NURS 167: Exam 1

Which medication is used for treating infertility? 1 Oxytocin 2 Clomiphene 3 Indomethacin 4 Dinoprostone

2 Clomiphene Infertility is an absence of ovulation caused by an imbalance in reproductive hormones. Clomiphene stimulates the production of gonadotropin hormones, which in turn leads to ovulation. Oxytocin is used to induce labor when uterine contractions are weak. Indomethacin is used during preterm labor. Dinoprostone is used to evacuate the uterine contents during miscarriage and for cervical ripening.

Which statement indicates that the patient understands the benefit of continuous administration of progestin with an estrogen regimen? 1. "Endometrial cancer risk can be reduced by adding progestin." 2. "The progestin in the regimen will help prevent breast cancer." 3. "The progestin in the regimen will help prevent ovarian cancer." 4. "Vaginal cancer is prevented by adding progestin to the regimen."

1. "Endometrial cancer risk can be reduced by adding progestin." Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia.

A female patient is taking estrogen with progesterone. To facilitate monitoring of the risks associated with this therapy, what instruction should the nurse include in patient teaching? 1. "Have a yearly mammogram." 2. "Have tests for serum cholesterol." 3. "Perform weight-bearing exercise." 4. "Report missed menstrual periods."

1. "Have a yearly mammogram." Estrogen in combination with progesterone increases the risk of breast cancer, so the nurse should instruct the patient to have a yearly mammogram. Although patients taking estrogen with progestin are at increased risk of thromboembolic events, the effect on serum lipids is unclear. The risk of osteoporosis decreases for women who take estrogen therapy; hence, it is not necessary to perform weight-bearing exercise. Pregnancy is generally not a concern when women take this combination as hormone replacement therapy, and missed periods are common. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

To better help a client understand the action of clomiphene, the nurse should include which information in the teaching plan for female client who will begin taking the drug? 1. Check deep tendon reflexes 2. Auscultate lung sounds every 15 minutes. 3. Ask the client to report sudden flank pain 4. Percuss the suprapubic area every hour.

1. Check deep tendon reflexes

The perinatal nurse is assigned to several clients. The nurse anticipates that which client is most likely to be a candidate for drug therapy with terbutaline? 1. Client at 27 weeks' gestation who has regular uterine contractions. 2. Client at 41 weeks' gestation with irregular uterine contractions. 3. Client with postpartum hemorrhage following delivery. 4. Client at 38 weeks' gestation with HTN and seizures.

1. Client at 27 weeks' gestation who has regular uterine contractions.

A female patient with strep throat is taking amoxicillin with clavulanate to treat the infection. Because the patient also takes an oral contraceptive (OC), how long should the nurse instruct the patient to use a different method of birth control? 1. For at least a month after starting the antibiotic 2. During the entire period the patient is taking the antibiotic 3. Until three throat cultures have been negative for the pathogen 4. For at least 6 weeks, starting at the end of the antibiotic regimen

1. For at least a month after starting the antibiotic Because antibiotics, especially penicillin and cephalosporins, can impair the action of OCs, the nurse should instruct the patient to use another method of birth control for at least 1 month after starting the antibiotic. The effect of OCs is reduced when antibiotic therapy is started. Hence, using birth control only at the end of the antibiotic regimen is not effective. If three throat cultures are negative for the pathogen, it indicates a need to stop the antibiotic therapy, not to resume the use of birth control.

A patient is receiving intravenous methylergonovine after a vaginal delivery. Which postpartum assessment is the nurse's priority to prevent complications of therapy? 1. HTN 2. Hypoglycemia 3. Decreased lochia 4. Uterine contractions

1. HTN The therapeutic goal is contraction of the fundus to stop postpartum bleeding. Hypertension is likely to increase the severity of postpartum bleeding, so the prevention of hypertension is the nurse's priority for a postpartum patient receiving an ergot alkaloid, because ergot alkaloids can increase blood pressure. Hypoglycemia is not an adverse effect of methylergonovine. Decreased lochia rubra is the therapeutic goal. Uterine contractions are expected during methylergonovine therapy, because this is the mechanism of action behind the cessation of postpartum uterine bleeding. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? 1. Male condom 2. Spermicidal agent 3. IUD 4. Cervical diaphragm

1. Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease, because they provide the most barrier protection. A spermicidal agent kills sperm. An intrauterine device is placed in the uterus. A cervical diaphragm is not as effective as condoms.

During a postpartum assessment, the nurse notes a boggy uterus and increased uterine bleeding. Which drug should the nurse anticipate will be prescribed? 1. Oxytocin 2. Terbutaline 3. Clomiphene 4. Prostaglandin E

1. Oxytocin Oxytocin is a uterine stimulant that causes uterine contractions, which will decrease the bleeding. Terbutaline was formerly the drug of choice for preterm labor; in 2011, the FDA stated that terbutaline should not be used to prevent preterm labor or for prolonged treatment because of maternal and fetal safety risks. Clomiphene is an ovulation stimulant and is not used for uterine bleeding. Prostaglandin E is used for termination of pregnancy. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

The labor and delivery nurse is caring for a patient in preterm labor who is receiving indomethacin. The patient develops hypotension. What should be the nurse's initial action? 1. Place the patient on her left side. 2. Immediately discontinue IV fluids. 3. Administer phentolamine mesylate. Instruct the patient to bear down and push.

1. Place the patient on her left side. Placement of the patient in the left lateral recumbent position minimizes hypotension, increases renal blood flow, and increases blood flow to the fetus. Phentolamine mesylate is an alpha-adrenergic blocker and antihypertensive and is not indicated in the treatment of hypotension. Bearing down and pushing when the patient is not ready to deliver could result in fetal compromise.

Which medication is contraindicated in a patient who has osteoporosis and a history of deep vein thrombosis? 1. Raloxifene 2. Denosumab 3. Risedronate 4. Alendronate

1. Raloxifene Selective estrogen receptor modulators (SERM) are used to treat osteoporosis. Raloxifene is a SERM medication. This medication is contraindicated for patients who have a history of deep vein thrombosis, because it increases the risk for blood clots. Denosumab is used to prevent bone resorption in patients who have osteoporosis and is contraindicated in patients who have a history of renal failure. Risedronate and alendronate are bisphosphonates used in treating osteoporosis and are contraindicated in patients who have hypocalcemia and esophageal dysfunction. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol? 1. Rifampin 2. Furosemide 3. Calcium citrate 4. Acetaminophen

1. Rifampin Rifampin decreases the estrogenic effects of oral contraceptives. Furosemide is used for the treatment of edema. Calcium citrate is a calcium supplement used for preventing osteoporosis. Acetaminophen is used to relieve pain and fever.

The nurse should conclude that a female client has understood medication instructions when she makes which statement about clomiphene? 1. This medication will help me ovulate. 2. I'll take this medication orally for 1 month. 3. The medication prepares the wall of the uterus for fertilization. 4. My husband is going to ask if he can take the medication as well.

1. This medication will help me ovulate.

A 46-year-old female patient who complains of hot flashes, fatigue, and sleep disorders is unwilling to start hormonal therapy. Which is the best nursing intervention for this patient? 1. Persuade the patient to start the therapy. 2. Ask the patient to include soy in her diet. 3. Advise the patient to engage in quiet activities. 4. Inform the patient about the benefits and risks of the therapy.

2. Ask the patient to include soy in her diet. The isoflavones in soy are chemically similar to the female hormone estradiol. It helps to reduce menopausal symptoms in perimenopausal women. Hence, the patient can be asked to include soy in her diet. It is ethically incorrect to persuade the patient; instead the nurse can assess the reasons why the patient is unwilling to take the therapy and clear any misunderstandings that the patient has. Asking the patient to engage in quiet activities will not help diminish menopausal symptoms. Informing the patient about the benefits and risks of the therapy will not help to convince the patient if she is not interested in the therapy.

Which hormonal change directly causes the breakdown of the endometrium and resultant menstrual bleeding? 1. Increased levels of estrogens. 2. Decreased level of progesterone. 3. Increased LH 4. Decreased level of FSH

2. Decreased level of progesterone The breakdown of the endometrium and the resultant menstrual bleeding are caused by the fall of the progesterone level at the end of the menstrual cycle. The decline in estrogens plays a role, but the decrease in progesterone is responsible for bleeding. The increase in estrogens after menstruation is responsible for the restoration of the endometrium. LH and FSH are not directly related to menstrual bleeding.

Which medication is used in management of preterm labor? 1. Megestrol 2. Indomethacin 3. Methylergonovine 4. Medroxyprogesterone acetate

2. Indomethacin Indomethacin is a nonsteroidal antiinflammatory agent used in management of preterm labor. Megestrol is a progestational medication used to treat uterine bleeding. Methylergonovine is a uterine stimulant used to treat postpartum uterine hemorrhage. Medroxyprogesterone acetate is a progestational medication used to treat amenorrhea and uterine bleeding. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.

After dinoprostone is administered to a client, a nurse plans to monitor for which of the following? 1. Fetal heart tones on a client who had difficulty conceiving. 2. Initiation of contractions for a client desiring an elective abortion. 3. Initiation of lactation for a client interested in breastfeeding. 4. Early signs and symptoms of pregnancy.

2. Initiation of contractions for a client desiring an elective abortion.

Which location should be used for placing a transdermal patch of testosterone on a patient for the treatment of primary hypogonadism? 1. Thighs 2. Scrotum 3. Abdomen 4. Upper arms

2. Scrotum A transdermal patch is applied on the scrotum to treat primary hypogonadism. A testosterone transdermal patch is not applied on the thighs, abdomen, or upper arms.

What is the reason for prescribing dinoprostone to a patient who is at 38 weeks' gestation? 1. To terminate pregnancy 2. To induce cervical ripening 3. To treat gestational HTN 4. To treat PID

2. To induce cervical ripening Dinoprostone is a cervical ripening agent that is used to induce labor near term. Although certain forms of this medication can be used to terminate a pregnancy, this is not its use near term. This medication is not used to treat gestational hypertension or pelvic inflammatory disease. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

Which medication is used to treat hypogonadism? 1. Megestrol 2. Alendronate 3. Esterified estrogens 4. Medroxyprogesterone

3. Esterified estrogens Esterified estrogens are a type of estrogen used in the treatment of hypogonadism. Megestrol is a synthetic progestin used to treat uterine bleeding. Alendronate is used to minimize bone loss in osteoporosis. Medroxyprogesterone is used to prevent pregnancy.

What is the purpose of administering menotropins to a male patient? 1. Decreases libido 2. Decreases fertility 3. Increases sperm production 4. Depresses sperm production

3. Increases sperm production Menotropins may be used to promote spermatogenesis in infertile men. They are used primarily for the promotion of ovulation in anovulatory female patients. They increase fertility and stimulate sperm production. This may often lead to enhanced libido.

A pregnant patient has been prescribed oxytocin. What is the nurse's primary intervention for this patient? 1. Assess pulse oximetry continuously. 2. Administer acetaminophen as needed. 3. Monitor the patient's BP frequently. 4. Suggest the patient take aluminum hydroxide with the medication.

3. Monitor the patient's BP frequently. Hypertensive episodes can occur with oxytocin use, so the nurse should monitor the patient's blood pressure frequently. Pulse oximetry is not indicated. Acetaminophen is not given for pain. It is not necessary to give aluminum hydroxide.

A female patient using contraceptives complains of headaches. Which contraceptive is the patient most likely using? 1. Medroxyprogesterone 2. Cervical cap with spermicidal jelly 3. Norethindrone and ethinyl estradiol 4. Male condom with spermicidal jelly

3. Norethindrone and ethinyl estradiol The patient has headaches, which are common side effects of estrogens. Progestin, the cervical cap, and male condom are reasonable alternatives for the prevention of pregnancy in this patient, because they are not associated with headache.

What condition is usually treated by administering menotropins? 1. Menopause 2. Endometriosis 3. Ovulatory dysfunction 4. Central precocious puberty

3. Ovulatory dysfunction Menotropins is the drug name for a standardized mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that is derived from the urine of postmenopausal women. The FSH component stimulates the development of ovarian follicles, which leads to ovulation. The LH component stimulates the development of the corpus luteum, which supplies female sex hormones (estrogens and progesterone) during the first trimester of pregnancy. Hormone replacement therapy is used to treat symptoms associated with menopause-related estrogen deficiency. Progestins are used in treating endometriosis. Menotropins are not used to treat central precocious puberty.

Which phase of the menstrual cycle involves the release of an unfertilized ovum? 1. Phase 1 2. Phase 2 3. Phase 3 4. Phase 4

3. Phase 3 The menstrual cycle has four phases. The unfertilized ovum is released from the ovum during phase 3, which is the ovulation phase. Phase 1 is referred to as the menstruation phase. The phase initiates the cycle and lasts 5 to 7 days. Phase 2 is known as the follicular phase. During this phase, the mature ovum develops from the ovarian follicle. Phase 4 is the luteal phase. During this phase, the corpus luteum is formed from the ruptured ovarian follicle.

The nurse is assessing a female patient who has osteoporosis. The nurse finds that the patient is prescribed a bisphosphonate instead of calcitonin. What is the possible reason for this prescription? 1. The patient has breast cancer. 2. The patient smokes frequently. 3. The patient is allergic to salmon. 4. The patient experiences joint pain.

3. The patient is allergic to salmon. Calcitonin is derived from salmon; hence the drug is not prescribed for patients who are allergic to salmon. Breast cancer is not a reason to prescribe a bisphosphonate. Smoking is harmful only if the patient is taking estrogen therapy, because it leads to thrombosis. Joint pain is a potential adverse effect of a bisphosphonate.

What is the purpose of giving estrogen therapy in combination with progestins? 1. To treat ovarian cancer. 2. To treat breast cancer. 3. To prevent endometrial cancer. 4. To reduce the chances of vaginal cancer.

3. To prevent endometrial cancer. To reduce the risk of endometrial hyperplasia or cancer, the concurrent use of a progestin for 10 to 14 days of the cycle is recommended for women with an intact uterus. Estrogens are administered to prevent complications from ovarian failure but not to treat ovarian cancer. Estrogen therapy raises recurrence risk if administered to patients with breast cancer. Vaginal cancer is treated with surgery or chemotherapy.

What information should the nurse include when teaching about cancer risks in postmenopausal women? 1. Estrogen monotherapy increases the risk of breast cancer. 2. Monotherapy with a progestin increases breast cancer risk. 3. Unopposed estrogen increases the risk of endometrial cancer. 4. Estradiol with progestin increases the risk of endometrial cancer.

3. Unopposed estrogen increases the risk of endometrial cancer. The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. Estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.

The clinical reports of a patient taking fertility drugs indicate an increase in prolactin concentrations, which leads to impaired fertility. What should the nurse plan to assess in the patient? 1. Whether the patient is smoking frequently 2. Whether the patient has abnormal uterine bleeding 3. Whether the patient is taking medications for depression 4. Whether the patient is not complying with the fertility drugs

3. Whether the patient is taking medications for depression Tricyclic antidepressant medications, usually taken for depression, interact with the fertility drugs and increase prolactin concentrations. Smoking is harmful in patients who take estrogen therapy, because it may lead to thrombosis. Smoking does not increase prolactin concentrations. Fertility drugs are contraindicated in patients with abnormal uterine bleeding. Abnormal uterine bleeding does not increase prolactin concentrations. Noncompliance with fertility drugs will not increase prolactin concentrations, nor will it aid in conception.

Which patient statement indicates to the nurse full patient understanding of the discharge instructions regarding alendronate? 1. "I need to decrease my intake of dairy products to prevent hypercalcemia." 2. "I need to take this medication with food to prevent damage to my esophagus." 3. "This medication will help relieve the bone pain I have from my osteoporosis." 4. "I will take the medication on an empty stomach and not lie down for 30 minutes."

4. "I will take the medication on an empty stomach and not lie down for 30 minutes." Alendronate can cause erosive esophagitis. To prevent this side effect, it is important to take the medication first thing in the morning on an empty stomach without any other medications and to maintain an upright position for 30 minutes. These actions facilitate rapid absorption and prevent reflux into the esophagus. Decreasing dairy intake is not indicated. The medication does not directly relieve bone pain caused by osteoporosis.

Which instruction should a nurse provide to a patient who is taking alendronate? 1. "Take the medication with aspirin." 2. "Take the medication with antacids." 3. "Take the medication with calcium supplements." 4. "Take the medication on an empty stomach with an 8-oz glass of water."

4. "Take the medication on an empty stomach with an 8-oz glass of water." Alendronate is a bisphosphonate medication used to treat osteoporosis. This medication causes esophageal burns and can lead to gastrointestinal upset. To prevent the esophageal burns, the nurse should instruct the patient to take the medication with an 8-oz of glass of water on an empty stomach. The nurse should not instruct the patient to take the medication along with antacids, because antacids can decrease the absorption of alendronate. Aspirin can cause gastric irritation if it is ingested along with alendronate. Calcium supplements can decrease the absorption of bisphosphonates; therefore, the nurse should suggest that the patient take calcium supplements 1 hour after receiving alendronate. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, what day and time, and what material you will cover.

A patient who is 26 weeks pregnant and who has diabetes mellitus begins to experience preterm labor. Which treatment is the best initial therapy for the prevention of uterine contractions and complications in this patient's pregnancy? 1. Ritodrine 2. Terbutaline 3. Magnesium sulfate 4. Bed rest and hydration

4. Bed rest and hydration Bed rest and hydration are especially good choices for this patient, because they do not carry the risk of increased blood sugar that terbutaline therapy does. Because pressure on the cervix or cervical incompetence can stimulate uterine contractions, bed rest may also be effective in relieving pressure on the cervix and inhibiting uterine activity. Ritodrine is generally reserved for when conservative measures and terbutaline have failed. Generally terbutaline, the drug of choice for preterm labor, is used after conservative measures have failed. Magnesium sulfate is used as an off-label therapy for preterm labor.

The nurse encounters a male patient who is taking finasteride. Which condition should the nurse suspect in the patient? 1. Priapism 2. Bladder cancer 3. Testicular cancer 4. Benign prostatic hyperplasia (BPH)

4. Benign prostatic hyperplasia (BPH) Finasteride is specifically administered for the treatment of BPH, which leads to enlargement of the prostate. Finasteride is also administered for the treatment of hair loss, occurring in men between the ages of 30 and 80. Finasteride helps lower the dihydrotestosterone (DHT) level. The medication is not directly related to priapism, bladder cancer, or testicular cancer.

The nurse is assessing a patient who is prescribed estrogen replacement therapy. A history of which medical condition would be a contraindication to this therapy? 1. Weight loss 2. Dysmenorrhea 3. Uterine bleeding 4. DVT

4. DVT The most serious adverse effects of the estrogens are thromboembolic events. A previous history would put the patient at increased risk. Uterine bleeding is an indication for estrogen therapy. A history of weight loss or dysmenorrhea would not be a contraindication for estrogen replacement therapy.

Which medication is contraindicated in patients who have osteoporosis and a history of renal dysfunction? 1. Calcitonin 2. Tamoxifen 3. Ibandronate 4. Denosumab

4. Denosumab Denosumab prevents bone resorption in patients who have osteoporosis; however, it is contraindicated for patients who have a history of renal dysfunction, because it increases the risk for renal failure. Calcitonin is used to treat osteoporosis and is contraindicated in patients who are allergic to salmon, because it is derived from salmon. Tamoxifen is a selective estrogen receptor modulator (SERM) used to treat osteoporosis and is contraindicated in patients who have deep vein thrombosis or pulmonary embolism, because it increases the risk for thrombosis. Ibandronate is used in the treatment of osteoporosis and is contraindicated if the patient has hypocalcemia and esophageal dysfunction.

Which of the following hormones initiates the cycle of events in the female ovary? 1. ADH 2. LH 3. Adrenocorticotropic hormone 4. FSH

4. FSH In women, follicle-stimulating hormone initiates the cycle of events in the ovary. Later in the cycle, the combined surges in the levels of estrogen, FSH, and LH stimulate ovulation. Antidiuretic hormone hinders the release of urine.

Which medication is suitable therapy for oral contraception in women who cannot take estrogen? 1. Estrone 2. Megestrol 3. Estropipate 4. Medroxyprogesterone

4. Medroxyprogesterone Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Estrone and estropipate are synthetic estrogens. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers.

Which medication is used to treat amenorrhea? 1. Estradiol 2. Denosumab 3. Alendronate 4. Medroxyprogesterone acetate

4. Medroxyprogesterone acetate Medroxyprogesterone acetate is a progestational medication used to treat amenorrhea. Estradiol is an estrogenic medication used to treat ovarian failure. Denosumab is used to treat osteoporosis. Alendronate is an oral bisphosphonate used in the treatment of osteoporosis. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

The nurse observes that a female patient is at risk for postpartum uterine hemorrhage. Which medication should the nurse discuss with the primary health care provider to initiate? 1. Estradiol 2. Megestrol 3. Alendronate 4. Methylergonovine

4. Methylergonovine Methylergonovine is used to prevent postpartum uterine hemorrhage. Estradiol is used for relieving vasomotor symptoms of menopause, female castration, and ovarian failure. Megestrol is used in the treatment of recurrent, inoperable, or metastatic endometrial or breast cancer. Alendronate is an oral bisphosphonate used for preventing bone loss.

The nurse is providing postpartum care for a female patient who is prescribed methylergonovine. Which aspect of the patient's medical history would be a contraindication for receiving this drug? 1. HTN 2. Uterine atony 3. N/V 4. PID

4. PID Methylergonovine is used for postpartum uterine hemorrhage. It is contraindicated in patients with pelvic inflammatory disease. Hence, the nurse needs to inform the primary health care provider about this. Methylergonovine should be used cautiously in patients with hypertension, but it is not a contraindication. The medication is used to treat uterine atony. Nausea and vomiting is not a contraindication.

The nurse finds that concentrated solutions of magnesium sulfate administered to prevent premature labor have caused toxicity in a patient. What is the best nursing intervention in this case? 1. Obtain a prescription for terbutaline. 2. Decrease the drug dose immediately. 3. Obtain a prescription for indomethacin. 4. Request a prescription to give calcium gluconate.

4. Request a prescription to give calcium gluconate. The nurse administers calcium gluconate, as it reverses magnesium toxicity in the patient. Terbutaline is a beta-adrenergic drug used to prevent premature labor, but it has maternal and fetal safety risks. Decreasing the drug dose will not have the desired drug effect on the patient. Indomethacin is an effective drug for preterm labor, but the most important action here is to reverse magnesium toxicity. Test-Taking Tip: Attempt to select the answer that is most complete and includes the other answers within it. For example, a stem might read, "A child's intelligence is influenced by what?" and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer.

The client in preterm labor who has a history of asthma received 2.5 mg of terbutaline sulfate subQ. After the client expresses concern about the use of this drug, which reply by the nurse would be most appropriate? 1. The HCP wanted to make sure you did not have asthma problems and early labor. 2. I am sure the HCP has a very good reason for ordering this medication. 3. What do you normally take to control your asthmatic attacks? 4. Terbutaline sulfate causes the respiratory tract to relax as well as the uterine wall.

4. Terbutaline sulfate causes the respiratory tract to relax as well as the uterine wall.

The nurse is about to administer dinoprostone to a patient. What condition is this medication used for? 1. Premature labor 2. Accelerated labor 3. Postpartum hemorrhage 4. Termination of pregnancy

4. Termination of pregnancy The use of dinoprostone or other prostaglandin E 2 drugs is indicated in specific situations requiring termination of pregnancy. It is not required during premature labor, accelerated labor, or postpartum hemorrhage.

The nurse administers diluted oxytocin solution to a female patient for labor induction and continuously monitors the maternal blood pressure and pulse rate, as well as the fetal heart rate. The nurse stops the oxytocin infusion when the contractions are more frequent than every 2 minutes. What is the purpose of this action? 1. The fetal heart rate is stable. 2. The patient is ready for delivery. 3. The patient's BP is stable. 4. The contractions can be fatal to the patient.

4. The contractions can be fatal to the patient. Contractions every 2 minutes indicates hyperstimulation in the patient, which may result in uterine rupture. Therefore, the nurse needs to stop the drug infusion immediately. Hyperstimulation also causes changes in other parameters, such as blood pressure and fetal heart rate, which may prove fatal to the patient. Hyperstimulation increases the patient's blood pressure level and also the fetal heart rate. The patient is not ready for delivery; rather, the patient is facing a serious complication. The nurse can administer intravenous fluids, administer oxygen, and place the patient in a side-lying position to reduce hyperstimulation. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

Which condition is an indication for a primary health care provider to prescribe danazol for a female patient? 1. Facial hair 2. Endometriosis 3. High testosterone levels 4. Cardiovascular disorder

2. Endometriosis Danazol is a synthetic androgen. It is prescribed to women for the treatment of endometriosis, because it causes atrophy of the endometrium and therefore helps alleviate its symptoms. Danazol increases the testosterone levels and may cause growth of facial hair. Therefore, it is not given for the treatment of facial hair. Women treated with the drug may develop infertility from the medication, because it also increases the production of testosterone. Danazol causes cardiovascular disorders. Therefore, danazol should not be prescribed if the patient has facial hair, high testosterone levels, or cardiovascular disorders.

Which group of college students does the nurse need to include in a teaching session on the risks of androgen abuse? 1. Students who are often tardy 2. Students who are on athletic teams 3. Students who do not socialize well in school 4. Students who perform extraordinarily in class

2. Students who are on athletic teams

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A ~ human papillomavirus (HPV) Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

What should be the daily dose of finasteride for an adult patient who is being treated for androgenetic alopecia? 1. 1 mg by mouth 2. 5 mg by mouth 3. 25 to 100 mg 1 hour before intercourse 4. 50 to 400 mg by intramuscular injection

1. 1 mg by mouth

After a female client taking an estrogen-progestin combination reports by phone a sudden onset of blurred vision, the nurse at the outpatient clinic should ask what most appropriate question? 1. Is there someone there with you? 2. When was the last time you had your eyeglasses prescription changed? 3. When is your next appointment with your GYN? 4. Do you have problems with migraine headaches?

1. Is there someone there with you?

The nurse is planning to administer vardenafil to a patient with a past history of a myocardial infarction (MI). What intervention should the nurse perform first? 1. Assess the patient's blood pressure. 2. Perform a thorough history, including medication. 3. Instruct the patient to take all cardiac medications first. 4. Call the health care provider to change the prescription.

2. Perform a thorough history, including medication. Vardenafil is safe for patients with a past history of MI; however, it is contraindicated with nitrate use. The nurse's primary responsibility is to assess medications the patient is receiving before administration.

Which hormone is responsible for initiating activity in the ovary? 1. Luteotropic hormone 2. LH 3. FSH 4. Interstitial cell-stimulating hormone

3. FSH FSH is responsible for initiating ovarian activity in women. FSH stimulates the ovaries to produce estrogen (primarily estradiol). Prolactin (PRL), also known as luteotropic hormone or luteotropin, is a protein that allows women to produce milk. Later in the cycle, the combined surges in the levels of estrogen, FSH, and LH stimulate ovulation. In males, LH is also called interstitial cell-stimulating hormone and stimulates Leydig cell production of testosterone.

Which statement by the nursing student regarding endogenous testosterone indicates effective learning? 1. "It promotes male catabolic metabolism." 2. "It helps eliminate nitrogen from the body." 3. "This drug is used to treat alcoholic hepatitis." 4. "The seminiferous tubules produce testosterone."

4. "The seminiferous tubules produce testosterone." Testosterone is produced in the testicles, in the interstitial cells of the seminiferous tubules. Testosterone promotes anabolic metabolism and helps retain nitrogen in the body. Oxandrolone is used to treat alcoholic hepatitis.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) "This combination of medications will eradicate the infection faster than a single antibiotic." b) "Many people infected with gonorrhea are infected with chlamydia as well." c) "The combination of these two antibiotics reduces the risk of reinfection." d) "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment."

B) Many people infected with gonorrhea are infected with chlamydia as well Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Genital herpes b) Gonorrhea c) Syphilis d) Chlamydia

Genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

Which medication is most likely to promote follicular maturation in an infertile female patient? 1. Clomiphene 2. Progesterone 3. Ethinyl estradiol 4. Choriogonadotropin alfa

1. Clomiphene Clomiphene facilitates follicular maturation by promoting the release of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Progesterone is more likely to be used to maintain a pregnancy. Ethinyl estradiol is a steroidal estrogen used in hormone replacement. Choriogonadotropin alfa causes ovulation from mature follicles.

The nurse determines a client with endometriosis understands the purpose of the newly prescribed danazol when the client makes which statement? 1. It suppresses pituitary output of the FSH. 2. I'll need to take this medication for the rest of my life. 3. I have to administer injections weekly. 4. This medication will relieve hot flashes.

1. It suppresses pituitary output of the FSH.

The nurse is caring for a patient who has erectile dysfunction who has been prescribed alprostadil. How will the nurse administer the medication to the patient? 1. Placing the medication in the patient's urethra 2. Placing the medication under the patient's tongue 3. Asking the patient to take the medication with milk 4. Asking the patient to chew the medication thoroughly

1. Placing the medication in the patient's urethra Alprostadil is a prostaglandin analog that is used for the treatment of erectile dysfunction. It increases the blood flow into the penis by causing vasodilation. This medication is available as an intravenous injection and intraurethral suppository. Therefore, the nurse can either insert the suppository by pushing it through the urethra, or the nurse may inject the medication into the erectile tissue of the penis. The medication is not available as sublingual tablets or chewable tablets. Therefore, the nurse should neither place the tablet under the patient's tongue nor ask the patient to chew the tablet thoroughly. The medication cannot be taken with milk, because this causes adverse effects.

The nurse is explaining the effects of estrogen therapy to a patient. Which effect mentioned by the patient indicates a need for additional teaching? 1 Prevention of breast cancer 2 Treatment of prostate cancer 3 Decrease in vasomotor symptoms 4 Improvement of atrophic vaginitis

1. Prevention of breast cancer Estrogen therapy increases the chances of breast cancer in women. Estrogen therapy leads to improvement of atrophic vaginitis, female hypogonadism, insufficient primary ovarian function, abnormal uterine bleeding, and severe vasomotor symptoms in women. It is also used to treat prostate cancer.

Which has the greatest potential to increase the risk of thromboembolism in a patient taking norethindrone and ethinyl estradiol? 1. Sedentary lifestyle 2. Smoking heavily every day 3. Consumption of saturated fats 4. Increased BMI

2. Smoking heavily every day. Women taking oral contraceptives are at increased risk of thromboembolic events if they smoke heavily or have a history of thromboembolism; this higher risk is partially caused by an increase in circulating levels of clotting factors. A sedentary lifestyle and increased BMI elevate the risk of several health problems and can contribute to the development of thromboemboli, but that risk is secondary to the risk resulting from concurrent smoking and use of oral contraceptives. Consumption of saturated fats is likely to increase the risk of a thromboembolic event in a patient who takes an oral contraceptive, but not as much as smoking.

The nurse is assessing a patient at a follow-up visit after starting treatment with sildenafil for erectile dysfunction. Which assessment finding would indicate that the treatment needs to be revised? 1. The patient's cardiac output is 5.6 L/min. 2. The patient's blood pressure is 90/60 mm Hg. 3. The patient verbalizes the ability to maintain an erection. 4. The patient does not have dry mouth, nausea, or vomiting.

2. The patient's blood pressure is 90/60 mm Hg. Sildenafil is usually prescribed for the treatment of erectile dysfunction. The drug may cause severe hypotension. Therefore, if the patient has a blood pressure of 90/60 mm Hg, it means that the patient is unable to take sildenafil because of concern for further blood pressure lowering effects. A cardiac output of 5.6 L/min is a normal finding and indicates a positive response to the treatment. The ability to maintain an erection indicates the effectiveness of the treatment. Dry mouth, nausea, and vomiting are potential side effects of sildenafil. The absence of these symptoms indicates a positive outcome of the treatment.

Which is a benefit of synthetic androgens? 1. Prolonged erection 2. Increased hair growth 3. Relief from fluid retention 4. Enhancement of the male libido

4. Enhancement of the male libido Synthetic androgen, administered through androgen-replacement therapy, helps treat testicular failure in a male patient. It helps improve the performance of the male libido. Prolonged erection and fluid retention are adverse effects of androgens. Finasteride causes increased hair growth.

Which type of oral contraceptive (OC) delivers hormones for more than 30 days? 1. Biphasic 2. Triphasic 3. Monophasic 4. Extended-cycle

4. Extended Cycle Extended-cycle oral contraceptives deliver hormones for 84 to 365 consecutive days, shortening or eliminating the hormone-free period. Biphasic OCs, which deliver estrogen in a fixed amount for 21 or 28 days, contain a low dose of progestin for the first 10 days and a higher dose of progestin for the remainder of the cycle. Triphasic OCs deliver three different estrogen-progestin combinations over the course of the cycle. Monophasic OCs deliver an unchanging combination of estrogen and progestin.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? A) Acyclovir B) Ceftriaxone C) Podophyllum resin D) Tetracycline

Ans: D Feedback: Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

The nurse determines teaching regarding the levonorgestrel-releasing intrauterine delivery system has been effective when the client makes which statement? 1. These devices are 100% effective. 2. I can keep this device in place for up to 5 years. 3. I will need to use a barrier method of birth control in addition to this device. 4. I will have the device removed every 2 years and replaced.

2. I can keep this device in place for up to 5 years.

Which conditions are contraindications for treatment with testosterone? Select all that apply. 1. Pregnancy 2. Oligospermia 3. Renal disease 4. Hypogonadism 5. Hepatic disease

1, 3, 5 Testosterone is contraindicated for patients who are pregnant and for those who are diagnosed with renal and hepatic disease. Testosterone is used to treat oligospermia and hypogonadism.

Which medication is an alpha 1-adrenergic blocker? 1. Alfuzosin 2. Goserelin 3. Nilutamide 4. Nandrolone

1. Alfuzosin Alfuzosin is an alpha 1-adrenergic blocker. Goserelin is a gonadotropin-hormone-releasing analogue. Nilutamide is an antiandrogen. Nandrolone is an anabolic steroid.

The nurse should consult with the HCP after noting that testosterone enanthate has been prescribed for which client? 1. 16 year old with moderate acne 2. 32 year old client with increased PSA level 3. 66 year old with melanoma 4. 65 year old male with HDL level of 88

2. 32 year old client with increased PSA level

A patient is prescribed sildenafil for erectile dysfunction. Which is the best time to take the dose? 1. 1 hour before sexual intercourse 2. 2 hours before sexual intercourse 3. 30 minutes before sexual intercourse 4. 10 minutes before sexual intercourse

1. 1 hour before sexual intercourse The appropriate time to take sildenafil is exactly 1 hour before sexual intercourse takes place. The medication does not have the desired effect if taken 2 hours, 30 minutes, or 10 minutes before sexual intercourse.

The client taking an estrogen-progesterone combination oral contraceptive calls the clinic reporting that she has forgotten her pills for the last two days. what medication directions should the nurse provide? 1. Take 2 pills today and 2 pills tomorrow, then one pill daily for the rest of the pill pack. 2. Take 2 pills today and then one each day until the pill pack is finished. 3. Notify your HCP of the missed dosage. 4. Stop tking the pills and have your partner use condoms until the next menses, then restart a new pill pack.

1. Take 2 pills today and 2 pills tomorrow, then one pill daily for the rest of the pill pack.

The nurse should inform a male patient about which potential type of cancer associated with testosterone therapy? 1. Kidney cancer 2. Prostate cancer 3. Bladder cancer 4. Intestine cancer

2. Prostate cancer Testosterone plays a role in the development of prostate cancer, but the extent to which supplemental testosterone therapy increases cancer risk is unclear. Testosterone does not affect the kidneys, bladder, or intestines in a direct way.

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B) Ceftriaxone The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with cefixime (Suprax).

What is an adverse effect associated with estrogen therapy? 1. Nausea 2. Dry Skin 3. Weight loss 4. Higher-pitched voice

1. Nausea The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma, not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy.

The nurse is teaching students about applying a transdermal estradiol patch. Which statement made by a student suggests effective learning? 1. "Rotate the patch every 2 weeks." 2. "Rotate the patch at the same time each day." 3. "Apply the patch to the breast area for better absorption." 4. "Apply the patch to the lower abdomen for better absorption."

4. "Apply the patch to the lower abdomen for better absorption." The estradiol transdermal patch should be applied as prescribed, which is usually one patch applied once or twice weekly to the lower abdomen and not to the breast or chest areas. The patch is not rotated unless prescribed by the primary health care provider and is changed once or twice each week, not daily or bi-weekly. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

A nurse is teaching a patient how to self-administer sildenafil. Which patient statement indicates effective learning? 1. "I should apply it to my abdomen." 2. "I should apply it onto the scrotal skin." 3. "I should push the suppository into my urethra." 4. "I should take the tablet 1 hour before intercourse."

4. "I should take the tablet 1 hour before intercourse." Sildenafil is available in tablet form and should be taken 1 hour before intercourse. Gels, ointments, creams, and transdermal patches are applied topically. Sildenafil is not a topical or suppository medication; therefore, it cannot be applied to the abdomen or scrotal skin or pushed into the urethra.

Which medication helps reduce postpartum uterine hemorrhage? 1. Megestrol 2. Raloxifene 3. Clomiphene 4. Methylergonovine

4. Methylergonovine Methylergonovine is a uterine stimulant used to treat postpartum hemorrhage. Megestrol is a progestational medication used to treat uterine bleeding. Raloxifene is a selective estrogen receptor modulator (SERM) used to prevent the occurrence of postmenopausal osteoporosis. Clomiphene is used to treat infertility. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? A) Anemia. B) Hypertension. C) Dysmenorrhea. D) Acne vulgaris.

Answer: B Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives often improves facial acne

If fertilization of an ovum does not occur during a menstrual cycle, which of the following structures responds to the increased levels of estrogen and progesterone? 1 Ovary 2 Hypothalamus 3 Pituitary gland 4 Corpus luteum

3. Pituitary gland If fertilization does not occur, the pituitary responds to the increased levels of estrogen and progesterone by shutting off the release of follicle-stimulating hormone and luteinizing hormone. The ovaries, hypothalamus, and corpus luteum are not directly involved.

The obstetrics nurse reviews a postpartum patient's history. The patient is prescribed methylergonovine for control of postpartum hemorrhage. Which are essential nursing interventions for a patient receiving this medication? Select all that apply. 1. Monitor the patient for blurred vision. 2. Administer it before placenta delivery. 3. Monitor BP during administration. 4. Assess for liver disease or PID. 5. Question the prescription if the patient has liver disease.

1, 3, 4, 5 Blurred vision is an adverse effect, and the patient should report this symptom to the nurse and health care provider. Blood pressure should be assessed throughout administration of methylergonovine, because hypertension is a common adverse effect. If this drug is given to hypertensive women, it may precipitate seizures or a stroke. Pelvic inflammatory disease and liver disease are contraindications to the use of methylergonovine. Methylergonovine is administered after delivery of the placenta.

A patient is sterile because of low testosterone levels. Which other complication should the nurse suspect in this patient? 1. Anemia 2. Fatty liver 3. Hyperacidity 4. Hypoglycemia

1. Anemia Testosterone is a hormone that plays an important role in erythropoiesis. It helps in the formation of red blood cells. Reduced levels of testosterone cause reduced production of red blood cells, which in turn causes anemia from reduced hemoglobin. Unlike alcohol consumption, low levels of testosterone do not cause fatty liver. Testosterone does not affect the function of the proton pump in the stomach, and hence, it does not cause hyperacidity. Testosterone does not affect the function of the pancreas. Therefore, it does not cause hypoglycemia.

A patient who has been taking sildenafil has developed angina. The health care provider has prescribed isosorbide mononitrate. What is the nurse's primary intervention? 1. Take the patient's blood pressure. 2. Advise the patient not to take the sildenafil. 3. Instruct the patient to take the medications on opposite days. 4. Tell the patient to take the isosorbide mononitrate before the sildenafil.

2. Advise the patient not to take the sildenafil. When taken in conjunction with nitrates, sildenafil can cause severe hypotension that is unresponsive to treatment. The patient should never take these medications together. The remaining responses are not the priority intervention.

Drugs from which drug class can cause both syncope and dyspnea as adverse reactions? 1. Androgens 2. Alpha 1-adrenergic blockers 3. 5-alpha reductase inhibitors 4. Topical peripheral vasodilators

2. Alpha 1-adrenergic blockers Alpha 1-adrenergic blockers are associated with the adverse effects of producing syncope and dyspnea. Changes in libido, anxiety, and depression occur in patients prescribed androgens. 5-alpha reductase inhibitors cause the adverse effects of hypotension, drowsiness, and dizziness. Topical peripheral vasodilators are associated with precipitating dermatologic reactions, such as erythema, pruritus, and eczema.

Which drug will be prescribed for a patient who presents with erectile dysfunction? 1. Finasteride 2. Alprostadil 3. Testosterone 4. Fluoxymesterone

2. Alprostadil Alprostadil is used in the treatment of erectile dysfunction. The intracavernous injection is also used as a single injection in the diagnosis of erectile dysfunction. Finasteride is used to treat benign prostatic hyperplasia. Fluoxymesterone and testosterone are used to treat male hypogonadism.

Which is a contraindication to the use of nandrolone? 1. Metastatic breast cancer 2. Androgen-sensitive tumor 3. Male hormone replacement 4. To reverse muscle debilitation

2. Androgen-sensitive tumor Nandrolone is a synthetic androgen (an anabolic steroid) that is contraindicated, because it would promote growth of the tumor. Metastatic breast cancer is an indication of nandrolone use. Synthetic androgens are used in male hormone replacement and to reverse muscle debilitation.

The nurse will administer testosterone to a patient. Which route will provide the best absorption? 1. Oral 2. Buccal 3. Injection 4. Transdermal

2. Buccal Testosterone tablets, which are administered in the buccal cavity, can be easily dissolved and absorbed by the liver. Compared to the buccal process, oral administration has a very poor rate of absorption; the dose is metabolized and destroyed. Injections are another preferable way to administer the hormone, second to buccal application as an ideal option. The transdermal route, or skin patches, is useful when it comes to administration of the hormone, but they are not as useful as buccal administration.

A client beginning oral contraceptive therapy with desogestrel and ethinyl estradiol asks the nurse why two different drugs are needed in the pill. Which explanation by the nurse is the best? 1. This medication is a weak estrogen and progestin combination that requires additional estrogen to work. 2. Together the hormones prevent the ovum from maturing and the sperm from penetrating through the cervical mucus. 3. Estrogens alone would prevent pregnancy, but progestins are added so that spotting doesn't occur. 4. Taking each hormone separately would prevent most pregnancies, but the combination taken together in one pill is more effective.

2. Together the hormones prevent the ovum from maturing and the sperm from penetrating through the cervical mucus.

How does an increased progesterone level promote pregnancy? 1. By thinning the cervical mucosa. 2. By thickening the vaginal mucosa 3. By suppressing uterine contractions 4. By stimulating the development of breast tissue.

3. By suppressing uterine contractions The progesterone level increases during pregnancy and helps sustain a pregnancy by suppressing uterine contractions. Estrogen thins the cervical mucosa, thickens the vaginal mucosa, and stimulates the development of breast tissue.

A patient with which condition should not use oral contraceptives as a method of birth control? 1. Renal failure 2. Ovarian failure 3. Pulmonary embolism 4. Abnormal vaginal bleeding

3. Pulmonary embolism A history of pulmonary embolism increases the patient's risk for developing thromboembolism, so this patient should not use oral contraceptives. Renal failure, ovarian failure, and abnormal vaginal bleeding are not contraindications for the use of oral contraceptives. Denosumab is contraindicated in patients who have renal failure. Fertility medications, such as clomiphene, are contraindicated in patients who have ovarian failure. Estrogen therapy is contraindicated in patients who have abnormal vaginal bleeding.

Which patient assessment finding does the nurse expect after the vaginal administration of dinoprostone? 1. Midline fundus 2. Decreased pain 3. Softened cervix 4. Strong contractions

3. Softened cervix Dinoprostone is indicated to ripen the cervix in preparation for labor induction. If labor induction is attempted without sufficient preparation of the cervix, cervical injury may occur. A midline fundus is expected during the postpartum period. Dinoprostone does not have analgesic properties and should not stimulate uterine contractions.

A patient with hypogonadism gives a return demonstration of application of a testosterone dermal patch. Which patient action when applying the patch indicates the need for additional teaching? 1. The patient applies the patch on the scrotum. 2. The patient applies the patch on shaved skin. 3. The patient replaces the patch every other day. 4. The patient applies the patch on clean, dry skin.

3. The patient replaces the patch every other day. The testosterone patch is usually prescribed to treat hypogonadism. The patch shows its maximum effect when it is used as prescribed. The patch is replaced every day, rather than on alternate days, for maximum benefit. Therefore, the nurse should instruct the patient to replace the patch every day. The patch is applied only on the scrotal skin for optimal action. The patch should be applied on shaved scrotal skin to facilitate maximum skin contact. The scrotal skin should be clean and dry for easy application.

The nurse is teaching a patient about finasteride therapy. How long will the drug take to achieve its full effect? 1. 1 to 2 weeks 2. 2 to 4 weeks 3. 1 to 3 months 4. 3 to 6 months

4. 3 to 6 months Finasteride is available in tablet form and must be taken orally. It is administered for the treatment of androgenetic alopecia in men (at a dose of 1 mg) or benign prostatic hyperplasia (BPH; at a dose of 5 mg). The results take from 3 to 6 months to achieve complete effect.

The nurse notes that a patient is prescribed dutasteride. Which condition should the nurse suspect in the patient? 1. Impotence 2. Hypogonadism 3. Testicular cancer 4. BPH

4. BPH Dutasteride is an alternative for finasteride, indicated for the treatment of benign prostatic hyperplasia (BPH). The medicine is available in 0.5 mg capsules. Dutasteride has no effect on impotence or testicular cancer. Testosterone is used for the treatment of hypogonadism.

The nurse is asked to administer medications to several patients. Which patient is prescribed a proper dose, indication, and route of administration of the medication? 1. Sildenafil, 50 mg injected into the penile shaft 2. Finasteride, 5 mg/day by mouth, for baldness 3. Transdermal testosterone, 4 mg/day applied to the back 4. Testosterone cypionate, 300 mg intramuscularly each month

4. Testosterone cypionate, 300 mg intramuscularly each month The dosage range for testosterone cypionate is an intramuscular injection of 50 to 400 mg every second or fourth week. Sildenafil is taken as a dose of 25 to 100 mg by mouth, 1 hour before intercourse; finasteride is administered in a dos of 1 mg/day for male pattern baldness and 5 mg/day for benign prostatic hyperplasia; and transdermal testosterone is administered as 4 to 6 mg/day; it must be applied to the scrotum.

After testosterone cypionate is prescribed for a 16-year-old male client diagnosed with hypogonadism, the client asks, "Why do I need these hormones anyway?" The nurse should provide which description of the relationship between hypogonadism and this drug? 1. Testosterone is necessary to prevent your muscles from atrophying. 2. This medication is a form of testosterone. Your doctor can best explain it to you. 3. Testosterone prevents your body from becoming feminine looking. 4. This medication will increase your testosterone to a normal level.

4. This medication will increase your testosterone to a normal level.

The nurse is assessing an elderly patient who has angina pectoris who has been prescribed nitroglycerin. After reviewing the patient's medical history, the nurse advises the patient to avoid vardenafil. What is the reason for giving this advice to the patient? 1. Vardenafil reduces the efficacy of nitroglycerin. 2. Vardenafil may cause erectile dysfunction in patients. 3. Vardenafil is contraindicated for use in elderly patients. 4. Vardenafil causes hypotension if taken with nitroglycerin.

4. Vardenafil causes hypotension if taken with nitroglycerin. Vardenafil is a phosphodiesterase inhibitor. It is contraindicated in patients with cardiovascular disorders. This medication will be discontinued when nitrates such as nitroglycerin are prescribed for the patient, because it causes hypotension. This effect is the result of synergistic action of the medications, which results in excessive vasodilation. Vardenafil does not reduce the efficacy of nitroglycerine, because it does not interact with the drug. Vardenafil is prescribed for the treatment of erectile dysfunction. Therefore, it does not cause erectile dysfunction. Vardenafil is not contraindicated in elderly patients. It can be prescribed for them unless they have cardiovascular disorders.

A pregnant client is being prepared for labor induction with oxytocin. The nurse concludes that the client has adequate understanding when the client verbalizes the medication will have which action? SATA 1. Cause an increase in BP to provide adequate oxygen for the baby. 2. Cause the uterus to contract harder and more often. 3. Start contractions that will be almost continuous until the baby is born. 4. Be given through IV in small continuous amounts that can be adjusted as needed. 5. Cause the client to be in real labor.

2, 4, 5

The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis? 1 The patient smokes cigarettes. 2 The patient's fluid intake is low. 3 The patient takes herbal supplements. 4 The patient takes tricyclic antidepressants.

1 The patient smokes cigarettes. Smoking causes thrombosis in patients who undergo estrogen therapy. Thrombosis is not caused by a decrease in fluids. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant.

Which clinical manifestations can be observed in a patient who is receiving teriparatide therapy? Select all that apply. 1. Vertigo 2. Joint pain 3. Chest pain 4. Hot flashes 5. Loss of appetite

1, 2, 3 Teriparatide is used to treat osteoporosis. Adverse reactions of this medication include vertigo (dizziness), joint pain (arthralgia), and chest pain. Hot flashes occur as an adverse effect of raloxifene therapy. Reduced appetite is an adverse effect of calcitonin therapy.

The nurse is reviewing the health history of a client who is to begin therapy with a combined oral contraceptive drug. Which findings in the client's history should the nurse address with the client? SATA 1. Use of St. John's wort for depression 2. Smoking cessation over 10 years ago 3. Frequent migraines 4. Follows a vegan diet 5. Cholecystectomy 3 months ago

1, 3

The nurse at the fertility clinic is instructing a patient about the adverse effects of clomiphene. Which effects should the nurse instruct the patient to report to the health care provider? Select all that apply. 1. Anxiety 2. Hirsutism 3. Dizziness 4. Bradycardia 5. Blurred vision 6. Increased diuresis

1, 3, 5 Adverse effects of clomiphene, an ovarian stimulant, include anxiety, dizziness, blurred vision, tachycardia, deep vein thrombosis, nausea, constipation, urticaria, and others. Hirsutism, bradycardia, and increased diuresis are not known adverse effects associated with clomiphene.

A patient with menopausal symptoms is seeking hormone replacement therapy. During the assessment, the nurse finds that the patient has a history of endometrial cancer and is a smoker. Which is the most important information for this patient? 1 "The therapy may cause thromboembolic events." 2 "You may need to stop smoking during the therapy." 3 "The treatment should be started as soon as possible." 4 "The treatment is likely to cause endometrial cancer."

1 "The therapy may cause thromboembolic events." Progesterone therapy may result in thromboembolic events, which should be the first information shared with the patient. In patients with a history of endometrial cancer, estrogen therapy may increase the possibility of recurrence of cancer. The nurse may advise the patient to stop smoking if she starts the therapy. The treatment is not started as soon as possible, but may be prevented.

Which medication is used to induce labor? 1 Oxytocin 2 Terbutaline 3 Methylergonovine 4 Magnesium sulfate

1 Oxytocin Oxytocin is a uterine stimulant that is used to induce uterine contractions for labor. Terbutaline is a medication used to arrest preterm labor. Methylergonovine is used to treat postpartum hemorrhage. Magnesium sulfate is used to treat gestational hypertension.

Because the client is being prepared for labor induction with oxytocin, the nurse instructs the LPN to report which client data? SATA 1. Sudden rise in BP 2. Changes in discomfort level immediately after drug is initiated 3. Gain of more than 5 lb during last month of pregnancy 4. Sensation of nausea without vomiting 5. Changed in LOC

1, 5

Which adverse reaction may occur as a result of raloxifene use during perimenopause? 1. Hot flashes 2. Loss of hair 3. Brown discoloration of face 4. Yellow undertone to the skin

1. Hot flashes Raloxifene is a selective estrogen receptor modulator (SERM) used in the treatment of osteoporosis. An adverse reaction associated with this medication, especially during perimenopause, is hot flashes. Although hair loss and chloasma may occur with other estrogen therapies, these are not adverse reactions associated with this specific medication. Progestin therapy can cause liver dysfunction and jaundice, which is a yellowing of the skin and the sclera of the eyes. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

Which of the following hormones promotes the formation of progesterone in women? 1. LH 2. ADH 3. FSH 4. Adrenocorticotropic hormone

1. LH Luteinizing hormone promotes the secretory activity of the corpus luteum and the formation of progesterone. Antidiuretic hormone hinders the release of urine. In women, follicle-stimulating hormone initiates the cycle of events in the ovary. Adrenocorticotropic hormone is not directly involved in reproduction.

The clinical reports of a patient taking a bisphosphonate and calcium supplement indicate poor therapeutic levels of the bisphosphonate. Which changes in the medication administration will the nurse need to encourage the patient to implement? 1. "Discontinue the calcium supplement." 2. "Space the medications 1 to 2 hours apart." 3. "Replace the bisphosphonate with calcitonin." 4. "Obtain a prescription for increasing the bisphosphonate dose."

2. "Space the medications 1 to 2 hours apart." Calcium supplements interfere with the absorption of bisphosphonates. Spacing the medications 1 to 2 hours apart helps prevent this interaction. The nurse does not replace the drug without consulting the primary health care provider. The nurse does not discontinue the calcium supplement, because it may affect the patient's health. Increasing the dose of bisphosphonate will not aid in absorption if it interacts with calcium supplements.

Several clients in an outpatient clinic have requested prescriptions for sildenafil. The nurse anticipates having to inform which client that the request has been denied by the prescriber? 1. Client diagnosed with type 2 diabetes 2. Client taking medication therapy for angina pectoris 3. Client with BHP who is being managed medically 4. Client who has chronic sinusitis with flare ups in the spring

2. Client taking medication therapy for angina pectoris

The nurse is teaching a group of students about the use of megestrol. Which statement by a student suggests the need for additional teaching? 1. "It is used for breast cancer." 2. "It is used for endometrial cancer." 3. "It is used for the prevention of pregnancy." 4. "It is used for cachexia of AIDS."

3. "It is used for the prevention of pregnancy." Megestrol is not used for prevention of pregnancy. It is a synthetic progestin that is structurally very similar to progesterone. Although megestrol shares the actions of the progestins, it is primarily used in the palliative management of recurrent, inoperable, or metastatic endometrial or breast cancer. Because it can cause appetite stimulation and weight gain, it is also used in the management of anorexia, cachexia, or unexplained substantial weight loss in patients with AIDS and in patients with cancer.

Ovulation commonly occurs at which day during the menstrual cycle? 1. Day 3 2. Day 7 3. Day 14 4. Day 21

3. Day 14 Ovulation typically occurs at day 14 in the menstrual cycle, when the mature follicle ruptures and releases its ovum. It does not occur on day 3, 7, or 21. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

A 26-year-old woman is considering Depo-Provera as the form of contraception that is best for her since she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: 1. is a combination of progesterone and estrogen. 2. is a small adhesive hormonal birth control patch that is applied weekly. 3. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. 4. has an effectiveness rate in preventing pregnancy of 99% when used correctly.

3. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. The effectiveness rate is 99% or greater over 5 years.

A patient tests positive for pregnancy even though she has been taking oral contraceptives. What is a possible cause of this unintended pregnancy? 1 The patient has diabetes. 2 The patient has hypertension. 3 The patient takes anticonvulsants. 4 The patient is on antibiotic therapy.

4 The patient is on antibiotic therapy. Antibiotics reduce the effectiveness of oral contraceptives; hence, the nurse needs to instruct patients to use alternative birth control methods during antibiotic therapy. Diabetes does not reduce the effect of oral contraceptives. Hypertension may be an adverse effect of oral contraceptives. The effectiveness of anticonvulsants is reduced when taken with oral contraceptives. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints."

A patient who reports difficulty passing urine is prescribed finasteride by the primary health care provider. What condition should the nurse suspect to have caused difficulty in urination? 1. Renal calculi 2. Neurogenic bladder 3. Urinary tract infection 4. Benign prostatic hyperplasia

4. Benign prostatic hyperplasia

The nurse is teaching students about progestin-only oral contraceptives. Which statement by a student suggests effective learning? 1. "They are taken every week." 2. They produce anovulatory cycles." 3. They are taken with lunch and dinner. 4. They may cause breakthrough bleeding.

4. They may cause breakthrough bleeding. The use of progestin-only formulations (often referred to as the "minipill") may cause breakthrough bleeding. They are taken daily. They have a higher incidence of ovulatory cycles. It is important for the patient to take this oral contraceptive at the same time every day to maintain effective hormone serum levels. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action.

Which condition in a patient's history is a contraindication for the administration of estrogens? 1. Weight gain 2. HTN 3. Dysmenorrhea 4. Thrombophlebitis

4. Thrombophlebitis Contraindications for estrogen administration include known drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or a history of such a disorder. It is not contraindicated in patients with weight gain, hypertension, or dysmenorrhea.

A patient who is pregnant tells the nurse, "My husband is losing his hair, and I apply finasteride cream on his scalp daily." Which test should the nurse discuss with the patient's health care provider? 1. Lipid profile 2. Liver function test 3. Exercise tolerance test 4. Ultrasonography of the fetus

4. Ultrasonography of the fetus Exposure to finasteride is contraindicated in women of childbearing age, because this drug has teratogenic effects. The patient has been applying finasteride to her husband; this indicates that the drug would have been topically absorbed into the skin of the patient. Thus, the nurse should suggest an ultrasound scan of the fetus to check for fetal abnormalities. Unlike anabolic steroids, finasteride does not affect the lipid levels. Therefore, the nurse need not refer the patient for a lipid profile. Unlike anabolic steroids, finasteride does not affect liver function; therefore, the nurse need not refer the patient for a liver function test. Finasteride does not affect cardiac function. Moreover, an exercise tolerance test is contraindicated in pregnant women.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Palmar rash b) Development of gummas c) Development of central nervous system lesions d) Genital chancres

D) Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

What monitoring parameter should be evaluated for drug effectiveness for a patient in labor who is receiving oxytocin? Select all that apply. 1 Fetal heart rate 2 Asking no questions about fetal movement 3 Continuing the agent if uterine hyperactivity occurs 4 The patient's blood pressure and pulse during administration of the oxytocic agent

1, 4 Before administering uterine stimulants (e.g., oxytocin or prostaglandins), the nurse should determine the fetal heart rate and contraction-related fetal heart rates and document findings. The nurse should also assess and document the patient's blood pressure, pulse, and respiration. Continuing the agent if uterine hyperactivity occurs is not safe. Asking no questions about fetal movement will not reveal anything useful for assessment. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

The HCP at an outpatient clinic is considering prescribing sildenafil for a 61-year-old client. The nurse would make it a priority to discuss which item in the client's health history with the prescriber? 1. CAD with nitroglycerin use 2. Renal impairment with elevated creatinine level 3. Blurred vision of unknown etiology 4. Gout managed with allopurinol

1. CAD with nitroglycerin use

Because a hypertensive client is experiencing postpartum hemorrhage, the nurse anticipates that the HCP will most likely prescribe which drug to treat the hemorrhage? 1. Ergonovine 2. Methylergonovine 3. Oxytocin 4. Carboprost tromethamine

3. Oxytocin

The nurse should conclude that which client is most likely to have testosterone transdermal prescribed for his condition? 1. a 45 year old with status-post bilateral vasectomy 2. 17 year old with status-post right cryptorchidism repair 3. 23 year old with status-post varicocele repair 4. 32 year old with status-post bilateral orchidectomy

4. 32 year old with status-post bilateral orchidectomy