Ch 40: Female repro drugs

The nurse is discussing estrogen therapy with a 52-year-old woman. What information will the nurse share with this client regarding estrogen's benefit to the cardiac system? "Any dose of estrogen should not be used as a cardioprotective drug." "Estrogen therapy is only beneficial to the cardiac system if it is started before age 50." "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."

"Any dose of estrogen should not be used as a cardioprotective drug." Though controversy exists regarding the increased risk of chronic heart disease and female cancers with the use of estrogen. Estrogen should not be used as a cardioprotective drug. Transdermal delivery systems are being explored to reduce the use of oral estradiol products and provide lower concentrations in the circulatory system.

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." "If you have a physical within 2 years, I can get your medication refilled." "Since you are doing well on this regimen, I'll arrange to get the prescription filled for a month to last until your clinic appointment." "Before estrogen based drugs are prescribed, you must see the health care provider to get an order for a mammogram."

"Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended." Because estrogens, progestins, and hormonal contraceptives are often taken for years and may cause adverse reactions, clients taking these drugs need continued supervision by a health care provider. Before the drugs are prescribed, a complete medical history; a physical examination including breast and pelvic examinations and a Pap test; urinalysis; and weight and blood pressure measurements are recommended. These examinations should be repeated at least annually if the client is taking the drugs.

A client 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? "There is an increase in the gonadotropins." "The menstrual cycle becomes irregular." "Hot flashes and night sweats are prominent." "Estrogen and progesterone diminish."

"Estrogen and progesterone diminish." During menopause, estrogen and progesterone diminish causing the menstrual cycle to become more irregular and then stops altogether. Symptoms of the decrease in estrogen and progesterone are hot flashes, night sweats, vaginal dryness, and sleep problems. There is not an increase of gonadotropins during menopause.

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? "We'll have to check your bone density first, because if it's too low then it's not safe to start HRT." "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" "Actually, most of the current research is suggesting that HRT may not be all that effective in treating the symptoms of menopause." "HRT might be quite beneficial to you, and it carries the additional benefit of modest protection against breast cancer."

"It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" Research from the WHI trial indicates that estrogen given to postmenopausal women in combination with progestin significantly increases the risk of stroke and coronary heart disease (CHD). HRT is associated with increased, not decreased, risk of breast cancer and it may complicate early diagnosis of the disease. HRT does not exacerbate low bone density or constitute a risk factor for osteoporosis.

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." "You need to carefully consider whether you might want to get pregnant later in your life." "It will take 10 to 12 weeks before the birth control pills will actually prevent pregnancy, so be vigilant with other contraceptives until then." "Some women get some pain in their chest or abdomen when they take oral contraceptives, but this will pass as your body gets used to them."

"Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." An important nursing intervention is teaching about signs and symptoms of potential complications of estrogen and progestin contraceptives. These may include headaches, vision changes or pain in the calves, abdomen or chest and should be reported promptly. The use of oral contraceptives does not preclude future pregnancy. There is not a 10- to 12-week time span between the initiation of oral contraceptives use and the prevention of pregnancy.

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? "Medication adjustments are based on baseline laboratory values." "Additional labs will be ordered if these values indicate problems with your body." "I will get the prescriber to talk to you about the laboratory assessments ordered." "The labs will identify your body's ability to filter and excrete medications."

"The labs will identify your body's ability to filter and excrete medications." Estrogens are used cautiously in a variety of disease processes, including liver impairment. The liver filter or metabolizes medications. The kidneys are the main organ that excretes medications. The nurse is providing a rationale to the client about drawing laboratory assessments. Medication adjustments are based on baseline laboratory values, but this does not explain why labs are needed currently. The health care provider or the nurse can discuss the laboratory assessments when they are completed. Additional labs may be ordered on a future date but teaching is focused on the need for labs currently.v

During client teaching, a young woman asks the nurse, "If I get pregnant on the 'pill' should I continue to take it?" What is the nurse's best response? "The pill will cause miscarriage." "The pill can be harmful to the female fetus." "The pill is not harmful to the male fetus." "The pill has no effect on pregnancy."

"The pill can be harmful to the female fetus." If pregnancy does occur, estrogens are contraindicated because their use during pregnancy has been associated with the occurrence of vaginal cancer in female offspring. The pill will affect the pregnancy and should be discontinued. The pill will not cause miscarriage. The pill can cause harmful effects on male offspring if it is continued through pregnancy.

Which client who is taking progesterone would a nurse monitor most carefully for potential adverse effects? A 38-year-old woman who is HIV-positive A 45-year-old woman who has hepatitis C A 56-year-old woman with hypotension A 32-year-old woman with epilepsy

A 32-year-old woman with epilepsy Progesterone therapy may result in fluid retention. Clients with pathologies that may be adversely affected by fluid retention, such as epilepsy, migraines, asthma, cardiac dysfunction, and renal dysfunction, need to be given progesterone with extra caution. Clients with hypotension, those who are HIV-positive, and clients who have hepatitis would not require as careful monitoring directly related to progesterone therapy as the client with epilepsy.

Oral contraceptive use would be contraindicated for which client? A 45-year-old client who has a family history of pancreatic cancer A 40-year-old client who has a family history of hypofunction of the pituitary gland A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day A 50-year-old client who is taking a cholesterol-lowering medication

A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day Because of their widespread effects on body tissues and reported adverse reactions, estrogens, progestins, and hormonal contraceptives are contraindicated in thrombotic disorders, known or suspected cancers of breast or genital tissues, undiagnosed vaginal or uterine bleeding, fibroid tumors of the uterus, family history of breast or reproductive system cancers, active liver disease or impaired liver function, history of cerebrovascular disease, coronary artery disease, hypertension, or conditions predisposing to these disease processes and women older than 35 years of age who smoke cigarettes.

After teaching a group of students about abortifacients, the instructor determines that the teaching was successful when students identify which condition as a contraindication to their use? Hypertension Adrenal disease Active pelvic inflammatory disease Asthma

Active pelvic inflammatory disease Active PID is a contraindication to the use of abortifacients because the infection could be exacerbated by the drug. Abortifacients are used cautiously in patients with asthma. Abortifacients are used cautiously in patients with hypertension. Abortifacients are used cautiously in patients with adrenal disease.

A nurse administers methylergonovine (Methergine) to a client immediately after delivery of a normal, healthy baby boy. The nurse will advise her that she may experience which common adverse effect of the drug? An increase in blood pressure Diarrhea Numbness Tingling of the extremities

An increase in blood pressure Methylergonovine is given orally three or four times a day beginning immediately postpartum for a maximum of 1 week. Hypertension, sometimes with seizures or headache, is the most common adverse effect. Tingling of the extremities and numbness are signs of acute overdose. Diarrhea is not associated with the use of the drug.

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? Cardiac stress testing Renal ultrasound Evaluation of triglyceride levels Bone density testing

Bone density testing There is a black box warning regarding the use of medroxyprogesterone that relates to its being associated with the loss of stored calcium from bones, which increases the risk of broken bones and osteoporosis, especially after menopause. There is a greater risk of bone loss with long-term use. Consequently, bone density testing may be warranted. There is no particular in

A female client began an infusion of oxytocin 2 hours ago and the nurse has been conducting regular assessments on her as well as monitoring the fetal heart rate closely. The nurse should prioritize which potential nursing diagnosis in the organization of the client's immediate care? Ineffective breathing pattern Excess fluid volume Hyperthermia Altered thought processes

Excess fluid volume There are numerous potentially adverse effects associated with the use of oxytocin. Paramount among these, however, is the risk of excess fluid volume and water intoxication. This risk supersedes the potential for respiratory, cognitive, or thermoregulatory problems.

Clomiphene is administered subcutaneously as well as orally. False True

False Clomiphene is administered orally only.

An adult woman began using oral contraceptives several months ago and has presented for an appointment to discuss recent worrisome changes in her health status. Which change in the woman's health may the nurse potentially attribute to the use of oral contraceptives? Nausea and vomiting Frequent high blood pressure readings Fatigue Frequent headaches without aura

Frequent high blood pressure readings It is very important to monitor for adverse drug effects such as high blood pressure, gallbladder disease, and blood-clotting disorders, which may be associated with oral contraceptive use. Headaches, nausea, and fatigue are not among the more common adverse effects of oral contraceptives.

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? Cholestatic jaundice Amenorrhea Headaches Breast tenderness

Headaches Pain in the groin, headaches, dizziness, and chest pain are symptoms of thrombophlebitis and thromboembolism, which are two common adverse effects of taking estrogen. Cholestatic jaundice is an adverse effect of estrogen. Amenorrhea is an indication for progesterone therapy. Breast tenderness is an adverse effect of progesterone.

The nurse is aware that intranasal oxytocin is used for what reason? Firm and boggy fundus in the postpartum period Control of postpartum bleeding Decreasing the intensity of postpartum contractions Help with milk letdown in breastfeeding

Help with milk letdown in breastfeeding Intranasal oxytocin is only used to stimulate the milk ejection (milk letdown) reflex to allow for successful breastfeeding. Oxytocin in the intranasal form is not used to cause contraction of the fundus, nor to control bleeding in the postpartum period. Oxytocin is only ever used to stimulate the uterus, not prevent, slow down or decrease the intensity of contractions.

A patient is to start on misoprostol (Cytotec) therapy to produce uterine contractions. Before therapy begins, the nurse should prioritize which assessment? History of hypertension History of previous cesarean delivery Intake and output for the last 24 hours Mental status

History of previous cesarean delivery Even though the assessment of the patient's mental status, blood pressure, and intake and output is important and should be done, it is not as important as determining if the patient has had a cesarean delivery or prior uterine surgery. Either condition could cause the uterus to rupture with the use of misoprostol.

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? Anaphylactic shock Hypertension Respiratory failure Heart attack

Hypertension Combining oxytocin with vasopressor drugs increases the risk of severe hypertension. Combining oxytocin and vasopressors does not increase the risk of heart attack or respiratory failure. Anaphylactic shock is associated with a hypersensitivity reaction and does not occur with the interaction of vasopressors with oxytocin.

A patient is receiving oxytocin intravenously. The nurse would expect this drug to begin acting within which time frame? 8 to 11 minutes Immediately 5 to 8 minutes 3 to 5 minutes

Immediately Oxytocin IV has an immediate onset of action.

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 2 years In 3 years In a year In 4 years

In 3 years Etonogestrel subdermal implant may be left in place for up to 3 years and then it must be removed. Another implant could be placed at that time.

A client with a complex medical history is considering the use of oral contraceptives. The nurse should be aware that many antibiotics and antiseizure medications cause what effect when combined with oral contraceptives? Increased gastric acid Increased blood pressure Increased risk of pregnancy Increased risk of thromboembolism

Increased risk of pregnancy Several medications may reduce the effectiveness of oral contraceptives (i.e., increase the likelihood of pregnancy). These include several antibiotics and antiseizure medications. This combination does not increase blood pressure, risk of thromboembolism, or gastric acid secretion.

A 26-year-old is prescribed clomiphene as part of treatment for infertility. What is the mechanism of action of clomiphene? Decreases secretion of FSH Increases the output of the pituitary gonadotropins Increases estrogen at the receptor sites Decreases the output of LH

Increases the output of the pituitary gonadotropins Clomiphene (Clomid, Milophene, Serophene) is an ovulation stimulant. This nonsteroidal agent promotes ovulation by indirectly increasing the output of the pituitary gonadotropins. Clomiphene binds to estrogenic receptors, preventing estrogen from binding. The hypothalamus and pituitary gland interpret this development as indicative of low estrogen levels and respond by increasing secretion of LH, FSH, and gonadotropins, thus stimulating ovulation.

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. It activates estrogen receptors in the breasts. It is used to treat ovarian cancer. It prevents osteoporosis.

It blocks estrogen effects in different tissues in the body. Tamoxifen is a selective estrogen receptor modulator drug. SERMS potentiate or block estrogen effects in different tissues and aid in hormonal treatment of postmenopausal symptoms. Tamoxifen is used to treat breast cancer, not ovarian cancer. Tamoxifen can be used for osteoporosis prevention but this is not indicated in the client's history. Tamoxifen does not activate estrogen receptors in the breasts.

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 Complete blood count Renal function test Electrolyte test

Liver function test Progestin use often results in inaccurate liver function and endocrine function tests.

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.) Encourage the client to force fluids. Measure the client's output hourly. Discontinue the oxytocin infusion. Increase the client's maintenance IV. Administer oxytocin intranasally.

Measure the client's output hourly. Discontinue the oxytocin infusion If the nurse observes any signs of fluid overload, the nurse should discontinue the oxytocin infusion but let the primary IV line run at the rate ordered until the health care provider examines the client. The nurse should continue to monitor the client's input and output frequently. The client's oral fluids should be limited because this can contribute to water intoxication. The client should not receive any more oxytocin until the health care provider gives the approval. Intranasal oxytocin is only used to assist in milk letdown with breast feeding..

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? Raloxifene Etidronate Misoprostol Alendronate

Misoprostol After taking mifepristone, if the medical abortion is not complete in 3 days, the patient will take two tablets of misoprostol. Misoprostol is a synthetic prostaglandin E1 analogue. Although it is used to prevent gastric ulcers resulting from the use of nonsteroidal anti-inflammatory drugs, it is also known to have abortifacient properties, by producing uterine contractions. Alendronate, raloxifene, and etidronate are drugs given for osteoporosis.

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 Weight loss Reduction of breast tissue Cessation of bleeding and/or spotting

Nausea Taking combination oral contraceptives is commonly accompanied by nausea. The nurse should tell the client to anticipate this adverse effect. Breakthrough bleeding or spotting is likely with the medication. The nurse would be incorrect to inform the client that bleeding with cease completely. More commonly, clients taking oral contraceptives experience mild to moderate weight gain, not loss. Breast swelling and tenderness is common with this medication, not a reduction in breast tissue.

A nurse is teaching a young adult client about oral contraceptives, which the client will soon begin taking. The client's primary concern is the effectiveness of the medication in preventing pregnancy. The nurse should teach the client that oral contraceptives, when taken consistently, are how effective in preventing pregnancy? Highly effective, but partially dependent on genetic factors Nearly 100% Between 96% and 98% Approximately 98.5%

Nearly 100% When taken correctly, estrogen-progestin contraceptive preparations are nearly 100% effective in preventing pregnancy. Genetics do not significantly affect treatment.

A 16-year-old is prescribed estrogen therapy for hypogonadism. During therapy, what will the nurse monitor the client closely for? Ovarian cancer Cardiovascular complications Endometrial cancer Normal sexual development and growth

Normal sexual development and growth When a prepubescent girl is given estrogen to treat lack of the same hormone, the nurse should monitor for growth throughout therapy to prevent premature closing of the epiphyses and also evaluate for normal sexual development with therapy. Other complications and disorders are mostly to be found in postmenopausal women who are given estrogen.

A 32-year-old pregnant woman has been prescribed an IV infusion of oxytocin to induce labor. Which intervention should the nurse implement before starting the IV infusion of oxytocin for the patient? Obtain an obstetric and general health history. Examine for signs of water intoxication. Ask the patient to drink plenty of water. Place the patient in an upright position.

Obtain an obstetric and general health history. Before starting an IV infusion of oxytocin to induce labor, the nurse should obtain a complete obstetric history (e.g., parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live-birth infant abnormalities) and a general health history. Patient should not have water before labor, as the oxytocin may lead to water intoxication. The nurse should examine for any signs of water intoxication or fluid overload as a sign of an adverse reaction to the drug and need not assess this before administration of the medication. Placing the patient in an upright position is advised when oxytocin is administered intranasally to facilitate the letdown of milk for breastfeeding.

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 Once a week Once every other day Once a month

Once a day Intravaginal estradiol is administered every day.

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? Intramuscular Transdermal Intravaginal Oral

Oral Raloxifene is administered only by the oral route.

After teaching a woman who is receiving estrogen hormonal therapy about substances to avoid, the nurse determines that additional teaching is needed when the patient cites: Grapefruit juice Orange juice Smoking St. John's wort

Orange juice Orange juice does not need to be avoided with estrogen hormonal therapy. However, St. John's wort, smoking, and grapefruit juice should be avoided.

A postmenopausal woman is administered estradiol for the purpose of preventing which condition? Endometriosis Amenorrhea Osteoporosis Uterine cancer

Osteoporosis Conjugated estrogens are used to prevent osteoporosis in postmenopausal women. Conjugated estrogens are not administered in postmenopausal women to treat endometriosis, amenorrhea, or uterine cancer.

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

Osteoporosis Estropipate and other estrogens are sometimes prescribed to postmenopausal women to prevent or treat osteoporosis associated with hormone deficiency. However, given the potentially significant risks associated with hormone replacement therapy, this use is not currently considered a first-line treatment.

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

Osteoporosis It is very important to monitor for adverse drug effects such as high blood pressure, gallbladder disease, and blood-clotting disorders, which may be associated with oral contraceptive use. Headaches, nausea, and fatigue are not among the more common adverse effects of oral contraceptives.

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 Estrogen Progesterone Prolactin

Oxytocin Oxytocin is the hormone that is responsible for milk letdown. During letdown, the increased amounts of oxytocin in the circulation can lead to uterine contractions.

When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins? Epilepsy Pelvic inflammatory disease Asthma Migraine headaches

Pelvic inflammatory disease Progestins are contraindicated in patients with pelvic inflammatory disease because progestins affect the vasculature of the uterus. Cautious use is necessary for women with migraine headaches, asthma, and epilepsy due to possible exacerbation of these conditions with the use of progestins.

After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.) Pulse Respiratory rate Blood glucose Temperature Blood pressure

Pulse Respiratory rate Blood pressure After an injection of oxytocin (Pitocin), during ongoing assessment the nurse monitors the client's blood pressure, pulse, and respiratory rate.

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? Observe the skin daily for localized signs of infection. Report any sore throat, cough, or fever. Instruct the patient about proper injection technique. Rotate sites and examine previous sites for redness.

Rotate sites and examine previous sites for redness. When the patient experiences pain after menotropins are administered by the intramuscular route, the nurse should rotate sites and examine previous sites for redness and irritation. The nurse need not report sore throat, cough, or fever, instruct the patient about proper injection technique, or observe the skin daily for localized signs of infection. The nurse needs to report sore throat, cough, or fever in a patient taking adrenocorticotropic hormones (ACTH). When a patient is receiving growth hormones, the nurse needs to instruct the family members of the patient about the proper injection technique. The nurse needs to observe the skin daily for localized signs of infection in a patient receiving adrenocorticotropic hormones (ACTH).

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? Supports development of the placenta Restricts deposition of fat to abdomen and thighs Depresses formation of connective tissue during the 3rd decade of life Stimulates construction of milk ducts

Stimulates construction of milk ducts Estrogens are important for the development of the female reproductive system and secondary sex characteristics.

When caring for a postpartum patient who is receiving oxytocin intranasally, the nurse understands what is the action of oxytocin? Controls antepartum bleeding Has a diuretic effect Stimulates the milk ejection reflex Anti-stimulating properties on the uterus

Stimulates the milk ejection reflex Oxytocin, when administered intranasally, stimulates the milk ejection (milk letdown) reflex. Oxytocin has uterine-stimulating properties, not antistimulating properties, on the uterus. Tocolytics have an antistimulating effect on the uterus. Oxytocin has an antidiuretic effect, which might lead to a danger of excessive fluid volume (water intoxication), and not a diuretic effect. Oxytocin is given IM during the third stage of labor to produce uterine contractions and control postpartum, and not antepartum bleeding and hemorrhage.

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 do not affect the course of the disease. The hormonal contraceptives will impair uterine bleeding. The hormonal contraceptives will stimulate tumor growth. The hormonal contraceptives will stimulate uterine bleeding.

The hormonal contraceptives will stimulate tumor growth. With known or suspected cancers of the breast or genital tissues, hormonal contraceptives may stimulate tumor growth. The hormonal contraceptives should be discontinued due to adverse reactions and stimulated tumor growth. The hormonal contraceptives will not inhibit tumor growth. The hormonal contraceptives can decrease uterine bleeding, but this action is not related to the breast tumor. The hormonal contraceptives will not stimulate or impair uterine bleeding in relation to the breast mass.

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 nurse will provide patient teaching for drug therapy. The patient will take drugs accurately and for the length of time prescribed. The nurse will assist the patient in obtaining follow-up health care when indicated. The nurse will schedule appointments to monitor drug effects.

The patient will take drugs accurately and for the length of time prescribed. Goals for patients for patients to achieve while receiving hormone therapy include taking drugs accurately and for the prescribed length of time. Educating the patient and assisting in securing follow-up care are nursing interventions.

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 fetal heart rate is between 136 and 159. The client's pulse is 90. The client's blood pressure is 109/68. The uterine contractions are occurring every 90 seconds.

The uterine contractions are occurring every 90 seconds. The health care provider should be notified immediately if there is a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions that last more than 60 seconds; and contractions occurring more frequently than every 2-3 minutes. The client's blood pressure and pulse are within normal limits and the fetal heart rate is within normal limits.

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 has a family history of breast cancer. The woman takes an antiplatelet medication for coronary artery disease. The woman has a diagnosis of type 2 diabetes. The woman has asthma and uses inhaled corticosteroids and bronchodilators.

The woman takes an antiplatelet medication for coronary artery disease. Coronary artery disease is a contraindication to the use of oral contraceptives. Diabetes and asthma do not necessarily contraindicate this treatment. A family history of breast cancer is relevant but would not absolutely contraindicate oral contraceptive use.

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. The client should speak with her health care provider concerning the need for both prescriptions. Taking both medications together will make her periods lighter and of shorter duration. The client needs both estrogen and progesterone to stop menopausal hot flashes.

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer. During menopause, estrogens are prescribed to relieve symptoms of estrogen deficiency and to prevent or treat osteoporosis. When estrogen is prescribed for women with an intact uterus, a progestin is also given to prevent unwanted thickening of the lining of the uterus and to decrease the risk of cancer of the uterus, a possible result of using estrogen alone. Both drug therapies are commonly referred to as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT). None of the other options accurately describe the reason for the prescription of both medications.

A monophasic oral contraceptives composition is described as having which characteristic? fixed amounts of both estrogen and progestin components fixed amounts of estrogen and varied amounts of progestin three different doses of estrogen and progestin primarily follicle-stimulating hormone

fixed amounts of both estrogen and progestin components Three different types of hormonal contraceptives are common: monophasic contraceptives, which contain fixed amounts of both estrogen and progestin components; biphasics, which contain fixed amounts of estrogen and varied amounts of progestin; and triphasics, which contain three different doses of estrogen and progestin. Primarily follicle-stimulating hormone is not found in such contraceptives.

A client is prescribed methylergonovine. The nurse reviews the client's medical record for possible contraindications to the use of this drug. Which, if found, would the nurse identify as being a contraindication to the prescribed drug? hypertriglyceridemia hypertension diabetes asthma

hypertension The use of methylergonovine is contraindicated in clients with hypertension. Terbutaline should not be used in women with heart disease, hyperthyroid, or poorly controlled diabetes. Clients with asthma can have exacerbations of the asthma if taking aspirin, NSAIDs, beta blockers, and ACE inhibitors. Treatment with bile acid-binding resins in hypercholesterolemic clients is contraindicated in the presence of hypertriglyceridemia.

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 development of hypertension weight gain persistent nausea

hysterectomy Women who have an intact uterus should take both estrogen and progestin; the progestin component prevents endometrial cancer, an adverse effect of estrogen-only therapy. Posthysterectomy, clients should take estrogen-only medications. None of the other options would require a treatment change.

A client is prescribed oxytocin to stimulate the milk ejection reflex. The nurse would expect this drug to be administered by which route? orally intramuscularly topically intranasally

intranasally The nurse should administer oxytocin intranasally to a client to stimulate the milk ejection reflex. Oxytocin can be given intramuscularly (IM) during the third stage of labor (period from the time the baby is born until the placenta is expelled) to produce uterine contractions and control postpartum bleeding and lessen hemorrhage potential. The other uterine stimulants may be given orally, rectally, or IM during the postpartum period to reduce the possibility of postpartum hemorrhage and to prevent relaxation of the uterus. Oxytocin is not given topically.

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: experiences breast tenderness. misses a dose of the medication. misses a menstrual period. experiences nausea.

misses a menstrual period. If a client taking oral contraceptives misses a menstrual period, she should contact a health care provider to be evaluated for pregnancy. Continuing to take the medication while pregnant can cause fetal damage. Breast tenderness and nausea are common adverse effects of the hormones in the contraceptives, but they are unlikely to cause harm. If the client misses a dose of an oral contraceptive, she should take the next dose as soon as possible; it may be appropriate to take two doses in the same day if this occurs.

A 37-year-old woman has a 10 pack-year smoking history and has been using oral contraceptives for the past 2 years. The nurse should plan health education interventions in the knowledge that this client faces a priority increased risk of: deep vein thrombosis. dementia. myocardial infarction. osteoporosis.

myocardial infarction. For women 35 years of age and older who smoke, there is an increased risk of myocardial infarction and other cardiovascular disorders, even with low-dose oral contraceptives. The increase in this risk supersedes that of osteoporosis, dementia, or DVT.

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. blockage of estrogen receptor sites. effects secondary to ergotism. stimulation of the neuroreceptor sites.

release of antidiuretic hormone. Oxytocin can cause severe water intoxication, which is thought to occur because of related effects of antidiuretic hormone, which may be released in response to oxytocin activity. Oxytocin does stimulate neuroreceptor sites but this is not the reason for the development of water intoxication. Ergonovine and methylergonovine can produce ergotism. Blockage of estrogen receptor sites occurs with estrogen receptor modulators.

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? ginger tea tree St. John's wort saw palmetto

saw palmetto Saw palmetto is used to relieve the symptoms of BPH, which include urinary frequency, decreased flow of urine, and nocturia. Tea tree is used for a variety of ailments and also has antioxidant properties. Ginger is used for nausea. St. John's wort is used for depression.

The nurse is on the phone with a woman who is taking an antispasmodic for overactive bladder syndrome. The woman states that her mouth is very dry, but she is afraid to drink because she does not want the urge to urinate to increase. What is the nurse's best response to this client? "You shouldn't restrict your fluid intake because it will only make your bladder problems worse." "To ensure that you don't have to go to the bathroom all the time, you should chew gum." "When your mouth is dry, rinse it with strong mouthwash." "You will just have to put up with the dry mouth if you want to take this medication."

"You shouldn't restrict your fluid intake because it will only make your bladder problems worse." Dry mouth related to antispasmodics can be treated with sugarless hard candy, pieces of ice, or sugarless lozenges. The client may also perform frequent mouth care but strong mouthwash may cause oral irritation. The client shouldn't limit the amount of fluid because it will only make the urinary symptoms worse.

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? 6 AM 12 PM 10 AM 4 AM

12 PM With emergency contraception, the first dose is started within 72 hours after unprotected intercourse; then, a follow-up dose of the same dosage must be taken 12 hours after the first dose.

The contractions of a client who is receiving tocolytic therapy stop at 4 pm. The nurse would expect to continue to administer the drug infusion for at least which time frame? 24 hours 48 hours 36 hours 12 hours

12 hours After contractions cease, the drug dosage is tapered to the lowest effective dose by decreasing the drug infusion rate at regular intervals prescribed by the primary health care provider. The infusion continues for at least 12 hours after uterine contractions cease. The time frames of greater than 12 hours are excessive and inappropriate.

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? 4:10 PM 6:00 PM 7:00 PM 4:15 PM

4:15 PM Dinoprostone begins to act in 10 minutes, reaching a peak action in 15 minutes with a duration of action of 2 to 3 hours.

After teaching a group of students about abortifacients, the instructor determines that the teaching was successful when students identify which condition as a contraindication to their use? Asthma Active pelvic inflammatory disease Adrenal disease Hypertension

Active pelvic inflammatory disease Active PID is a contraindication to the use of abortifacients because the infection could be exacerbated by the drug. Abortifacients are used cautiously in patients with asthma. Abortifacients are used cautiously in patients with hypertension. Abortifacients are used cautiously in patients with adrenal disease.

A client who was prescribed vardenafil has a sustained erection and is being seen in the emergency department. What is the priority nursing diagnosis? Deficient knowledge Risk for injury Impaired oral mucous membranes Acute pain

Acute pain The client is experiencing acute pain related to priapism. When a client with priapism seeks care, injection of an alpha adrenergic stimulant like phenylephrine or norepinephrine may be helpful. Impaired oral mucous membranes, Deficient knowledge or Risk for injury are not appropriate nursing diagnosis.

The nurse is preparing to give a 25-year-old female client an injection of carboprost. What would be most important for the nurse to do? Try to talk the mother out of taking the drug. Assess vital signs. Draw up the medication and inject within 5 minutes. Assess for contraindications or cautions.

Assess for contraindications or cautions. Abortifacients should not be used with any known allergy to abortifacients or prostaglandins to avoid hypersensitivity reactions, after 20 weeks from the last menstrual period which would be too late into the pregnancy for an abortion, or with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Assessing vital signs would be important and so would drawing up the medication and injecting within 5 minutes, but they are not the most important nursing actions. It would be inappropriate to try to talk the mother out of taking the drug.

A couple comes to the fertility clinic to get information about treatment for their infertility. What would be included in the information this couple receives regarding adverse effects? Renal failure Cardiovascular events. Peripheral edema Birth defects

Birth defects A major adverse effect of fertility drugs is multiple births and birth defects. Adverse effects of fertility medications do not include peripheral edema, cardiovascular events, or renal failure.

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? Renal failure Respiratory difficulties Cardiovascular complications Seizures

Cardiovascular complications Clients who use progestins are at an increased risk for cardiovascular complications. This adverse effect is similar for both estrogens and progestins.

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? Cetrorelix Ganirelix Follitropin alfa Clomiphene

Clomiphene Clomiphene is administered orally. Cetrorelix, follitropin alfa, and ganirelix are administered parenterally.

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.) Lung cancer Brain cancer Endometrial cancer Breast cancer Melanoma

Endometrial cancer Breast cancer Estrogen use has been associated with the development of breast and endometrial cancer.

A 28-year-old patient, on infusion of methyl ergonovine, suddenly develops numbness, tingling of extremities, dyspnea, nausea, confusion, tachycardia, chest pain, hallucinations, and convulsions. Which is the possible condition the nurse should suspect in this case? Hypersensitivity Hypertension Ergotism Respiratory failure

Ergotism Ergotism or ergot poisoning may occur with the administration of excessive amounts of ergonovine or methylergonovine. Symptoms of ergotism involve coolness, numbness and tingling of extremities, dyspnea, nausea, confusion, tachycardia or bradycardia, chest pain, hallucinations, and convulsions. Hypersensitivity, hypertension, and respiratory failure are not conditions associated with the symptoms experienced by the patient.

A patient is using an oral contraceptive combination that includes drospirenone. The nurse would assess the patient for: Hyperkalemia Abdominal pain Irritation Headache

Hyperkalemia Drospirenone used in combination contraceptives has antimineralocorticoid activity and can block aldosterone, leading to increased potassium levels. Irritation is associated with transdermal or vaginal use. Headache is associated with vaginal ge

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

Oral Conjugated estrogens are administered orally.

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? Antispasmodics Progestins Androgen hormone inhibitors Aromatase inhibitors

Progestins When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, progestins must also be used to decrease the risk of endometrial cancer. Antispasmodics are used to treat issues of the bladder. Androgen hormone inhibitors are used to treat benign prostatic hypertrophy. Aromatase inhibitors are used to treat breast cancer.

A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which potential nursing diagnosis? Risk for Injury related to loss of vision or thrombotic events Incontinence, Functional, related to neurosensory and musculoskeletal changes Fluid Volume Deficit related to metabolic changes secondary to drug therapy Confusion, Chronic, related to CNS changes resulting from adverse drug effects

Risk for Injury related to loss of vision or thrombotic events Progesterone therapy carries risks of thrombotic events and vision loss. It is not associated with fluid loss, incontinence, or cognitive changes.

A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately? Weight gain Abdominal bloating Dizziness Shortness of breath

Shortness of breath Estrogens are associated with the development of thrombi and emboli. Reports of shortness of breath may indicate a possible pulmonary embolism necessitating emergency treatment. Abdominal bloating, weight gain, and dizziness are common adverse effects of estrogen therapy that should be reported, but it is not necessary to report them immediately.

A patient is to receive lutropin alfa. The nurse would expect to administer this agent by which route? Intramuscular Intravaginal Oral Subcutaneous

Subcutaneous Lutropin alfa is a fertility drug that is administered subcutaneously with follitropin alfa.

What is the most plausible rationale for a female client being prescribed danazol? The client has recently had a hysterectomy surgery performed. The client has endometriosis. The client is being treated for symptoms of menopause. The client has ductal carcinoma in situ (DCIS).

The client has endometriosis. Clinicians may use danazol, a synthetic form of testosterone, in women to prevent or treat endometriosis or fibrocystic breast disease. None of the other options are accepted reasons for prescribing danazol.

The nurse anticipates the health care provider will order methylergonovine for which purpose? To cause delivery of the placenta To ripen the cervix To strengthen labor contractions To contract the uterus after delivery of the placenta

To contract the uterus after delivery of the placenta Methylergonovine is not used before delivery of the placenta. Its purpose is to contract the uterus after delivery of the placenta and reduce postpartum bleeding.

The nurse anticipates that the health care provider will order carboprost to treat which condition related to labor and delivery? Ripening of the cervix Postpartum infection Labor induction Uterine atony

Uterine atony Carboprost is used to treat postpartum hemorrhage caused by uterine atony. It is not indicated for cervical ripening, labor induction, or postpartum infection.

Medroxyprogesterone acetate is indicated for the treatment of women with what disorder? Ovarian cancer Fibromyalgia Cervical cancer Uterine bleeding

Uterine bleeding Health care providers use progestins to suppress ovarian function in dysmenorrhea, endometriosis, endometrial cancer, and uterine bleeding. Progestins are not normally used to treat cervical cancer, ovarian cancer, and fibromyalgia.

The health care provider has ordered oxytocin to be administered via IV pump and titrated until a client's contractions are every 3 minutes. The nurse caring for the client is aware that oxytocin can cause dangerous effects to the CNS, musculoskeletal, and cardiovascular systems of the client. What is the cause of these adverse effects? Water intoxication Asperger's disorder Tachysystole Abnormal atrioventricular rhythms

Water intoxication Oxytocin increases the water permeability of the nephron, which causes more water retention than sodium reabsorption and, in turn, leads to water intoxication. Symptoms of water intoxication primarily affect the CNS and musculoskeletal systems. Oxytocin infusions, when given to a client with autism or Asperger's disorder, result in a significant reduction in repetitive behaviors. Tachysystole and abnormal atrioventricular rhythms are not the cause of adverse effects.

A client has been diagnosed with benign prostatic hypertrophy. Which group of medications are used to treat this disorder? cholinergic agents beta adrenergic blockers calcium channel blockers alpha adrenergic blockers

alpha adrenergic blockers The most widely used drugs to treat BPH are the alpha adrenergic blockers. Beta blockers are used for cardiac disorders. Calcium channel blockers are used in hypertension. Cholinergic agents are used in a variety of disorders but not BPH.

A woman experiencing menopausal symptoms asks the nurse about herbal products that might help. Which would the nurse include in the response? saw palmetto ginger black cohosh ephedra

black cohosh Black cohosh is an herbal product that is reported to be beneficial in managing the symptoms of menopause. Ephedra sinica, a species of ephedra (ma huang), contains ephedrine and pseudoephedrine. Ephedra has been found to stimulate the nervous system, increase airflow into the lungs, and constrict blood vessels. Ginger is commonly used to treat gastrointestinal discomfort including motion sickness, morning sickness, colic, upset stomach, gas, diarrhea, irritable bowel syndrome (IBS), and nausea. Saw palmetto is an herbal product that may delay the need for prostate surgery in clients with benign prostatic hypertrophy.

When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment? chest auscultation skin integrity blood pressure heart rate and rhythm

blood pressure Oral contraceptives can result in increased blood pressure. Regular monitoring is consequently indicated. It is not normally necessary to assess skin integrity or respiration. These drugs have adverse effects influencing the cardiovascular system, but such effects are unlikely to result in alterations in rate and rhythm.

A nurse should monitor a client receiving oxytocin for which adverse effects? headache cardiac arrhythmia hypotension dizziness

cardiac arrhythmia A nurse should monitor a client receiving oxytocin for the following adverse effects: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Hypotension, headache, and dizziness are not adverse reactions of oxytocin. Hypotension can be seen with uterine rupture due to hypovolemia, along with dizziness due to low blood pressure. Headache can be seen with the use of hormone medications such as birth control.

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for: decreased libido. a decrease in secondary sexual characteristics. cardiovascular complications. early epiphyseal closure.

cardiovascular complications. Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen.

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: progesterone. conjugated estrogen. clomiphene. mifepristone.

clomiphene Clomiphene is used in treating ovulatory failure in patients who want to become pregnant and have a fertile partner. Estrogen and progesterone are contraindicated in women who may become pregnant and neither drug increases the chance of conception. Mifepristone is used to end an early pregnancy.

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. arthritis deep vein thrombosis stroke myocardial infarction

deep vein thrombosis stroke myocardial infarction SERMS, like tamoxifen, are used in caution with menopausal women with a history of deep vein thrombosis, stroke, and/or myocardial infarction.

The nurse would be alert for signs and symptoms of which if methylergonovine is prescribed for a client who is a heavy smoker? diuresis electrolyte imbalance vasodilation vasoconstriction

vasoconstriction Vasoconstriction can occur when methylergonovine is administered to a client who is a heavy smoker not vasodilation. Diuresis is the effect of the use of diuretic medications used as in the condition of congestive heart failure. Electrolyte imbalance can occur with the use of diuretics; as water is eliminated, electrolytes are also eliminated unless potassium-sparing diuretics are used.

Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect? water intoxication polydipsia dehydration hypotension

water intoxication Water intoxication is an adverse effect caused by all uterine stimulants because of their antidiuretic effect. Dehydration occurs when the body does not have enough fluid to sustain homeostasis. Hypotension can result in pregnancy with uterine rupture and loss of circulating blood volume. Polydipsia is seen in diabetes as well as pregnancy-induced diabetes.