Chapter 52: Drugs Affecting Women's Health and Sexuality

A client who has been on estrogen therapy for two months calls the clinic and tells the nurse that she has developed increased pigmentation to her facial skin. What is the nurse's best response to this client? "This must be a reaction to some makeup you are using. It is not related to the estrogen." "This will go away as soon as you stop the therapy." "Changes to the skin may not go away even after the medication is discontinued." "If you wash your face in hot, soapy water three times a day, it will go away."

"Changes to the skin may not go away even after the medication is discontinued."

The nurse is discussing estrogen therapy with a woman age 52 years. What information will the nurse share with this client regarding estrogen's benefit to the cardiac system? "Low-dose estrogen in women under the age of 60 may be beneficial to the cardiac system." "High-dose estrogen in women under the age of 60 will reverse the effects of aging in the heart." "Estrogen therapy has shown no benefit to the cardiac system." "Estrogen therapy is only beneficial to the cardiac system if it is started before age 50."

"Low-dose estrogen in women under the age of 60 may be beneficial to the cardiac system."

Conjugated estrogen therapy would be most appropriate for which one of these patients? A 72-year-old with newly diagnosed breast cancer A 25-year-old female with primary ovarian failure A 35-year-old with a history of thrombophlebitis, to prevent pregnancy A 65-year-old with a history of abnormal vaginal bleeding

A 25-year-old female with primary ovarian failure Conjugated estrogen is used primarily in hormone replacement therapy (HRT), female hypogonadism, female castration, and primary ovarian failure. Estrogen is contraindicated in the following conditions: estrogen-dependent neoplastic diseases, undiagnosed abnormal genital bleeding, active thrombophlebitis or thromboembolic disorders, history of thrombophlebitis, thrombosis, or thromboembolic disorders, and known or suspected pregnancy (estrogen is a pregnancy category X drug because of known adverse effects on the developing fetus).

It was formerly common practice to include progestin with estrogen in hormone replacement therapy (HRT) to prevent endometrial cancer resulting from unopposed estrogenic stimulation. Why is long-term use of this combination no longer recommended? It was found that unopposed estrogen stimulation does not actually increase the risk of endometrial cancer. The combination was found to increase the incidence of endometrial cancer. Estrogen-progestin combinations were found to cause serious adverse effects. None of the above

Estrogen-progestin combinations were found to cause serious adverse effects.

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

Osteoporosis

Progestin medications can cause a variety of adverse effects. When assessing a patient who is taking such a medication, what might you observe? Mental depression Breakthrough bleeding Weight gain All the above

All the above

A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed regarding the administration? The medication, when exposed to sunlight, can increase the risk of breast cancer development. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations. Exposure of the medication to cold will increase effectiveness with application once a month. The application of heat at the patch site will decrease effectiveness and result in pregnancy.

Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.

A young mother is requesting oral contraceptives at her 6-week postnatal visit. Which of the following would be a contraindication for the use of progestin? Family history of cardiovascular disease History of recent cholecystectomy History of pelvic inflammatory disease Breastfeeding

Breastfeeding

The U.S. Food and Drug Administration (FDA) has issued a Black Box Warning concerning estrogen's use and associated increased risk of which of the following? Lung disease Pelvic inflammatory disease Osteosarcoma Endometrial carcinoma

Endometrial carcinoma

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: As long as estrogen and progesterone are taken together, there are no increased health risks. Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots. Estrogen has not been proven to increase any medical conditions. Estrogen decreases the risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot.

Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.

The nurse knows that megestrol (Megace) is used in the treatment of breast and endometrial cancer, but it is used for what reason in clients with human immunodeficiency (HIV) infection? Improved mental acuity Pain control Weight gain Reduction of viral load

Weight gain

A woman is prescribed hormonal contraceptives. What places her at risk for the development of blood clots? Hormonal contraceptives increase blood levels of clotting factors. Hormonal contraceptives stimulate skeletal growth and RBC production. Hormonal contraceptives will cause peripheral vasoconstriction. Hormonal contraceptives increase serum triglyceride and cholesterol.

Hormonal contraceptives increase blood levels of clotting factors.

A 37-year-old woman recently underwent a bilateral salpingo-oophorectomy. During the assessment, which of the following situations should the nurse ask about to determine the client's surgical menopausal status? Headaches Decreased appetite Weight gain Hot flashes

Hot flashes

When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process? Directing the patient to weigh herelf weekly and to report sudden weight gain Interviewing the patient and observing for therapeutic and adverse effects Teaching the patient that combined estrogen-progestin therapy may increase blood sugar levels in women with diabetes Teaching the patient to take estrogens and progestins with food or at bedtime to decrease nausea

Interviewing the patient and observing for therapeutic and adverse effects

A patient is receiving menotropins. The nurse would anticipate administering this drug by which route? Subcutaneous Oral Intradermal Intramuscular

Intramuscular

A post-menopausal patient has been diagnosed with breast cancer. The patient is being treated with methyltestosterone (Testred). What would indicate that she is developing a complication from the medication? Increased blood pressure Jaundice Weight loss High-pitched voice

Jaundice

The client is about to begin therapy for erectile dysfunction and asks the nurse about the likelihood of priapism occurring with these medications. The nurse knows that priapism is most likely to occur in clients with which condition? Select all that apply. Testicular torsion Multiple myeloma Iron deficiency anemia Raynaud's disease Leukemia

Multiple myeloma Leukemia Priapism is more likely to occur in clients with sickle cell anemia (no iron deficiency), multiple myeloma, leukemia, or an anatomic deformity of the penis. A history of testicular torsion or Raynaud's disease does not increase the chance that the client will develop priapism.

Which is an example of a progestin? Raloxifene (Evista) Estradiol (Estrace) Norethindrone (Aygestin) Bicalutamide (Casodex)

Norethindrone (Aygestin)

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 month Once a week Once every other day Once a day

Once a day

A patient is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route? Intravenous Intravaginal Oral Subcutaneous

Oral

A postmenopausal woman is administered estradiol (Estraderm). What condition will be prevented in this patient? Uterine cancer Osteoporosis Amenorrhea Endometriosis

Osteoporosis

Estradiol is sometimes administered to postmenopausal women to prevent which condition? Osteoporosis Dysfunctional uterine bleeding Endometriosis Uterine cancer

Osteoporosis

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the physician? Weight gain Abnormal menstrual bleeding Breast tenderness Pain in one leg

Pain in one leg Pain in one leg could indicate a thrombus formation. Common side effects of progesterone are abnormal menstrual bleeding, including spotting; breast tenderness; and weight gain.

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the physician? Abnormal menstrual bleeding Weight gain Breast tenderness Pain in one leg

Pain in one leg (thrombus formation)

The nurse knows that, in a client whose uterus is intact, estrogen must be paired with what other drug when used to treat menopausal symptoms? Antispasmodics Progestins Aromatase inhibitors Androgen hormone inhibitors

Progestins

A client who is on estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse tells the client to go to the emergency department immediately, because the nurse suspects what adverse reaction related to estrogen therapy? Pulmonary embolism Deep vein thrombosis Skeletal pain Breast pain

Pulmonary embolism

The nurse is aware that progestins will be prescribed with great caution in a client with which condition? (Select all that apply.) Epilepsy Tension headaches Renal disase Asthma Arthritis

Renal disase Epilepsy Asthma Progestins are used with great caution in clients with renal impairment, migraine headaches, epilepsy, asthma, and cardiac disease. There is no caution if clients with tension headache or arthritis use progestins.

The anatomy and physiology instructor is describing the secretion of endogenous estrogen in nonpregnant women. According to the instructor, what happens to estrogen secretion two to three days before the onset of menstruation? Secretion is stopped. Secretion decreases gradually. Secretion decreases abruptly. Secretion increases abruptly.

Secretion decreases abruptly. In nonpregnant women, between puberty and menopause, estrogens are secreted in a monthly cycle called the menstrual cycle. During the first half of the cycle, before ovulation, estrogens are secreted in progressively larger amounts. During the second half of the cycle, estrogens and progesterone are secreted in increasing amounts until 2 to 3 days before the onset of menstruation. At that time, secretion of both hormones decreases abruptly.

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: You need both estrogen and progesterone to stop the hot flashes. Taking both of the medications together will make your periods lighter and of shorter duration. You should speak to your health care provider because you do not need to take both prescriptions. When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

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

Patient education is necessary to ensure proper use of exogenous estrogen and to enable the patient to recognize adverse effects. Which of the following should a nurse teach the patient? Maintenance of proper records Self-breast examination Proper use of barriers to prevent STDs Basal body temperature evaluation

Self-breast examination

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 decrease in weight bearing exercise A craving for sugar Smoking a pack of cigarettes a day Gaining ten pounds in the last 3 months

Smoking a pack of cigarettes a day

When prescribing estrogen therapy, the U.S. Food and Drug Administration (FDA) recommends what dosing protocol? Following age dosage chart as provided by pharmaceutical company Adequate dose to maintain a certain serum blood level Supervised use at the lowest dose for the shortest duration Following recommendations of the pharmaceutical company

Supervised use at the lowest dose for the shortest duration

Hormones from various organs regulate the menstrual cycle. Which of the following hormones does not directly influence the cycle? Gonadotropin-releasing hormone Testosterone Follicle-stimulating hormone Luteinizing hormone

Testosterone

Why does the presence of estrogen in oral contraceptives increase the risk for developing blood clots? The estrogen increases serum triglyceride, cholesterol, and glucose levels. The estrogen causes peripheral vasoconstriction. The estrogen stimulates skeletal growth, causing increased production of red blood cells. The estrogen increases production of clotting factors.

The estrogen increases production of clotting factors.

A woman of childbearing age is diagnosed with breast cancer. She is currently taking hormonal contraceptives. What information should the woman be given regarding the hormonal contraceptives? The hormonal contraceptives will impair uterine bleeding. The hormonal contraceptives will inhibit tumor growth. The hormonal contraceptives will stimulate tumor growth. The hormonal contraceptives will stimulate uterine bleeding.

The hormonal contraceptives will stimulate tumor growth.

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? Edema of the feet Thromboembolism Chloasma Gastrointestinal upset

Thromboembolism The nursing diagnosis of impaired tissue perfusion is related to thromboembolism, which is a complication of estrogen replacement therapy.

A 49-year-old female patient 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. testosterone. human chorionic gonadotropin. progesterone.

estrogen