NUR 2092 Pharm Ch 40 Drugs affecting the female reproductive system
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."
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 come into the clinic until next month. She insists she is "doing fine" on this medication and must have her prescription now. Considering the circumstances and related safety issues, how should the clinic nurse respond?
"Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended."
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 alerts the nurse that they have been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective?
"Estrogen and progesterone diminish."
Which statements indicate that a client understands the need for a follow-up after the initial injection of medroxyprogesterone?
"I know that this injection lasts for 3 months."
A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's best statement?
"It works by relaxing the smooth muscle of the prostate and the bladder neck."
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"
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."
A woman who is at 31 weeks' gestation comes to the clinic in labor. The health care provider decides to use terbutaline therapy before transferring the woman to the hospital. The client is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be:
"The drug provides sufficient time for other medications to be given to improve your baby's outcome."
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."
A group of nursing students are reviewing information about oxytocin for labor induction. The students demonstrate understanding of this drug, identifying which as the maximum dose for induction?
10 units/min
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
A client with postpartum bleeding has been prescribed 0.6 mg of methyl-ergonovine IM. The available drug is in the form of a 0.2 mg/mL. To meet the recommended dose, what volume of the solution should the nurse administer to the client?
3 mL
A patient is to receive dinoprostone at 4:00 PM. The nurse would expect the patient to begin to experience uterine contractions at which time?
4:15 PM
Conjugated estrogen therapy would be most appropriate for which one of these clients?
A 25-year-old female with primary ovarian failure
Oral contraceptive use would be contraindicated for which client?
A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day
When explaining the potentially harmful effects of anabolic steroid abuse, the nurse should stress which related fact?
Abuse of anabolic steroids can result in addiction.
Which classification of medication is used to treat overactive bladder syndrome?
Antispasmodics
The nurse's ongoing assessment of outpatient clients receiving estrogen, progestin, or combination products should include what assessments? (Select all that apply.)
Blood pressure Therapeutic effects Pulse Respiratory rate
A 34-year-old woman has presented to the clinic for the first time, and the nurse learns that she has been taking medroxyprogesterone for the past 13 years. This aspect of the woman's medical history should prompt what assessment?
Bone density testing
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? (Select all that apply.)
Breast cancer Endometrial cancer
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
A patient is receiving treatment for infertility and is receiving a drug that stimulates ovulation. Which drug would this most likely be?
Chorionic gonadotropin
A group of students are reviewing the various fertility drugs that are available. The students demonstrate understanding when they identify which drug as being administered orally?
Clomiphene
The health care provider has prescribed a combination of estrogen and progestin for a client. The nurse knows that this combination carries an increased risk of which conditions? (Select all that apply.)
Dementia Blood clots Myocardial infarction
The client informs the nurse that she had unprotected intercourse last night. The client is considering requesting emergency postcoital contraception. The nurse's best response is:
Emergency contraception is most effective if started within 24 hours and no later than 72 hours after exposure.
Dinoprostone can be used to terminate a pregnancy after 20 weeks.
False
The nurse monitors the antepartum client receiving oxytocin for induction of labor and should report which as an adverse reactions? Select all that apply.
Fetal bradycardia Uterine hypertonicity
The nurse must complete which assessments prior to starting an IV infusion of oxytocin for induction of labor? (Select all that apply.)
Fetal heart rate Client blood pressure Client respiratory rate
Which are normal physiological changes in the urinary system that occur with age? Select all that apply.
Filtration changes and the urine becomes more dilute. Urethra shortens and the lining becomes thinner, resulting in increasing susceptibility to infection.
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
A patient is using an oral contraceptive combination that includes drospirenone. The nurse would assess the patient for:
Hyperkalemia
A 30-year-old pregnant woman has been prescribed administration of oxytocin. When assessing the patient's drug regimen, the nurse understands that the patient is taking vasopressors. Which risk is the patient most susceptible to if oxytocin is administered along with vasopressors?
Hypertension
A patient is receiving oxytocin intravenously. The nurse would expect this drug to begin acting within which time frame?
Immediately
The nurse is teaching a patient about etonogestrel, which the patient is receiving as a subdermal implant. The nurse informs the patient that the implant will need to be removed at which time?
In 3 years
When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process?
Interviewing the patient and observing for therapeutic and adverse effects
A client is prescribed tamoxifen for vaginal atrophy and menopausal symptoms. The client asks the nurse how this drug works. What is the nurse's best response?
It blocks estrogen effects in different tissues in the body.
The nurse is caring for a female client who is taking medroxyprogesterone and the health care provider has ordered lab work. The nurse understands that which laboratory test may give inaccurate results in clients who take progestins?
Liver function test
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.)
Measure the client's output hourly. Discontinue the oxytocin infusion.
A male patient is receiving therapy to stimulate spermatogenesis. Which agent would most likely be used?
Menotropins
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
The nurse is caring for a 23-year-old female client who is on estrogen therapy. What intervention would be appropriate in a care plan for this client?
Monitor liver function periodically.
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
The nurse is assessing a client who states that she has been taking a lot of black cohosh to deal with her menopausal symptoms. What assessment findings would indicate that the client is experiencing black cohosh toxicity? (Select all that apply.)
Nausea Impaired vision Headache
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
A client is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route?
Oral
A postmenopausal woman is receiving raloxifene as part of a treatment plan for osteoporosis. The nurse would instruct the patient that this drug is administered by which route?
Oral
A postmenopausal woman is administered estradiol for the purpose of preventing which condition?
Osteoporosis
Medroxyprogesterone is an effective form of birth control. Long-term use can cause what serious adverse effect?
Osteoporosis
A 26-year-old client who delivered a baby 24 hours prior, reports cramping pain while breast-feeding. The nurse caring for the client understands that breast-feeding causes the release of which hormone, which can cause uterine cramping?
Oxytocin
When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins?
Pelvic inflammatory disease
Pitocin is given to prevent what condition?
Postpartum bleeding
A 31-year-old pregnant woman has been prescribed administration of a tocolytic drug. During which period is a tocolytic drug usually administered?
Pre-term labor
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
After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.)
Respiratory rate Blood pressure Pulse
A nurse is caring for a patient who has been administered menotropins by the intramuscular route for the secretion of sex hormones. The patient reports pain after the drug is injected. Which intervention should the nurse perform for the patient?
Rotate sites and examine previous sites for redness.
The anatomy and physiology instructor is discussing the action of endogenous estrogen on the body. What effect would the instructor tell the students estrogen has on breast tissue in the body?
Stimulates construction of milk ducts
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 patient is to receive lutropin alfa. The nurse would expect to administer this agent by which route?
Subcutaneous
The nurse is discussing the plan of care another nurse has developed with the client. What is an appropriate outcome that the nurse and the client may decide on?
The client can verbalize an understanding of preventable adverse drug effects.
The nurse is caring for a patient who is beginning hormone replacement therapy. Which goal is appropriate to include in the patient's plan of care?
The patient will take drugs accurately and for the length of time prescribed.
A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?
The risks of stroke and breast cancer are unacceptably high in women taking HRT.
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 occurring every 90 seconds.
A 37-year-old woman has just experienced the end of a long-term relationship and has expressed a desire to begin using oral contraceptives. What aspect of this woman's current health status would contraindicate this treatment?
The woman takes an antiplatelet medication for coronary artery disease.
When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis?
Thromboembolism
The nurse anticipates the health care provider will order methylergonovine for which purpose?
To contract the uterus after delivery of the placenta
Medroxyprogesterone acetate is indicated for the treatment of women with what disorder?
Uterine bleeding
A menopausal client, prescribed estrogen and progesterone, asks why she should take two different medications. Which explanation best addresses the client's question?
When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.
A client has been diagnosed with benign prostatic hypertrophy. Which group of medications are used to treat this disorder?
alpha adrenergic blockers
When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment?
blood pressure
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.
After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from:
clomiphene.
A group of nursing students are reviewing information about hormonal therapy for cancer. The students demonstrate understanding of the information when they identify which medication as a gonadotropin-releasing hormone analog? Select all that apply.
degarelix leuprolide
A nurse is caring for a client who is receiving magnesium. The nurse would be alert for which finding?
depressed reflexes
What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen?
endometrial cancer
A 49-year-old female client is asking the nurse about how her changing hormones relate to menopause. The nurse explains that atrophic vaginitis is a common problem during menopause. The treatment for atrophic vaginitis requires replacing:
estrogen.
A patient is beginning therapy with a combined oral contraceptive. The nurse would instruct the patient to take the first pill on the:
fifth day of the cycle.
A monophasic oral contraceptives composition is described as having which characteristic?
fixed amounts of both estrogen and progestin components
A client is prescribed flavoxate. Which adverse effects should the nurse discuss with the client? Select all that apply.
headache dry mouth urinary retention
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?
hysterectomy
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.
A nurse is reading a journal article about female hormones. Which would the nurse identify as a progestin?
norethindrone
A female client tells the nurse that she has been experiencing a strong and sudden desire to urinate and often cannot make it to the bathroom. The client also tells the nurse that she has to urinate all day and "many times" at night. The nurse suspects:
overactive bladder.
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.
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 is prescribed tamoxifen. Which medical condition in the client's history would lead to tamoxifen being prescribed with caution? Select all that apply.
stroke deep vein thrombosis myocardial infarction
A client is diagnosed with overactive bladder syndrome. What would the nurse anticipate the health care provider to prescribe?
tolterodine
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?
venous thromboembolism
Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect?
water intoxication
