursing diagnosis for this patient? A) Sexual dysfunction B) Disturbed body image C) Ineffective sexuality pattern D) Disturbed tactile sensory perception
A Feedback: The patient is experiencing sexual dysfunction so that would be the most appropriate nursing diagnosis. The patient did not discuss feeling let down by or unhappy with his body so disturbed body image is incorrect. The effectiveness of sexual pattern is not known. No problem with sensory perception is indicated by this question.
The nurse is preparing to administer clomiphene to the female patient. What dosage would the nurse find is within usual dosage range? A) 100 mg B) 10 mg C) 1 mg D) 0.1 mg
A Feedback: The usual dosage range for clomiphene is 50 to 100 mg/d PO with length of therapy and timing dependent on the particular situation. Options B, C, and D are not correct.
The 22-year-old patient tells the nurse he doesn't have trouble obtaining and maintaining an erection but wonders if taking Viagra would improve the sexual experience anyway. What is the nurse's best response? A) The only thing Viagra does is improve blood flow to the penis to make it erect. B) Viagra improves stamina and sensation, making the sexual experience better. C) Viagra has its greatest effect if both the man and woman take it at the same time. D) Viagra does nothing to improve the sexual experience.
A Feedback: Viagra improves blood flow into the penis and that is its only effect. It does not improve stamina or sensation. Research has indicated it has no effect on women's sexual response. To say only that Viagra does nothing would not provide adequate information for the patient.
The nurse is developing a nursing plan of care for a patient who will receive a fast-acting abortifacient. What nursing diagnosis would apply to care provided shortly after administering the medication? A) Acute pain related to uterine contractions or headache B) Ineffective coping related to abortion or fetal death C) Risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis D) Deficient knowledge regarding drug therapy.
A The rapid-acting abortifacients work within 10 to 15 minutes , so shortly after administration of the drug, the patient will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur. Deficient knowledge regarding drug therapy should have been addressed before administering the medication. Ineffective coping usually occurs after acute symptoms subside and the patient begins to cope with the decision.
The nurse, working in a women's health center, is reviewing the patient's medical record and recognizes the patient with what medical history should not receive an abortifacient? (Select all that apply.) A) Active pelvic inflammatory disease (PID) B) Pulmonary disease C) Cardiovascular disease D) Hypertension E) Adrenal disease
A, B, C Feedback: Abortifacients should not be used with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Caution should be used with any history of asthma, hypertension, or adrenal disease.
The nurse is caring for a patient who has been taking androgens and has been admitted to the ICU following a car accident. What lab results will the nurse interpret as more indicative of androgen therapy than actual disease states? (Select all that apply.) A. Decreased thyroid function B. Increased creatinine levels C. Increased creatinine clearance D. Elevated liver enzymesIncreased white blood cell (WBC) count
A, B, C Feedback: While a patient is taking androgens, thyroid function may be decreased, as well as increased creatinine and creatinine clearance, results that are not associated with disease states. These effects can last up to 2 weeks after the discontinuation of therapy. Elevated liver enzymes may indicate a potentially life- threatening effect that has been documented is hepatocellular cancer. Increased WBC count would indicate an infection. Increased liver enzymes and WBC are not associated with androgen therapy but instead indicate a disease state.
The nurse assesses the postpartum patient who has been receiving ergonovine and suspects ergotism when what manifestations are found? (Select all that apply.) A) Weak pulse B) Dyspnea C) Numb cold extremities D) Chest pain D) Postpartum hemorrhage
A, B, C, D Feedback: Ergonovine and methylergonovine can produce ergotism, manifested by nausea, blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, and even coma. Postpartum hemorrhage can occur as an adverse effect of ergonovine but is not a manifestation of ergotism.
The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance his performance. What findings would the nurse associate with this practice? (Select all that apply.) A) Personality changes B) Sexual dysfunction C) Increased serum lipid levels D) Cardiomyopathy E) Weight loss
A, B, C, D Feedback: nurse administers danazol (Danocrine) be a woman for what purpose? Reverse folic acid deficienciesIncrease hair growthDecrease symptoms of endometriosis Prevent toxic shock syndrome. C Feedback: Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome. Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off-label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss.
The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what? A) Renal stones B) Death C) Cirrhosis D) Malignant hyperthermia
Ans: B Feedback: Prolonged use of high doses may cause potentially life-threatening conditions, placing the patient at risk of death. Conditions such as peliosis hepatis, hepatic neoplasms, and hepatocellular carcinoma are often seen with high-dose street use of these drugs. Renal stones, cirrhosis, and malignant hyperthermia are not associated with the use of anabolic steroids.
The nurse is talking with a menopausal woman about the use of hormone replacement therapy (HRT). What statement, if made by the nurse, would be accurate and appropriate to share with the patient? A) Symptoms of menopause are short-term and minor so HRT is not necessary. B) The newer drugs used in HRT cause cardiovascular events even when taken short-term. C) The risk for osteoporosis is much higher in women who take HRT. D) There is a possible increased risk of breast and cervical cancer when taking HRT.
Ans: D Feedback: The use of HRT can decrease the discomforts associated with menopause, although various forms of HRT have been associated with increased risks of breast and cervical cancer, heart disease, and stroke. The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use, they are associated with an increased risk of cardiovascular events. The risk for osteoporosis declines with HRT because of the bone saving effects of the drugs. It would be inappropriate and judgmental for the nurse to say symptoms of menopause are minor because some women experience more severe symptoms that can negatively impact their day-to- day life.
A 13-year-old teenage girl is started on oral contraceptives. When following this girl in the clinic, what is the nurse's priority assessment? A) Closure of the epiphyses B) Menstrual patterns C) Nutrition D) Cognitive development
B Feedback: A 13-year-old girl is still growing. Estrogens and progestins have undergone limited testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. It is important for the nurse to monitor metabolic and other effects as well. Menstrual patterns, nutrition, and cognitive development are all components of care of the adolescent, but they are not the priority consideration.
A postmenopausal patient has been diagnosed with breast cancer. The patient is being treated with methyltestosterone (Testred). What assessment finding would the nurse suspect is a complication from the medication? A) Increased blood pressure B) Jaundice C) Weight loss D) High-pitched voice
B Feedback: A potentially life-threatening effect of an androgen is hepatocellular cancer. Jaundice would indicate that the liver function has been compromised. Usually weight gain and deepening of the voice are adverse effects of this drug. An increase in blood pressure is not associated with methyltestosterone.
The 63-year-old male patient receives a prescription for androgens. The nurse evaluates that the patient understood drug teaching when he makes what statement? A. If I experience acne, I will contact my physician immediately. B. If I experience flushing, sweating, nervousness, or emotional lability I'll know it's the drug. C) I will report any difficulty urinating such as trouble starting my flow. D) These pills may make my skin turn yellow but it will go away when the drug is stopped.
B Feedback: Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. Nurses should teach these men the signs and symptoms of prostatic enlargement and the importance of reporting these manifestations immediately to prevent worsening of symptoms. Acne need not be reported immediately. Flushing, sweating, nervousness, and emotional lability are more usually experienced by women. Yellowing of the skin may be an indication of liver disease, which should be reported immediately.
The nurse is caring for a patient who is extremely agitated about finding out she is pregnant and wants to take an abortifacient that will have the fastest possible action. What drug will the nurse expect to be ordered? A. Mifepristone B. Carboprost C. Prostin 15 D. Bepridil
B Feedback: Carboprost is available as an intramuscular injection with an onset of 15 minutes and a 2-hour duration of effect. Mifepristone takes 5 to 7 days to produce the desired effect so would not be appropriate for this patient. Prostin 15 is only available in Europe. Bepridil is a calcium channel blocker and would not be used as an abortifacient.
A student athlete presents at the clinic for his physical checkup. The athlete tells the nurse that he is using large doses of creatine to increase muscle size and strength. What should the nurse instruct the student to do while taking this medication? A) Take nonsteroidal anti-inflammatory drugs (NSAIDs) to stop pain from expanding muscles. B) Drink plenty of fluids while using this drug and watch for swelling. C) Stop eating red meat or other animal products. D) Take cimetidine (Tagamet) to relieve the stomach upset associated with the use of this therapy.
B Feedback: Creatine is a protein by-product that has to be processed through the kidneys. If an athlete is using it to try to increase muscle size, he should be advised to drink plenty of fluids to help flush it through the kidney and to watch for any swelling that could indicate change in renal function. NSAIDs could aggravate renal problems and cause more swelling. Getting protein from food sources is a natural way to provide the body with proteins. If stomach upset occurs, the athlete should stop using the herbal therapy and not add another drug to his regimen, especially cimetidine that can increase risk of kidney damage.
The nurse is providing patient teaching for a woman who will begin receiving Depo-Provera injections. When will the nurse schedule the appointment for the next injection? A) 1 month from last injection B) 3 months from last injection C) 6 months from last injection D) 12 months from last injection
B Feedback: Depo-Provera is administered by deep intramuscular (IM) injection every 3 months. Options A, C, and D are not correct.
When the nurse administers an endogenous estrogen, what systemic effects does the nurse expect the drug will have? A. Causes proliferation of endometrial lining B. Provides protection of heart from atherosclerosis C. Retains calcium in the bloodstream D. Inhibits ovulation
B Feedback: Estrogens produce a wide variety of systemic effects, including protecting the heart from atherosclerosis, retaining calcium in the bones, not the bloodstream, and maintaining the secondary female sex characteristics. Proliferation of endometrial lining and inhibiting ovulation are effects of estrogen but are not systemic effects.
The patient comes to the women's health clinic to ask about emergency contraception. The patient is prescribed levonorgestrel (Plan B). How will the nurse instruct the patient to take this medication? A. Take one tablet within 4 days of unprotected intercourse. B. Take one tablet within 72 hours of unprotected intercourse and another 12 hours later. C. Take one tablet within 5 days of unprotected intercourse. D. Take one tablet within 72 hours of unprotected intercourse and another daily for 5 days.
B Feedback: Levonorgestrel (Plan B) is taken within 72 hours of unprotected intercourse with another tablet taken 12 hours after the first. Levonorgestrel (Plan B One-Step) is taken once within 72 hours after unprotected intercourse and is available OTC for patients 17 years and older. Ulipristal (Ella) is taken once within 5 days of unprotected intercourse.
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Penile implant C) Hypotension D) Lung cancer
B Feedback: Patients with a penile implant should not take tadalafil. Patients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects.
The nurse is preparing to administer an infusion of oxytocin (Pitocin) to the pregnant patient. What is the priority assessment before beginning the infusion? A) Cervical dilation B) Cephalopelvic proportions C) Electrocardiogram readings D) Respiratory excursion
B Feedback: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated so this is not a priority assessment, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting condition.
A patient has been prescribed sildenafil citrate. What should the nurse teach the patient about this medication? A) Take the medication with a glass of grapefruit juice. B) The drug should be taken 1 hour before attempting intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) A dose exceeding 80 mg will result in a change of vision, making everything appear blue.
B Feedback: The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. The blue haze that occurs with the 100-mg dosage is transient (it lasts about 1 hour). Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion.
A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse's priority response? A) The effect of oral contraceptives containing progestin is reduced by phenytoin. B) The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin. C) The effect of oral contraceptives containing estrogen is reduced by phenytoin.D) You will need to increase the dosage of your phenytoin once you start contraceptives.
B Feedback: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin.
A patient tells the nurse she is taking soy, calcium, and a multivitamin as an alternative to taking hormone replacement pills. What is the nurse's priority response? A) Increase her iron supplement. B) Discontinue her calcium supplement. C) Decrease the amount of carbohydrates in her diet. D) Increase calcium supplementation.
B Feedback: The nurse may advise the patient to stop using a calcium supplement because soy is not to be taken with calcium, iron, or zinc. However, the patient may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates is a healthy choice, especially for a menopausal woman, but would not be the priority concern.
The nurse is caring for a patient with an intact uterus who requests hormone replacement for short-term use to reduce menopausal symptoms. What combination drug would be appropriate for this patient? A) Estrace B) Premphase C) Premarin D) Estratab
B Feedback: The patient would be given Premphase because it is a combination of estrogen and progesterone. The combination is important to help avoid risk of endometrial hyperplasia. Estrace, Premarin, and Estratab contain only estrogen so they are not combination drugs.
A patient is using a progestin vaginal gel. What possible adverse effects should the nurse tell the patient about? A) Diarrhea B) Breast enlargement C) Abdominal pain D) Local skin irritation
B Feedback: The use of a progestin vaginal gel is associated with breast enlargement. Constipation, not diarrhea, is also an adverse effect. Abdominal pain with progestin therapy is associated with the use of an intrauterine device for birth control, not a vaginal gel. Local skin irritation can result from use of a dermal patch contraceptive.
A nurse is taking care of a woman receiving an abortifacient. The nurse is aware that the most serious adverse effect is what? A) V omiting B) Nausea C) Uterine rupture D) Diarrhea
C Feedback: All these options are adverse effects of abortifacients. However, the most serious adverse effect would be uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken.
The patient is prescribed oxandrolone 2.5 mg twice a day and is told to increase the dosage to gain weight to a maximum of 20 mg/d. If each tablet contains 2.5 mg, how many tablets would the nurse tell the patient he may take per day to avoid exceeding the 20 mg/d maximum? A) 4 B) 6 C) 8 D) 10
C Feedback: Calculate the number of tablets required to administer 20 mg by dividing 20 mg by 2.5 mg. 20/2.5 = 8 tablets
The nurse is preparing to give a patient an injection of carboprost. What is the nurse's priority action before administering the drug? A) Explain the ethical indications of the drug. B) Assess for contraindications or cautions. C) Verify that the woman thoroughly understands what will happen. D) Draw up the medication and inject within 5 minutes.
C Feedback: Carboprost is an abortifacient and it is important that the woman understand what will happen after the drug is taken and that she cannot change her mind. Contraindications and cautions should have been checked before the drug was prescribed. It is not the nurse's place to share ethical beliefs with the patient. After the patient's understanding is verified, the drug can be prepared.
The nurse administers danazol (Danocrine) be a woman for what purpose? A. Reverse folic acid deficiencies B. Increase hair growth C. Decrease symptoms of endometriosis D. Prevent toxic shock syndrome.
C Feedback: Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome.
The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication? A) Reduced risk of endometriosis B) Reduced risk of dysfunctional uterine bleeding C) Reduced risk of osteoporosis D) Reduced risk of uterine cancer
C Feedback: Estrogen slows the bone loss seen with osteoporosis so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer and screening for cancer should be performed before prescribing this drug.
The nurse has been conducting patient teaching for a 16-year-old who is starting oral contraception. What statement indicates that she needs additional teaching? A) I will monitor my weight and have my blood pressure checked monthly. B) I will see my woman's health provider and have a Pap smear done on a yearly basis. C) If I forget to take my pill for 2 consecutive days I will take three pills to catch up. D) I will take the pill every day at the same time and never miss a pill.
C Feedback: If one tablet is missed, take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the patient understood the nurse's teaching.
The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? A) The patient can demonstrate how to inject the medication. B) The patient can explain how medication will prevent sexually transmitted infections. C) The patient can verbalize how and when to take medication even if a pill is missed. D) The patient makes the necessary appointments for follow-up care.
C Feedback: It is most important for the nurse to evaluate the patient's understanding of how to take the medication properly, including how to respond when a pill is missed. The patient need not learn how to inject the medication because the prescription is of an oral medication. Oral contraceptives will not prevent sexually transmitted infections. Although making follow-up appointments is good, it is more important that the patient know how to take the medication.
A couple comes to the fertility clinic for help in getting pregnant and the nurse administers menotropin to the male partner. How does this classification of drug work? A. Stimulates endogenous estrogen B. Stimulates follicle development C. Stimulates spermatogenesis D. Blocks the secretion of testosterone
C Feedback: Menotropins stimulate spermatogenesis in men with low sperm counts and otherwise normally functioning testes. Options A, B, and D are not correct.
A patient will begin taking sildenafil (Viagra) for penile erectile dysfunction (ED). What is the nurse's priority teaching point about this drug? A) He will have an erection exactly 1 hour after taking the drug. B) The drug should not be taken with a penile implant or any anatomic penile obstruction. C) Avoid drinking grapefruit juice for 2 days before and after taking the drug. D) It is important to know the cause of ED because sildenafil does not treat all causes.
C Feedback: Patients who are using sildenafil need to be advised to avoid drinking grapefruit juice while using the drug. Grapefruit juice can cause a decrease in the metabolism of the PDE5 inhibitor, leading to increased serum levels and a risk of toxicity. They need to know that it takes 48 hours for grapefruit juice to be processed by the body, so they need to avoid it for several days before and after taking the drug. The patient should be screened for penile implants, anatomic penile obstruction, and the cause of ED before the drug is prescribed. Sildenafil has a median onset of 27 minutes and duration of 4 hours so the patient may have an erection as early as 27 minutes after taking it.
The patient calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the patient is taking on reviewing the medical record? A. Desogestrel B. Drospirenone C. Progesterone D. Norethindrone
C Feedback: Perineal pain and breast enlargement results from vaginal gel formulas, so the nurse would suspect the patient is receiving progesterone because this is the only progestin administered by this method. The other options are all oral medications that would not cause perineal pain or breast enlargement.
A patient has high blood pressure and penile erectile dysfunction. He asks the nurse if he could try tadalafil (Cialis) after seeing an advertisement on television. What medications, if taken by the patient, would the nurse recognize as increasing the risk associated with taking tadalafil? A) Beta-blockers B) Angiotensin-converting enzyme (ACE) inhibitors C) Alpha-adrenergic blockers D) Calcium channel blockers
C Feedback: Serious drops in blood pressure, leading to potentially fatal myocardial infarction or cerebrovascular event, have been reported when Cialis is combined with alpha-adrenergic blockers. This reaction has not been reported with beta-blockers, calcium channel blockers, or ACE inhibitors.
The nurse is caring for a patient taking raloxifene. What manifestation reported by the patient would raise the highest level of concern from the nurse? A. Headache B. Weight loss C. Calf pain D. Edema
C Feedback: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes. Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation. However, these are not symptoms.
A 28-year-old female patient is taking danazol (Danocrine) as treatment for endometriosis. The patient is upset about increased facial hair, a weight gain of 15 pounds, and a change in her voice; she discusses her concerns with the nurse. What nursing diagnoses would be most appropriate for this patient? A) Acute pain related to need for injections B) Deficient knowledge regarding drug therapy C) Disturbed body image related to drug therapy D) Sexual dysfunction related to androgenic effects
C Feedback: The patient is concerned about the way she looks and the sound of her voice. The most appropriate nursing diagnosis would be disturbed body image. Danazol is not administered by injections; therefore, acute pain would not be applicable. Sexual dysfunction and deficient knowledge would be possible nursing diagnoses for this patient, but the concerns expressed by the patient fail to support these diagnoses.
What therapeutic effect will the nurse assess for in the male patient taking anabolic steroids? A) Thinning of the skin B) Body hair loss C) Increase in red blood cells (RBCs) and hemoglobin D) Gynecomastia
C Feedback: Therapeutic effects include promotion of body tissue-building processes, reverse catabolic or tissue- destroying processes, and increased hemoglobin and red blood cell mass. Thinning of the skin and body hair loss are not associated effects of anabolic steroids. Gynecomastia is an adverse effect and would not be a therapeutic effect for which the drug was administered.
The nurse would question the use of what herbal supplement by a patient taking hormone replacement therapy (HRT) containing progesterone? A) Dong quai B) Devil's claw C) Wild yam D) Black cohosh
C Feedback: Wild yam contains progesterone. Do not use with hormone replacement therapy, because it may cause increased blood glucose and other toxic effects, and do not combine with disulfiram or metronidazolesevere reaction may occur. Dong quai, devil's claw, and black cohosh are not contraindicated with HRT.
What supplement would be safest for a diabetic female athlete wishing to improve athletic performance? A) Bee pollen B) Damiana C) Wild yam D) Spirulina
C Feedback: Wild yam is an estrogen-like herb used to increase athletic performance, slow the aging process, and improve energy and stamina. It can be toxic to the liver and may cause breast pain but is the safest of these supplements. Bee pollen is associated with serious allergic reactions and random studies have found wide variety of ingredients in each product. Damiana interferes with antidiabetic agents so it would not be appropriate for this patient. Spirulina may contain toxic metals and can cause serious reactions in children and pets. It interferes with vitamin B12absorption and there are no studies to prove it is effective in the claims it makes.
An older male patient, who has difficulty swallowing pills and tablets, will begin taking an androgen. What drug would the nurse identify as a good choice for this patient? A) Danazol (Danocrine) B) Fluoxymesterone (Androxy) C) Methyltestosterone (Testred) D) Testosterone (Androderm)
D Feedback: A good choice for this patient would be testosterone because the drug can be administered in long- acting depository forms and by dermatologic patch. These forms would eliminate the need for the patient to swallow a pill or tablet. The other options shown here are available only in oral form.
An adolescent patient asks the nurse, What should I do if I forget to take my birth control pill? What should the nurse reply? A. Abstain from intercourse for 7 days. B. It's okay to miss a day or two, as long as you don't go over 5 days. C. Just wait until your next dose, then take double the dose. D. Take the dose as soon as you discover your oversight.
D Feedback: A missed pill should be taken as soon as the error is noticed. Telling the patient to abstain from intercourse would be inappropriate but if the patient misses three tablets they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken the better contraceptive protection provided, so patients should not wait until the next dose and then double it.
The nurse assesses the patient taking anabolic steroids for what serious adverse effects? A. Elevated blood urea nitrogen (BUN) B. Elevated blood glucose level C. Bradycardia D. Jaundice
D Feedback: Anabolic steroids all have black box warnings as alerts to the potentially serious effects of liver tumors, hepatitis, and blood lipid level changes that might be associated with increased risk of coronary artery disease. As a result, the nurse should assess for jaundice that could be an early indication of liver dysfunction. Elevated BUN, blood glucose levels, and bradycardia are not commonly reported adverse effects.
The nurse administers an androgen and assesses the patient for what action caused by this drug? A) Decreased production of red blood cells B) Decreased protein anabolism C) Increased protein catabolism D) Increased retention of nitrogen
D Feedback: Androgens act to increase the retention of nitrogen, sodium, potassium, and phosphorous. They increase production of red blood cells and protein anabolism and decrease protein catabolism.
An woman is prescribed androgens. The nurse teaches the patient to anticipate what effect from the drug? A) Atrophy of breasts B) Rapid bone growth C) Loss of pubic hair D) Nervousness
D Feedback: Antiestrogen effectsflushing, sweating, vaginitis, nervousness, and emotional labilitycan be anticipated when these drugs are used in women. When androgens are administered to women you would not expect the results to include atrophy of the breasts, rapid bone growth, or loss of pubic hair.
A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? A) Liver function test (LFT) B) Cholesterol level C) Vision D) Hand and wrist radiographs
D Feedback: Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision.
The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs? A) Decreased appetite B) Dehydration C) Occasional headaches D) History of deep vein thrombosis
D Feedback: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. A loss of appetite would not contraindicate oral contraceptives but would require further assessment to determine the cause. Dehydration would require fluid administration to correct but is not a contraindication to oral contraceptives. Occasional headaches are not uncommon and would not contraindicate contraceptive use.
The nurse is caring for a patient who just had subdermal implantation ofNuvaRing. As part of drug teaching, the nurse will tell the patient this implant needs to be removed when? A) 3 months B) 6 months C) 1 year D) 3 years
D Feedback: Etonogestrel, in addition to being available as a vaginal ring, NuvaRing, is available as a subdermal implant that may be left in place for up to 3 years and then must be removed. Another implant could be placed at that time.
The patient calls the clinic and says she just started oral contraceptives last month and is experiencing breakthrough bleeding, fluid retention resulting in edema, changes in libido, and palpitations. What symptom would the nurse recognize is not an adverse effect of the oral contraceptive and requires an appointment as soon as possible so the patient can be evaluated? A) Breakthrough bleeding B) Fluid retention C) Changes in libido D) Palpitations
D Feedback: Palpitations are not commonly associated with contraceptives and so the patient would need to be seen and evaluated. The most common adverse effects of estrogens include breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, and changes in libido. Other adverse effects can result from the systemic effects of estrogens, including fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, and edema. GI effects also are fairly common and include nausea, vomiting, abdominal cramps and bloating, and colitis. Potentially serious GI effects, including acute pancreatitis, cholestatic jaundice, and hepatic adenoma, have been reported with the use of estrogens.
When caring for a patient on estrogen therapy, what is the nurse's priority assessment? A) Blood sugar levels B) Bowel sounds C) Weight D) Therapeutic and adverse drug effects
D Feedback: Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. Bowel sounds, weight, and blood sugar may be part of the assessment, but it is most important to assess for therapeutic and adverse effects of the medication.
The patient asks the nurse, Why can't I smoke when taking estrogen. Is the risk for blood clots really that high? What is the nurse's best response? A) The risk is truly that high because estrogen increases serum triglyceride, cholesterol, and glucose levels. B) The risk is high because estrogen stimulates skeletal growth, causing increased production of red blood cells (RBCs). C) The risk is pretty high because estrogen decreases blood levels of several clotting factors. D) There is documented high risk because estrogen combined with nicotine creates a significant drugdrug interaction.
Feedback: Smoking while taking estrogens should be strongly discouraged, because the combination of therapeutic estrogen with nicotine increases the risk for development of thrombi and emboli and this risk is well documented and researched. The risk is not due to skeletal growth, decreased clotting factors, or an impact on triglycerides, cholesterol, or glucose.
