Chapter 7: Pharmacology and Women's Health

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? A. Bronchiectasis B. Malignant hyperthermia C. Crohn's disease D. Venous thromboembolism

D. Venous thromboembolism Studies have demonstrated no evidence for HRT in secondary prevention of heart disease and showed increased rates of coronary heart disease, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer. HRT does not increase the risk for bronchiectasis, malignant hyperthermia, or Crohn's disease.

The nurse is aware that estrogen is used without progestin for hormone replacement therapy in what circumstance? If the client has had her ovaries removed If the client has had her uterus removed If the client has a history of thrombophlebitis If the client has a history of breast cancer

If the client has had her uterus removed Explanation: Estrogen may be used alone if the woman has had her uterus removed. The use of estrogen without progesterone in women who have an intact uterus can increase the risk of endometrial cancer. Estrogen therapy is contraindicated in clients who have had thrombophlebitis or breast cancer.

When teaching an adolescent about ovulation, the nurse would include that ovulation is initiated by a surge in: luteinizing hormone. progesterone. follicle-stimulating hormone. estrogen.

luteinizing hormone. Explanation: Luteinizing hormone is released from the pituitary gland to stimulate ovulation on approximately the 14th day of a typical cycle.

What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen? Diabetes mellitus Endometrial cancer Parkinson disease Cardiac valve dysfunction

Endometrial cancer Explanation: Warnings associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, and thromboembolic disease, and hypercalcemia in those with breast cancer and bone metastases.

The nurse is discussing contraception with a client who has been prescribed a triphasic oral contraceptive. The nurse knows that this preparation is used for what reason? It mimics normal variations of hormone secretions. It decreases the number of days of the menstrual period. It decreases the amount of blood lost during the menstrual period. It is effective for more than one menstrual cycle.

It mimics normal variations of hormone secretions. Explanation: Triphasic oral contraceptives are used because they mimic normal variations of hormone secretions.

A nurse practitioner prescribes estrogen replacement therapy to relieve severe menopausal symptoms of hot flashes or flushes, which are the result of A. insufficient gonadotropin secretion B. vasomotor instability C. high levels of estrogen D. decreased progesterone

B. vasomotor instability Vasomotor instability occurs as a result of estrogen deficiency. Blood vessels dilate, resulting in a sudden, intense warmth sensation that spreads over the body.

Postmenopausal women with an intact uterus taking estrogen for hormone replacement therapy require progestin because A. progestins enhance the effects of estrogen B. combination therapy provides osteoporosis prevention C. progestin opposes the effects of estrogen on the endometrium D. uterine cancer is increased

C. progestin opposes the effects of estrogen on the endometrium The use of unopposed estrogen on an intact uterus increases the risk of endometrial cancer greatly. Therefore, progestin is necessary to block the estrogenic effects on the endometrium.

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." "Estrogen and progesterone diminish." "Hot flashes and night sweats are prominent."

"Estrogen and progesterone diminish." Explanation: 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.

A client will begin estrogen therapy using the estradiol transdermal system. What statement by the client indicates a need for further instruction? "I will be able to hide the patch well under my belt." "I will apply it to clean, dry skin." "I can use my abdomen to place the patch." "I will remove one patch before I apply the new one."

"I will be able to hide the patch well under my belt." Explanation: The client should be instructed not to apply the patch to breasts, waistline, or a site exposed to sunlight. The client should apply the patch to clean, dry skin of the trunk, buttocks, abdomen, upper inner thigh, or upper arm. The area should not be oily or irritated and the client should not use a heat source such as an electric blanket, which can increase the rate of absorption. The client must take off one patch before applying another.

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

"The labs will identify your body's ability to filter and excrete medications." Explanation: 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.

Often medications are found useful in treating symptoms other than those for which they were designed. For what other condition has the Food and Drug Administration (FDA) approved Estrostep? Acne Premenstrual dysphoric disorder Renal impairment Jaundice

Acne Explanation: The FDA has approved some oral contraceptives for the treatment of acne. Yaz can be used to treat premenstrual dysphoric disorder. Patients with renal and liver impairment should be carefully evaluated, because these conditions are contraindications for estrogen use.

A client with delayed puberty has been advised to undertake transdermal androgen therapy. Which instructions should the nurse prioritize? Apply the ointment to the underside of the scrotum. Repeat the application to the scrotum after 3 days. Moisten the skin before the application. Apply immediately after removing the cover.

Apply immediately after removing the cover. Explanation: Applying the system immediately after opening the pouch and removing the protective cover may help obtain an optimal response to the transdermal androgen delivery system. The drug should not be applied to the underside of the scrotum. It is applied to clean, dry skin on the abdomen, thigh, back, or upper arm. Thus, the skin should not be moistened before the application; rather, it should be dry. Seven days should be allowed between applications to a specific site, and application to the same site should not be repeated after 3 days.

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 present to the clinic until next month. The client A. ''Before estrogen-based drugs are prescribed, you must see the health care provider to get an order for a mammogram.'' B. ''Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.'' C. ''If you have a physical within the past 2 years, I can get your medication refilled.'' D. ''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.''

B. ''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 experiencing menopause informs the nurse that the primary health care provider has prescribed estrogen and progesterone. The client asks the nurse why she should take two medications. What is the nurse's best response? A. ''You need both estrogen and progesterone to stop the hot flashes.'' B. ''Using estrogen alone can increase the risk of endometrial cancer.'' C. ''Taking both of the medications together will make your periods lighter and of shorter duration.'' D. ''You should speak to your health care provider because you do not need to take both prescriptions.''

B. ''Using estrogen alone can increase the risk of 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).

Patient teaching for a woman who will be using the transdermal patch Ortho Evra should include which of the following? (Select all that apply) A. Apply to the skin daily B. Apply to clean and dry skin C. Apply the patch on the same day of the week each week for 3 weeks D. Apply the patch the first day of the menstrual cycle initially E. Use a backup method for birth control the first 2 weeks of using the patch F. Use a backup method for birth control the first 3 weeks of using the patch

B. Apply to clean and dry skin C. Apply the patch on the same day of the week each week for 3 weeks D. Apply the patch the first day of the menstrual cycle initially The application of a transdermal patch to clean, dry skin is essential for the proper adherence and absorption. The patch should be applied the first day of menses or the Sunday following the star of menses. The woman should use a back-up method for the first week of use. Lotions and occlusive dressings should not be used at the application site, The patch should always be changed on the same day of the week. When a new patch cycle is delayed beyond the scheduled start date, the woman should be instructed to apply a patch as soon as she remembers and use back-up contraception for atleast one week.

A nurse is preparing to administer goserelin to a client with prostate cancer. Which assessment findings should the nurse prioritize on the ongoing assessment? Breast atrophy, sexual dysfunction Pharyngitis, asthenia Breast tenderness, edema Hyperglycemia, leukocytosis

Breast atrophy, sexual dysfunction Explanation: Breast atrophy and sexual dysfunction may be seen as adverse reactions of goserelin therapy. Pharyngitis and asthenia are seen with the use of anastrozole. Breast tenderness and edema are seen with drugs such as estramustine. Hyperglycemia and leukocytosis are seen as adverse reactions of mitotane.

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

C. 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. Oral contraception contains estrogen as an active ingredient. The most serious adverse effect of estrogen use is the increased risk of thromboembolic conditions. Thromboembolic disorders are most likely to occur in women older than 35 years of age who take oral contraceptives and smoke cigarettes, postmenopausal women taking long-term estrogen and progestin therapy, and men or women who receive large doses of estrogens for cancer treatment. None of the other clients have unusually high risks for thromboembolic conditions.

The nurse is assessing a client who has been prescribed contraception that contains the progestin drospirenone. What laboratory value should the nurse prioritize? A. Hemoglobin and hematocrit B. White blood cell differential C. Serum potassium D. Serum sodium

C. Serum potassium Contraceptives that contain the progestin drospirenone can increase serum potassium levels. Potassium monitoring may thus be indicated. Sodium, red cell, and white cell indices are not normally affected.

When oral contraceptives are contraindicated in women with liver disease, what other birth control option would be safe? A. Ortho Evra (contraceptive patch) B. Depo-Provera (injectable progestin) C. barrier method (condoms) D. Implanon (subdermal implant)

C. barrier method (condoms) Ortho Evra, DepoProvera, and Implanon are all hormonal methods of birth control in which the metabolism of these hormones occurs in the liver. Impaired liver function is a contraindication to hormonal contraceptive use. Thus, a barrier method would be most appropriate.

The nurse is scheduled to administer an oral contraceptive to a client admitted with type 2 diabetes. What is the priority teaching that would be provided regarding this medication? Take the medication the same time each day with food to decrease the development of nausea and vomiting. If you skip a dose, use another form of contraception until the first week of the next cycle of the oral contraceptive. Notify the primary care provider if your glucose is elevated because an adjustment in medication may be needed. Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg.

Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg. Explanation: The priority for teaching in the situation is that the major adverse effect of taking oral contraceptives is the possibility for developing venous thromboembolism, a life-threatening emergency that must be reported to the primary care provider (PCP) right away. The nurse must teach the client on the signs and symptoms of a deep venous thrombosis: leg pain, redness, and edema. The client could also develop a pulmonary embolus with sudden dyspnea, and chest pain. The other teaching points are not as high of a priority because they consist of how to take the medication to decrease the possible side effect of nausea, which usually decreases with taking the medication for a few months. Also, it is important to take the medication the same time of day to help remember to take it. Instructions about what to do if a dose is skipped is important to prevent pregnancy by instructing the client to use another form of contraception until the first week of the next cycle of the oral contraceptive. It is important for a client to report an elevated blood glucose level, so the PCP may consider what may be the cause for the increase and decide if an increase in the oral antidiabetic medications is necessary.

A 21-year-old woman is having difficulty finding an oral contraceptive that she can tolerate without experiencing daily nausea and vomiting. The nurse recognizes that which of the following should be a good choice? Climara Premarin Alesse Provera

Climara Explanation: Transdermal estradiol patches (Climara, Estraderm, and Vivelle) allow for absorption of estrogen through the skin, bypassing the liver. Patients experience less nausea and vomiting than with the oral route. Premarin is an oral estrogen. Provera is an oral progestin. Alesse is an oral estrogen-progestin combination.

A client who is menopausal has been given a prescription for estrogen. The client asks the nurse what some of the risks are in taking this medication. What is the nurse's best response? A. ''Estrogen decreases the risk of dementia and myocardial infarctions.'' B. ''Estrogen has not been proven to increase the risk of any medical condition.'' C. ''As long as estrogen and progesterone are taken together, there are no increased health risks.'' D. ''Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.''

D. ''Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.'' The FDA has issued a black box warning that estrogens increase the risk for developing cancer of the uterus. The warning instructs individuals who take estrogens with or without progestins of the increased risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot.

What assessment question is most appropriate when assessing a 58-year-old client for therapeutic effects of prescribed estrogen therapy? A. ''How long do you think you would like to continue with this drug?'' B. ''Have you stopped having menstrual bleeding since you started taking estrogen?'' C. ''How would you describe your energy levels since starting treatment?'' D. ''Have you been having as many hot flashes and night sweats lately?''

D. ''Have you been having as many hot flashes and night sweats lately?'' Treatment of menopausal symptoms is the most likely goal of estrogen therapy in a client who is 58 years old. Hot flashes and night sweats are among the most common symptoms of menopause. As such, assessing menstrual bleeding and energy levels is not a priority. Asking the client how long she would like to continue the drug does not address specific therapeutic effects.

A client who has been prescribed an oral contraceptive asks the nurse to explain why the medication is dispensed in a 28-day pack. What rationale will the nurse provide? A. ''It allows for a longer time between periods.'' B. ''This is a less expensive form of birth control method compared to those that contain placebo tablets.'' C. ''It allows for a rest of ovarian function between periods.'' D. ''It makes it less likely you will forget to take a pill every day.''

D. ''It makes it less likely you will forget to take a pill every day.' Dispensers with 28 tablets contain 7 inactive or placebo tablets of a different color than the active tablets. Because the inclusion of the placebo allows the client to take a pill every day, the action becomes routine, which makes forgetting doses less likely. Several combination products and alternative dosage forms are available to help individualize treatment and promote adherence. None of the other options are true statements.

The nurse is providing education for a client who will receive an injection of medroxyprogesterone. Which statement indicates that the client understands the teaching? A. ''This injection is good for 1 year at most.'' B. ''This injection protects against only some sexually transmitted infections.'' C. ''I will need to return in 6 months for another injection.'' D. ''This injection lasts for 3 months.''

D. ''This injection lasts for 3 months.'' Long-acting progestin contraceptive preparations such as the intramuscular depot medroxyprogesterone last for 3 months per injection; intrauterine progesterone lasts for 1 year; and levonorgestrel subcutaneous implants last for 5 years. The injection does not provide any protection against STIs.

The nurse is providing education to a client who will receive medication therapy for atrophic vaginitis. What information will the nurse include? A. ''Nonsteroidal synthetic preparations are the standard treatment for this condition.'' B. ''If you are not allergic to vibramycin, you will be prescribed an oral dose every 6 hours for 14 days.'' C. ''Your health care provider will prescribe miconazole topically daily for 1 week.'' D. ''You will be prescribed an estrogen preparation to help prevent osteoporosis.''

D. ''You will be prescribed an estrogen preparation to help prevent osteoporosis.'' Estrogens are prescribed to relieve symptoms of estrogen deficiency (e.g., atrophic vaginitis and vasomotor instability, which produces ''hot flashes'' or ''hot flushes'') and to prevent or treat osteoporosis. Such use is usually called estrogen replacement therapy (ERT). None of the other statements are relevant to the treatment of atrophic vaginitis.

When providing follow-up care for a client who has been prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment? A. Heart rate and rhythm B. Chest auscultation C. Skin integrity D. Blood pressure

D. 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 heart rate and rhythm.

A monophasic oral contraceptive is described as having which composition? A. Primarily follicle-stimulating hormone B. Fixed amounts of estrogen and varied amounts of progestin C. Three different doses of estrogen and progestin D. Fixed amounts of both estrogen and progestin components

D. 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.

The effects of endogenous estrogen are multifaceted. Which of the following statements in associated with the effects of endogenous estrogen? A. It decreases protein anabolism, bone growth and epiphyseal closure in young girls. B. It decreases low density lipoproteins. C. It decreases vascularity in the skin. D. It promotes bone formation and decreases bone loss.

D. It promotes bone formation and decreases bone loss. Estrogen increases protein anabolism, bone growth, and epiphyseal closure in young adults; decreases low-density lipoproteins; and increases vascularity in the skin.

A nurse is preparing to administer oxybutynin to a client and discovers the client is also prescribed haloperidol. The nurse predicts the client has the increased risk of which reaction related to the concomitant use of both drugs? Decreased effect of haloperidol Increased risk for bleeding Lowered plasma concentrations Increased effect of oxybutynin

Decreased effect of haloperidol Explanation: The nurse should observe for decreased effectiveness of the antipsychotic drug (haloperidol) in the client as the effect of the interaction of the antispasmodic drug (oxybutynin) and haloperidol. Increased risk for bleeding results from the interaction of oral anticoagulants with anti-infective drugs. Increased effect of the antispasmodic drug occurs with the interaction of an antispasmodic drug with a tricyclic antidepressant. Plasma concentrations are lowered due to the interaction of fosfomycin, which is an anti-infective, with metoclopramide, which is used to relieve gastric upset.

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 Explanation: 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 instructing a woman with type 2 diabetes mellitus who has been prescribed combined estrogen-progestin therapy. The nurse instructs the client to be alert for what change related to her diabetes? Decrease in blood glucose Increase in blood glucose Development of diabetic ketoacidosis Rapid weight loss

Increase in blood glucose Explanation: Combination estrogen-progestin use in clients with diabetes mellitus may cause an increase in blood glucose.

A nurse is preparing to administer oxybutynin to a client. The nurse should question this order if which disorder(s) is noted in the client's medical record? Select all that apply. Myasthenia gravis Urinary tract blockage Diabetes Intestinal blockage Hypertriglyceridemia

Myasthenia gravis Urinary tract blockage Intestinal blockage The use of oxybutynin is contraindicated in clients with the following: known hypersensitivity; glaucoma; myasthenia gravis; abdominal bleeding; and intestinal, gastric, or urinary tract blockages. Diabetes is a potential cause of erectile dysfunction. Women with diabetes and hypertriglyceridemia should use the transdermal delivery method of estrogens as it has been found to be the safest method.

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? Lack of menstruation Appearance of secondary sexual characteristics Occurrence of menstruation Decrease in hot flashes

Occurrence of menstruation Explanation: Amenorrhea is the lack of menstruation so an indication that the estrogen has been effective is the occurrence of menstruation.

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

Osteoporosis Explanation: 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.

After describing the events of the menstrual cycle to a group of students, the instructor determines that the students have understood the information when they identify what as the initial event that occurs following fertilization and implantation? Production of human chorionic gonadotropin Formation of the corpus luteum Development of the corpus albicans Involution of the corpus luteum

Production of human chorionic gonadotropin Explanation: Once the ovum is fertilized and implanted, human chorionic gonadotropin is produced to stimulate the corpus luteum to continue secretion of estrogen and progesterone until the placenta develops. The corpus luteum is the ruptured follicle that produces estrogen and progesterone for 10 to 14 days unless pregnancy occurs. The corpus albicans is the scar on the ovary that results from involution of the corpus luteum if pregnancy does not occur. The corpus luteum involutes if pregnancy does not occur.

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? Carrying the ovum to the endometrium Secretion of estrogen and progesterone Secretion of mucus that supplies lubrication for intercourse Location for implantation of a fertilized ovum

Secretion of estrogen and progesterone Explanation: The ovaries have two primary functions: development and release of the ovum and secretion of estrogen and progesterone. The fallopian tubes are responsible for conveying the ovum from the ovary to the uterus and sperm from the uterus toward the ovary. The Bartholin glands, when stimulated, secrete mucus that supplies lubrication for intercourse. The uterus is the site of implantation of a fertilized ovum.

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 Basal body temperature evaluation Maintenance of proper records Proper use of barriers to prevent STDs

Self-breast examination Explanation: Women who take a daily dose of conjugated estrogen and medroxyprogesterone acetate need education regarding the importance of self-breast examination. It is essential that nurses teach patients to notify their health care providers of any lumps. The basal body temperature can be used to determine if a woman is ovulating. Preventing STDs is important; however, using barriers will not prevent adverse effects from exogenous estrogen.

The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? The client describes a positive attitude toward sexual behavior. The client can explain how medication cannot prevent most sexually transmitted infections. The client can verbalize how and when to take medication even if a pill is missed. The client makes the necessary appointments for follow-up care.

The client can verbalize how and when to take medication even if a pill is missed. Explanation: It is most important for the nurse to evaluate the client's understanding of how to take the medication properly, including how to respond when a pill is missed. Oral contraceptives will not prevent against any sexually transmitted infections. Although making follow-up appointments is good, it is more important that the client know how to take the medication. The client's attitude toward sexuality is relevant to the nurse and to the client's well-being, but taking the medication, so it will have its intended effect is the priority.

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's body mass index (BMI) is 18.0 (underweight). The client uses marijuana one to two times per week. The client takes NSAIDs for the treatment of headaches and joint pain. The client was treated for deep vein thrombosis following surgery.

The client was treated for deep vein thrombosis following surgery. Explanation: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. The client's BMI is not prohibitively low and the use of NSAIDs or marijuana are not absolutely contraindicated with oral contraceptives.

The nurse reviews the female client's laboratory results and finds the level of gonadotropin-releasing hormone (GnRH) has increased significantly since yesterday. When assessing this client, what will the nurse expect to find? The client is pregnant. The client's menses have begun. The client is ovulating. The client is preparing to give birth.

The client's menses have begun. Explanation: The dropping levels of estrogen and progesterone trigger the release of gonadotropin-releasing hormone (GnRH) and then follicle-stimulating hormone (FSH) and luteinizing hormone (LH) again, along with the start of another menstrual cycle. Lowered hormone levels cause the inner lining of the uterus to slough off because it is no longer stimulated by the hormones, demonstrated by the beginning of menses. The client is not pregnant or ovulating at the start of another menstrual cycle nor is she preparing to deliver a baby.

The nurse is caring for a client who just had subdermal implantation of NuvaRing. What should the nurse teach the client about this intervention? The implant will prevent pregnancy until the client reaches menopause, barring any complications. The implant confers minimal protection against bacterial sexually-transmitted infections. The client will need to have serum levels of progesterone drawn in 1 month. The implant should be replaced in around 3 years.

The implant should be replaced in around 3 years. Explanation: Etonogestrel, in addition to being available as a vaginal ring, NuvaRing, is available as a subdermal implant that may be left in place for up to 3 years and then must be removed. Another implant could be placed at that time. Like all forms of hormonal contraception, there is no protection against STIs. Follow-up blood work is not necessar

A menopausal client, prescribed estrogen and progesterone, asks why she should take two different medications. Which explanation best addresses the client's question? 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. The client should speak with her health care provider concerning the need for both prescriptions.

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

The pubescent girl exhibits many changes as a result of estrogen production. Her mother asks the nurse what secondary sexual characteristics to look for in her daughter. What is the best information for the nurse to provide to the mother about secondary sexual characteristics? (Select all that apply.) Spinal curvature Lower percentage of body fat tissue Wider hip structure Pubic and axillary hair Breast development

Wider hip structure Pubic and axillary hair Breast development Secondary sexual characteristics of the female include a higher percentage of body fat tissue, wider hip structure, pubic and axillary hair, and development of breasts. Spinal curvature is an abnormal finding.

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 abiraterone bicalutamide estramustine

degarelix leuprolide Degarelix and leuprolide are examples of gonadotropin-releasing analogs. Abiraterone and bicalutamide are antiandrogens. Estramustine is an estrogen.

The layer of the uterus that is influenced by hormone changes in preparation for possible conception and pregnancy is the: myometrium. endometrium. perimetrium. fundus.

endometrium. Explanation: The endometrium is the inner layer of the uterus that builds with hormones during the month in potential preparation for pregnancy. The myometrium is the muscular layer. The perimetrium is a protective layer, and the fundus is the upper area of the uterus.

Which hormone causes ovulation to occur? adrenocorticotropic hormone (ACTH) luteinizing hormone (LH) prolactin follicle-stimulating hormone (FSH)

luteinizing hormone (LH) Explanation: When the circulating estrogen level rises high enough, it stimulates a massive release of LH from the anterior pituitary causing one of the developing follicles to burst and release the ovum with its stored hormones into the system. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the "fight-or-flight" response. Prolactin is responsible for milk production, and FSH in combination with LH stimulates follicles on the outer surface of the uterus to grow and develop and also stimulates the release of estrogen and progesterone.

A nurse is reading a journal article about female hormones. Which would the nurse identify as a progestin? norethindrone estradiol raloxifene bicalutamide

norethindrone Explanation: Norethindrone is an example of a progestin. Estradiol is an example of an estrogen. Raloxifene is an estrogen agonist/antagonist, commonly referred to as a selective estrogen receptor modulator (SERM). Bicalutamide is a nonsteroidal antiandrogen.

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 stress incontinence urge incontinence neurogenic bladder

overactive bladder syndrome Explanation: Overactive bladder syndrome involves conditions of urgency, frequency, and nocturia, with or without incontinence. Stress incontinence involves losing urine without meaning to during physical activity. Urge incontinence involves the strong, sudden need to void due to bladder spasms or contractions. Neurogenic bladder refers to impaired bladder function caused by a nervous system abnormality.

The production of estrogen during pregnancy would be negatively affected if which structure was not functioning effectively? uterus placenta fallopian tube amniotic sac

placenta Explanation: Estrogen is produced by the ovary, placenta, and adrenal gland. None of the other options are associated with estrogen production.

When caring for a client on estrogen therapy, what is the nurse's priority assessment? blood glucose levels bowel sounds weight therapeutic drug effects

therapeutic drug effects Explanation: Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. Bowel sounds, weight, and blood sugar may be part of the assessment, but it is most important to assess for therapeutic and adverse effects of the medication.

A client has a levonorgestrel implant contraceptive system inserted. The nurse understands that this type of contraceptive provides protection for how long? 1 year 3 years 5 years 7 years

5 years Explanation: Levonorgestrel, a progestin, is available as an implant contraceptive system. Six capsules, each containing levonorgestrel, are implanted using local anesthesia in the subdermal tissues of the midportion of the upper arm. The capsules provide contraceptive protection for 5 years but may be removed at any time at the request of the client.

The nurse is preparing a presentation oft he risk factors of oral contraceptives. What factor is an absolute contraindication? A. bulimia B. cigarette smoking at age 33 C. body mass index (BMI) of 23 D. history of thromboembolism

D. history of thromboembolism History of thromboembolism is an absolute contraindication of oral contraceptives because stroke and heart attack are greatly increased with previous thromboembolism.

A client is prescribed finasteride to treat symptoms of BPH. When teaching the client about this drug, the nurse should point out the potential for which adverse reaction(s)? Erectile dysfunction Dry mouth Constipation Decreased libido Weight gain

Erectile dysfunction Decreased libido Explanation: Androgen hormone inhibitors such as finasteride have been associated with the adverse reaction of erectile dysfunction and decreased libido. Dry mouth and constipation are associated with antispasmodics. Weight gain is associated with alpha-adrenergic blockers.

Administration of estrogen is different in women who have an intact uterus or a hysterectomy. Which statement is correct? Estrogen is used alone with an intact uterus. Estrogen is administered alone after a hysterectomy. Estrogen and progestin are prescribed after a hysterectomy. Estrogen and gonadotrophin are administered with an intact uterus.

Estrogen is administered alone after a hysterectomy. Explanation: After a hysterectomy, estrogen alone is prescribed because there is no fear of the effect on the endometrium when it has been removed. When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, concurrent use of progestin is recommended to decrease the risk of endometrial cancer.

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 Decreased appetite Weight gain Headaches

Hot flashes Explanation: Early symptoms of fluctuating estrogen levels include vasomotor changes such as hot flashes and profuse night sweats. Decreased appetite, weight gain, and headaches are recognized as major symptoms of menopause and occur later in the process.

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 every other day Once a week Once a month

Once a day Explanation: Intravaginal estradiol is administered every day.

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

Oral Explanation: Conjugated estrogens are administered orally.

After teaching a group of students about the events that occur with fertilization and implantation of an ovum, the instructor determines that the teaching has been effective when the students identify what as an endocrine structure? Placenta Fetus Uterus Umbilical cord

Placenta Explanation: The placenta serves as a massive endocrine gland during pregnancy, maintaining high levels of estrogens and progesterone to support the uterus and developing fetus. The fetus has no role in endocrine function. The uterus provides the area for implantation of the embryo and growth of the fetus. The umbilical cord is important for nutrient and oxygen exchange between the fetus and the mother.

After teaching a group of nursing students about drugs used to treat genitourinary problems in the older adult, the instructor determines that the teaching was successful when the students correctly choose which drug(s) as an alpha-adrenergic blocker used to treat BPH? Select all that apply. Darifenacin Oxybutynin Alfuzosin Tamsulosin Raloxifene

Alfuzosin Tamsulosin Alpha-adrenergic drugs used to treat BPH include alfuzosin and tamsulosin. Darifenacin and oxybutynin are antispasmodics. Raloxifene is a miscellaneous agent used to prevent and treat osteoporosis.

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? A. estrogen B. Progesterone C. follicle stimulating hormone D. luteinizing hormone

B. Progesterone Progesterone is known as the "hormone of pregnancy" because of the endometrial support that the hormone provides. It is produced by the corpus lute during the first few weeks of pregnancy and then by the placenta. This hormone maintains the optimal endometrial environment for fetal development.

Hormone Therapy is indicated for A. treatment of osteoporosis B. relief of vasomotor symptoms C. cardiovascular disease prevention D. endometrial cancer treatment

B. relief of vasomotor symptoms Hormone therapy is indicated for the relief of vasomotor symptoms related to estrogen deficiency. It is not indicated for the treatment of osteoporosis, cardiovascular disease prevention, or treatment of endometrial cancer.

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 Melanoma Breast cancer Endometrial cancer Brain cancer

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

A nurse is caring for an adolescent girl experiencing menstruation for the first time. What are the changes that occur in the body at this stage that the nurse should share with the adolescent girl? Menstrual related insomnia Loss of existing fat deposits Breast development Increased risk for bladder incontinence

Breast development Explanation: Breast development is a change that occurs in the body of an adolescent girl. Many changes take place in the body, such as the appearance of feminine contours, development of breast tissue, appearance of unique fatty deposits, and hair in the pubic and axillary areas. Menopausal clients often experience irritability and insomnia, hot flashes, and urinary incontinence.

Which hormone would be initially responsible for hormone secretion from the ovaries and testes? Follicle-stimulating hormone Luteinizing hormone Gonadotropin-releasing hormone Interstitial cell-stimulating hormone

Gonadotropin-releasing hormone Explanation: The gonadotropin-releasing hormone (GnRH) is the hormone responsible for the sequence of events that eventually lead to hormonal secretion from the ovaries and testes. GnRH released from the hypothalamus stimulates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH; sometimes referred to as the interstitial cell-stimulating hormone in males) from the anterior pituitary gland. These in turn stimulate the male and female glands to secrete their hormones.

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. May 26. May 30. June 1.

May 24. Explanation: For a woman with a 28-day cycle, ovulation typically occurs on day 14. Therefore, her next menses would begin 14 days later, on May 24.

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

Pulmonary embolism Explanation: Sudden, sharp chest pain that may or may not include hemoptysis is a sign of pulmonary embolism. It may begin as a deep vein thrombosis but the symptoms that the client describes are related to the lungs. Breast tenderness and skeletal pain do not indicate a visit to the emergency department.

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? 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

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

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 schedule appointments to monitor drug effects. 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 patient will take drugs accurately and for the length of time prescribed. Explanation: 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.

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 Edema of the feet Gastrointestinal upset Chloasma

Thromboembolism Explanation: The nursing diagnosis of impaired tissue perfusion is related to thromboembolism, which is a complication of estrogen replacement therapy. A nurse may note other female-hormone-related adverse reactions such as edema of the feet due to excess fluid volume, or gastrointestinal upset, which manifests as nausea, vomiting, abdominal cramps and bloating. Chloasma is a dermatologic reaction due to female hormones, which results in excessive pigmentation of the skin.

Which statement by a female client who is using the Estradiol transdermal system indicates a need for further instruction? "I will not apply it to my breasts or any area that can be exposed to sunlight." "I will avoid placing it in areas where my clothing can rub it." "I prefer to apply the patch to my upper thigh only." "I always hold in it place for 10 seconds during application."

"I prefer to apply the patch to my upper thigh only." Explanation: The client should be using more sites and must allow at least a one-week interval between applications to a particular site. The client is correct in knowledge of where to place it, to hold it in place for 10 seconds, and to keep it away from clothing that could rub and loosen the system.

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." "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." "You need to carefully consider whether you might want to get pregnant later in your life."

"Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." Explanation: 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.

A client calls the women's health clinic and tells the nurse that she went to the dentist for an abscessed tooth. The dentist put her on an antibiotic, and the client wants to know if it will cause problems with her prescribed oral contraceptives. What is the nurse's best response? "There is no interaction; you have nothing to worry about." "Take two pills each day. The provider will call if the additional medication is needed." "Take a pill every other day to prevent severe adverse effects." "Use alternate means of birth control until you are finished with the antibiotic."

"Use alternate means of birth control until you are finished with the antibiotic." Explanation: Antibiotics lessen the effectiveness of oral contraceptives, so the client should use alternative methods of birth control until the antibiotics are completed and the client begins a new cycle of oral contraceptives.

After patient teaching of the warning signs associated with combination hormonal contraception, what statement would result in the nurse providing additional education? A. "Breakthrough bleeding is a sign of a uterine abnormality." B. "I should immediately go to the emergency department if I get a sudden, severe headache that is not relieved with rest or an analgesic." C. "Severe leg pain and swelling should immediately be reported." D. "Cardiovascular problems are the most severe adverse effects associated with oral contraceptives."

A. "Breakthrough bleeding is a sign of a uterine abnormality." Breakthrough bleeding wit the administration of combination hormonal contraception is a common side effect associated with this method. Breakthrough bleeding does not indicate a sign of uterine abnormality. The client will need more client education regarding the adverse effects of combination hormonal contraception.

A nursing instructor is teaching a group of students about estrogens and their use. The instructor determines that the teaching was successful when the students correctly choose which statement(s) as true concerning estrogen? Select all that apply. Changes in lipids levels occur with the use of estrogens. Progestin use is recommended when estrogen is used after a hysterectomy. Estrogen replacement therapy (ERT) helps to lessen the changes to the aging tissues. Estrogens increase a woman's risk for gallbladder disease. The use of estrogens is associated with relatively few adverse reactions.

Changes in lipids levels occur with the use of estrogens. Estrogen replacement therapy (ERT) helps to lessen the changes to the aging tissues. Estrogens increase a woman's risk for gallbladder disease. Explanation: Estrogens can relieve symptoms of menopause but can lead to blood pressure and lipid changes. ERT can help lessen the changes to aging tissues, but the estrogen does increase a woman's risk for gallbladder disease. The addition of progestin is recommended when estrogen is used to treat menopausal symptoms in a woman with an intact uterus. Estrogen alone may be used for estrogen replacement therapy after a hysterectomy. The administration of estrogen by any route may result in many adverse reactions, although these reactions vary in incidence and intensity.

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

Hyperkalemia Explanation: 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 gel use. Abdominal pain may be due to intrauterine system administration.

In evaluating a plan of care for a client on estrogen therapy, what would be an appropriate part of the evaluation? Teach the client that combined estrogen-progestin therapy may increase blood sugar levels in women with diabetes. Take estrogens and progestins with food or at bedtime to decrease nausea, a common adverse reaction. Weigh weekly and report sudden weight gain. Interview and assess for therapeutic and adverse drug effects.

Interview and assess for therapeutic and adverse drug effects. Explanation: The nurse should monitor client response to the drug (palliation of signs and symptoms of menopause, prevention of pregnancy, decreased risk factors for coronary artery disease, palliation of certain cancers); adverse effects (liver changes, GI upset, edema, changes in secondary sex characteristics, headaches, thromboembolic episodes, breakthrough bleeding). The other options are client teaching guidelines for those on estrogen or progestin therapy. They are not part of the evaluation process of the care plan.

When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process? 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 Directing the patient to weigh herself weekly and to report sudden weight gain Interviewing the patient and observing for therapeutic and adverse effects

Interviewing the patient and observing for therapeutic and adverse effects Explanation: The evaluation should include interviewing the patient and observing for therapeutic and adverse drug effects. Although the other options describe important teaching guidelines for patients on estrogen or progestin therapy, they are not part of the evaluation process.

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. Teach client how to combine medications. Help plan for adequate calcium and vitamin D in the diet. Provide client teaching for diet therapy to prevent osteomyelitis.

Monitor liver function periodically. Explanation: Appropriate interventions for clients taking estrogen therapy include to monitor liver function periodically for the client on long-term therapy, to evaluate liver function and ensure discontinuation of drug at any sign of hepatic dysfunction. The nurse should help post-menopausal women plan for adequate calcium and vitamin D in the diet and adequate weight-bearing exercise to maintain bone strength and prevent osteoporosis; assist clients in obtaining follow-up health care when indicated; and provide client teaching for drug therapy. The client should not combine medications unless ordered. The client in the scenario is not old enough to be concerned about calcium and vitamin D in the diet connected with osteoporosis. The nurse would provide client teaching for anything to prevent osteomyelitis because nothing in the scenario says the client has osteomyelitis.

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

Nausea Explanation: 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 client with benign prostatic hypertrophy is questioning the nurse about saw palmetto. Which is the best response from the nurse related to the use of this herb Take the herb as tea, prepared in hot water. Improvement can be seen within 2-3 weeks. Need to be reevaluated after 6 months of use. Stop the herb after 3 months of intake.

Need to be reevaluated after 6 months of use. Explanation: The nurse should inform the client that saw palmetto might help relief the symptoms of benign prostatic hypertrophy. The active components are not water soluble and should not be taken as a tea. Improvement can be seen after 1-3 months of taking the herb, and not within 2-3 weeks. The herb intake should not be stopped after 3 months but should be continued for 6 months, followed by evaluation by the health care provider.

What is the function of the corpus luteum after the release of a mature ovum during ovulation? Stimulates the release of follicle stimulating hormone (FSH) Produces both estrogen and progesterone Serves as a negative feedback system for estrogen production Stimulates the uterine Leydig cells

Produces both estrogen and progesterone Explanation: Corpus luteum is the remains of a follicle that releases mature ovum at ovulation; becomes an endocrine gland producing estrogen and progesterone. None of the other options provides accurate information about the function of the corpus luteum after ovulation occurs.

A client has been prescribed a transdermal patch of estrogen. Which adverse effect should be included in the teaching plan about the medication? Pain at the injection site Irritation of the oral pharynx Redness at the application site Edema and rhinitis of the nose

Redness at the application site Explanation: Redness and irritation at the application site is an adverse reaction with the transdermal system. The client is receiving a transdermal patch, not an injection. Irritation of the oral pharynx would occur with an oral medication. Edema and rhinitis of the nose can occur with nasal medications or rhinitis.

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

Pain in one leg Explanation: 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.

A nurse has administered estrogen and phenytoin to a client. Which reaction should the nurse plan to monitor the client carefully for? Potential for blood clots Increased risk for infection Possibility of breakthrough bleeding Increased risk for seizures

Possibility of breakthrough bleeding Explanation: When estrogen is given with phenytoin, a hydantoin, the client is at increased risk for breakthrough bleeding not seizures. Blood clots can be an adverse reaction with estrogen therapy alone. There is no increased risk for infection. When given together, these drugs do not increase the risk for seizures.

After speaking with college students about birth control, the nurse realizes more education is needed when one student says: "Birth control pills will help prevent sexually transmitted diseases." "I should try to always take my pill at the same time each day." "I may have some nausea and vomiting when I first start taking these pills." "If my legs start to swell and hurt, I should seek medical help immediately."

"Birth control pills will help prevent sexually transmitted diseases." Explanation: Oral contraceptives are effective at preventing pregnancy but will not prevent STDs. Abstinence and physical barriers, such as condoms, are the most effective at preventing the spread of STDs.

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 8 hours 12 hours 24 hours

4 hours Explanation: The action of sildenafil persists for 4 hours. The duration of the drug is from 30 minutes to 4 hours before sexual activity. Medical attention should be sought for erections sustained for more than 4 hours. The action of the drug does not persist for 8, 12, or 24 hours.

The effect of which drug class is not affected by a simultaneous prescription for an oral contraceptive? A. Corticosteroids B. Sulfonylurea antidiabetic drugs C. Benzodiazepines D. Anticonvulsants

A. Corticosteroids Corticosteroids are not affected by oral contraception use. Oral contraceptives decrease the effects of some benzodiazepines (e.g., lorazepam, oxazepam, temazepam), anticonvulsants, sulfonylurea antidiabetic drugs, and warfarin. If one of these drugs is taken concurrently with an oral contraceptive, increased dosage may be needed for therapeutic effects.

A patient is prescribed estradiol in a vaginal ring form. The nurse would instruct the patient to insert a new vaginal ring at which frequency? Daily Weekly Monthly Every 3 months

Every 3 months Explanation: The vaginal ring formulation of estradiol is applied once every 3 months.

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

Shortness of breath Explanation: 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.

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

Supervised use at the lowest dose for the shortest duration Explanation: The FDA recommends supervised use of estrogen therapy at the lowest dose for the shortest duration to help prevent any adverse effects and lower the risks to the client.

The nurse is interviewing a postmenopausal woman. Which assessment question demonstrates the nurse's understanding of a condition associated with these hormonal changes? (Select all that apply.) "Do you every experience pain or burning when you urinate?" "Has sexual intercourse become painful?" "Do you seem to bruise more easily than before?" "Do you ever feel unexpected flashes of heat?" "Are you experiencing blurry vision?"

"Do you every experience pain or burning when you urinate?" "Has sexual intercourse become painful?" "Do you ever feel unexpected flashes of heat?" Explanation: Menopause is associated with loss of many of the effects of these two hormones on the body, including retention of calcium in the bones, lowered serum lipid levels, and maintenance of secondary sex characteristics. As estrogen leave the blood vessels, many women experience "hot flashes" or vasospasm. Drying vaginal tissue can lead to painful intercourse and more frequent urinary tract infections (UTIs).

The nurse performs which assessments when a female client comes to the clinic for a follow up visit while undergoing estrogen therapy? (Select all that apply.) Blood pressure check Client weight Peripheral oxygen saturation Temperature Peripheral pulse

Blood pressure check Client weight Peripheral pulse When a female client returns to the clinic while on estrogen therapy, the nurse will assess the client's blood pressure, pulse, respiratory rate, and weight. The nurse will also inquire if the client is experiencing any adverse reactions to the medication. A temperature is not indicated unless the client is showing signs of infection. Also, an oxygen saturation would not be checked unless there was a specific need for that test.

A nurse is caring for a client with advanced breast cancer who is receiving androgen therapy. Which signs might alert the nurse to the possibility of liver toxicity? Edema of the feet Increase in appetite Clinical jaundice Increase in weight

Clinical jaundice Explanation: Liver toxicity is indicated by the presence of jaundice. Edema of the feet and an increase in weight may be seen because of fluid and electrolyte imbalance but does not indicate liver toxicity. An increase in appetite shows that the client is responding well to the drug and is not a sign of liver toxicity.

A client is beginning therapy with terazosin. Based on the action of this drug, which nursing diagnosis should the nurse prioritize? Acute pain Injury risk Impaired oral mucous membranes Knowledge deficiency

Injury risk Explanation: Terazosin, an antiadrenergic drug, can cause a hypotensive reaction. Thus, the client may experience an immediate lowering of blood pressure when first starting this drug and be at risk for injury. Acute pain would be more appropriate for a client experiencing priapism from erectile dysfunction drugs. Impaired oral mucous membranes would be appropriate for the client receiving antispasmodics. Knowledge deficiency could apply to any client receiving medication

Which hormone is responsible for ovulation? Luteinizing hormone Follicle stimulating hormone Estrogen Progesterone

Luteinizing hormone Explanation: The surge of luteinizing hormone causes one of the developing follicles to burst and be released. This release of the ovum is called ovulation. Follicle stimulating hormone stimulates follicular growth and development. Rising estrogen levels causes the surge of luteinizing hormone, which results in ovulation. Progesterone is produced by the graafian follicles and retained in the follicle.

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 Normal sexual development and growth Endometrial cancer

Normal sexual development and growth Explanation: 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.

The nurse is seeing a client who reports having flu-like symptoms including a runny nose. This client has been on estrogen therapy. The nurse suspects the client is experiencing which adverse effect of the medication? Pulmonary embolism Dysmenorrhea Chloasma Rhinitis

Rhinitis Explanation: One of the adverse reactions to taking estrogen therapy is rhinitis, the client's reports of flu like symptoms is consistent with this finding. A pulmonary embolism would likely produce more imminent symptoms such as shortness of breath and/or chest pain. Dysmenorrhea refers to the pain associated with menstruation. Chloasma is a hyperpigmentation of skin that can occur with the use of estrogen.

A client comes to the emergency department and reports extreme pain. Physical assessment reveals a 6-hour erection. When obtaining the client's medication history, which drug would the nurse expect the client to report using? Tamsulosin Terazosin Tadalafil Tolterodine

Tadalafil Explanation: Priapism (an erection lasting more than 4-6 hours) occurs with the use of phosphodiesterase type 5 inhibitors, such as tadalafil. It is not associated with use of antiadrenergic drugs or antispasmodics.

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 stimulates skeletal growth, causing increased production of red blood cells. The estrogen increases production of factors II, VII, IX, and X. The estrogen causes peripheral vasoconstriction.

The estrogen increases production of factors II, VII, IX, and X. Explanation: Estrogen increases the risk of blood clots by increasing platelet aggregation and hepatic production of blood clotting factors (II, VII, IX, X). The risk is elevated in women older than 35 years of age who smoke.

The increase in thickness of the endometrial layer during the first half of the menstrual cycle is controlled by the: level of FSH. increasing level of HcG. dropping level of LH. increasing level of estrogen.

increasing level of estrogen. Explanation: Estrogen levels increase after menstruation. These levels promote a thickening of the endometrial tissue. FSH and LH are responsible for ovarian changes. HcG is the hormone present during pregnancy.

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? Renal function test Liver function test Complete blood count Electrolyte test

iver function test Explanation: Progestin use often results in inaccurate liver function and endocrine function tests.

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 arthritis deep vein thrombosis myocardial infarction

stroke deep vein thrombosis 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 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 Lung disease Pelvic inflammatory disease Osteosarcoma

Endometrial carcinoma Explanation: The U.S. FDA has issued a Black Box Warning with the solo use of estrogen presenting an increased risk of endometrial carcinoma. Estrogen is contraindicated for use in a patient with active liver disease. There is currently no indication that estrogen increases the risk of PID or osteosarcoma.

A nurse is teaching a client about the prescribed tolterodine. The nurse determines the session is successful when the client correctly chooses which potential adverse reaction(s) to report to the health care provider? Select all that apply. Anorexia Xerostomia Decreased lacrimation Blurred vision Diarrhea

Xerostomia Decreased lacrimation Blurred vision Common adverse reactions seen with the use of tolterodine include xerostomia, constipation, headache, and dizziness. Anorexia is a potential adverse reaction to testolactone. Diarrhea is a potential adverse reaction to mirabegron, silodosin, bicalutamide, enzalutamide, flutamide, and estramustine.

The original HRT therapy was found to be associated with increased risks of breast and cervical cancer. Newer drugs used in HRT are associated with only a possible increased risk of breast and cervical cancer, but with long-term care are associated with an increased risk of: cardiovascular events. ovarian cancer. osteoporosis. compression fractures.

cardiovascular events. Explanation: The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use are associated with an increased risk of cardiovascular events.

The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The client is on a low-residue diet for colitis. What factor in the client's history may contraindicate the use of birth control pills? migraine headaches age asthma colitis

migraine headaches Explanation: Progestins should be used with caution in clients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.

After explaining the various contraceptive options with a client, the client opts for the etonogestrel/ethinyl estradiol vaginal ring. After teaching the client about this choice, the nurse determines that the teaching was effective when the client makes which statement? "Once I insert the ring, it won't come out." "The ring should stay in place for 3 weeks." "When bleeding starts, that's the signal to change the ring." "I can reuse the ring several times before discarding it."

"The ring should stay in place for 3 weeks." Explanation: When using the vaginal ring, the client should insert the ring and keep it in place for 3 weeks and then remove it on the same day of the week it was inserted. The ring can be expelled accidentally, such as with straining on defecation or removing a tampon. Typically, bleeding occurs once the ring is removed. The ring should be discarded after each use.

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? A. Hysterectomy B. Persistent nausea C. Weight gain D. Development of hypertension

A. Hysterectomy Clients 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 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? Breastfeeding Family history of cardiovascular disease History of recent cholecystectomy History of pelvic inflammatory disease

Breastfeeding Explanation: Contraindications to progestin use include allergies to the drugs, pregnancy or suspected pregnancy, and breastfeeding. Other contraindications are history of active cardiovascular disease; thrombophlebitis; thromboembolic disorders; and carcinoma of the breast, ovaries, or endometrium. A final contraindication is undiagnosed vaginal bleeding. A history of depression warrants caution.

What statement by the client who has been prescribed a combination contraceptive several months ago indicates a need for health education? A. ''I've been checking my blood pressure at the drug store from time to time since I started on the pill.'' B. ''I've learned that the pill is almost 100% effective if you take it on schedule.'' C. ''It's good to know that the pill protects against some sexually transmitted infections.'' D. ''My friend says she takes the pill for problems with her period, not to avoid getting pregnant.''

C. ''It's good to know that the pill protects against some sexually transmitted infections.'' Oral contraceptives provide no protection against STIs. Effectiveness approaches 100%, and blood pressure monitoring is appropriate and necessary. Health care providers also use oral contraceptive preparations to treat menstrual disorders.

The release of gonadotropin releasing hormone by the hypothalamus signals the onset of: puberty. menarche. menopause. menstruation.

puberty. Explanation: The release of gonadotropin releasing hormone by the hypothalamus occurs at puberty

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 monitor my weight and have my blood pressure checked in 3 months." "I may gain or lose weight while I am taking these pills." "I will exercise more if I experience chest or leg pain." "I know my nausea is common, but it should subside in a few weeks."

"I will exercise more if I experience chest or leg pain." Explanation: Chest or leg pain may be indicative of a thrombus, and medical care should be sought immediately. The other options are correct statements but do not address the question asked.

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." "Actually, most of the current research is suggesting that HRT may not be all that effective in treating the symptoms of menopause." "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" "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" Explanation: 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.

Conjugated estrogen therapy would be most appropriate for which one of these clients? 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 72-year-old with newly diagnosed breast cancer

A 25-year-old female with primary ovarian failure Explanation: 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).

Progesterone is a progestin concerned almost entirely with reproduction. In non pregnant women, progesterone is secreted by which of the following? A. corpus luteum B. hypothalamus C. anterior pituitary D. adrenal cortex

A. corpus luteum Progesterone is secreted by the corpus lute in the first few weeks of pregnancy. It plays and important role in the stabilization of the endometrium to support the pregnancy.