Chapter 7 Drugs for Women's Health Prep U

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."

A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications?

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

Which statement by a female client who is using the Estradiol transdermal system indicates a need for further instruction?

"I prefer to apply the patch to my upper thigh only."

A nurse is caring for a 25-year-old clinic client who is starting on birth control pills. What statement by the client indicates that she needs further teaching?

"I will exercise more if I experience chest or leg pain."

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 client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time?

3 months

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

4 hours

Oral contraceptive use would be contraindicated for which client?

A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day

A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they state:

A primary function of the female breast is to produce milk.

A client has come in for her annual physical examination. During the assessment, the nurse learns the client is now taking carbamazepine after suffering a seizure of unknown etiology. This is concerning for which of the following reasons?

Anticonvulsants increase the metabolism of oral contraceptives.

The nurse is giving discharge instructions to a client who has begun to take medroxyprogesterone for treatment of irregular vaginal bleeding. The nurse instructs the client to take this medication at what time to reduce gastrointestinal effects?

At bedtime

A client has been prescribed transdermal estradiol. What important information does the nurse share with this client?

Avoid prolonged sun exposure

The nurse is discussing the use of Depo-Provera with a 17-year-old female who desires birth control. The nurse recognizes that this medication is used in this client for what reason?

Birth control for 3 months

The nurse is aware that medroxyprogesterone has a black box warning that the use of the medication can lead to what problem?

Bone breakage

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

What would a nurse attribute to estrogen?

Breast growth

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

Cardiovascular complications

The nurse is caring for a client in an outpatient clinic who plans to take an oral contraceptive. The nurse should perform which pre-administration assessment(s) before the client sees the primary care provider? Select all that apply.

Determine menstrual history, including age of onset of menses, pattern of menses, and any changes to the pattern. Assess sexual history, including number of partners, sexual practices, and reason for wanting the contraceptive. Obtain an assessment of using tobacco products, smokeless tobacco, or any attempts to quit using tobacco. Gather client history of any breast, uterine, or ovarian cancers and cardiovascular or thromboembolism disorders.

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

Endometrial cancer

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?

Endometrial carcinoma

Which hormone serves to stimulate the development of female characteristics and prepares the body for pregnancy?

Estrogen

The nurse examines the history of a client prescribed oral contraceptive with estrogen and progestin and should report which as contraindication(s)? Select all that apply.

Estrogen dependent breast cancer Fatty liver disease Migraine headaches Deep vein thrombosis

The school nurse is teaching some adolescent girls about the physiology of the menstrual cycle. In what sequence should the nurse describe the following events?

GnRH is released by the hypothalamus. The anterior pituitary releases FSH and LH. Follicles are stimulated, and release estrogen. Ovulation takes place. Reduced levels of estrogen and progesterone cause the uterine lining to slough.

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?

Hot flashes

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 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

A client with estrogen excess may report which symptoms to the nurse during ongoing assessment during treatment with Ortho-Novum 7/7/7? (Select all that apply.)

Nausea Cervical mucorrhea Edema

The nurse is caring for a woman who is receiving estrogen for treatment of amenorrhea. What evidence will the nurse use to indicate that the medication is working properly?

Occurrence of menstruation

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

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

Osteoporosis

During pregnancy, what becomes a massive endocrine gland?

Placenta

After teaching a group of students about female reproductive hormones, the instructor determines that the teaching was successful when the students identify which hormone as being primarily responsible for maintaining pregnancy?

Progesterone

After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies what as a primary function of the ovaries?

Secretion of estrogen and progesterone

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?

Self-breast examination

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

Shortness of breath

A 27-year-old woman is concerned that she is pregnant even though she has been using oral contraceptives. During the assessment, the nurse discovers the client has been using various herbs. Which of the following herbs is contraindicated for use with oral contraceptives?

St. John's wort

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

Hormones from various organs regulate the menstrual cycle. Which of the following hormones does not directly influence the cycle?

Testosterone

The nurse is caring for a client who would like to start taking oral contraceptives. What aspect of this client's health history should the nurse prioritize for follow-up?

The client was treated for deep vein thrombosis following surgery.

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."

Women generally do not eat foods high in calcium, which means that women of all ages generally consume less than the recommended amount of calcium. What supplement may be helpful in reducing bone loss?

Vitamin D

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.

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.

The nurse is completing a health history on a client experiencing menopause. What assessment findings indicate menopause? Select all that apply.

hot flashes mood changes sleep problems painful intercourse

A client with a 28-day cycle reports that she ovulated on May 10. The nurse would expect the client's next menses to begin on:

may 24

Regular monthly menstrual cycles cease at the time of:

menopause.

If a released egg is not fertilized, the lining of the uterus breaks down in the process called:

menstruation.

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

oral

A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would likely identify this as which condition?

overactive bladder syndrome