Pharm Ch. 52 Women's Health

Which treatment for dysfunctional uterine bleeding (DUB) is always used in combination with other drugs? 1 Estrogen 2 Progestin 3 Nonsteroidal antiinflammatory drugs (NSAIDs) 4 Gonadotropin-releasing hormone (GnRH) agonists

1 Estrogen is never used alone to treat DUB because the risk of endometrial cancer rises dramatically. Progestin is often used alone, especially in low-dose birth control pills. NSAIDs treat the pain associated with cramping that accompanies DUB but do not treat the underlying cause of the bleeding. GnRH agonists may be used specifically to treat endometriosis, not DUB. p 776

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

1 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. p 784

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

1 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. p 772

Which side effect occurs due to excess progestin? 1 Acne 2 Dyspareunia 3 Amenorrhea 4 Atrophic vaginitis

1 Progestin is synthetic progesterone, which in excess causes acne as a side effect. Dyspareunia is a physiologic effect caused by estrogen deficiency. Amenorrhea is caused by deficiency of progestin. Atrophic vaginitis is caused by deficiency of estrogen. p 770

Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol (Ortho-Novum)? 1 Rifampin (Rifadin) 2 Furosemide (Lasix) 3 Acetaminophen (Tylenol) 4 Calcium citrate (Citracal)

1 Rifampin (Rifadin) decreases the estrogenic effects of oral contraceptives. Furosemide (Lasix) is used for the treatment of edema. Acetaminophen (Tylenol) is used to relieve pain and fever. Calcium citrate (Citracal) is a calcium supplement used for preventing osteoporosis. p 764, 784

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 Smoking causes thrombosis in patients who undergo estrogen therapy. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. Thrombosis is not caused by a decrease in fluids. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant. p 783

A teenage patient is asking the nurse to explain how birth control pills work. What is the nurse's best response? 1 "Estrogen in the pills keeps you from ovulating." 2 "Just take the pills, or you'll get pregnant." 3 "The pills keep you from having a period." 4 "The pills kill sperm."

1 The basis for oral contraceptive mode of action is that estrogen inhibits ovulation, thereby drastically reducing the risk of pregnancy. Telling the patient to just take the pills does not educate the patient. Most birth control pills still allow for the woman to have periods, though the characteristics of that period may vary. Oral contraceptives have no effect on sperm viability. p 762

A patient is diagnosed with a deep vein thrombosis (DVT) and is taking enoxaparin injections. She requests birth control. What is the most appropriate contraceptive method for this patient? 1 Condom 2 Progestin-only pill 3 Triphasic pill 4 Withdrawal method

1 The condom is the safest option for women who cannot take oral contraceptives. In this case, both progestin-only and triphasic pills are contraindicated because of the patient's DVT history. The withdrawal method won't compromise the patient's health, but it is an unreliable method of contraception. p 769

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

1 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. p 784

A patient who uses a vaginal ring tells the nurse, "My vaginal ring had dislodged, but I reinserted it within 6 hours. I also took a backup oral contraceptive pill for 2 days." What can the nurse conclude from this information? 1 The patient is at a risk for pregnancy. 2 The patient may develop an infection. 3 The patient cannot use the vaginal ring. 4 The patient will not have withdrawal menses.

1 The vaginal ring should be reinserted within 3 hours, not 6; therefore, in this case, the patient would be at risk of pregnancy and should use a backup contraception for 7 days. Vaginal infection is a side effect of the vaginal ring and does not occur if the vaginal ring is dislodged. A patient uses a vaginal ring for three weeks and has withdrawal menses in the fourth week. If a patient can reinsert the vaginal ring after dislodgment, it indicates that the patient is able to use the vaginal ring effectively. p 766

Which precautions should the nurse take while administering Depot medroxyprogesterone acetate (Depo-Provera) injection to a patient? Select all that apply. 1 Use the ventrogluteal or deltoid muscle to administer the medication. 2 Provide a personalized calendar to the patient for subsequent doses. 3 Avoid massaging the injection site after administering the medication. 4 Administer a pregnancy test if the patient takes the next dose after 13 days. 5 Avoid shaking the Depot medroxyprogesterone acetate vial before administration.

1, 2, 3 The nurse should use a patient's ventrogluteal or deltoid muscle to administer Depot medroxyprogesterone acetate (Depo-Provera) injection for effective absorption. The nurse should not massage the injection site after administering the medication to prevent irritation at the injection site. The nurse should provide a personalized calendar to a patient for subsequent doses to ensure that the patient does not miss a dose. The nurse should shake the vial before administering the medication to obtain a uniform medication suspension. Depot medroxyprogesterone acetate is a long-acting injectable progestin that is taken every 11 to 13 weeks, not 13 days. p 767

A patient reports that the use of combined hormonal contraception (CHC) products has not been effective in preventing pregnancy. Which assessment finding is the most probable cause of the ineffectiveness of the CHC products? Select all that apply. 1 The patient has been ingesting St. John's wort. 2 The patient smokes and drinks alcohol regularly. 3 The patient has been taking antibiotics for an infection. 4 The patient experienced breakthrough bleeding (BTB). 5 The patient has been taking ascorbic acid (vitamin C) supplements.

1, 3 Herbs such as St. John's wort have the potential to interact with combined hormonal contraception (CHC) products and reduce their effectiveness. A patient who takes St. John's wort should use a backup method of birth control. Antibiotics interfere with the effectiveness of birth control pills; therefore, back up birth control methods should be used whenever an antibiotic is taken. Smoking and alcohol are associated with increased risks of teratogenic effects on the fetus and cardiovascular problems in the patient; however, there is no known interaction with COC products. BTB is a common side effect of COC products and is not related to pregnancy. The use of vitamin supplements, such as ascorbic acid, increases the effectiveness of COC products; therefore, pregnancy will not occur when such supplements are taken. p 763

A patient is taking a combined hormone contraception (CHC) product and ampicillin (Amoxil). The primary health care provider prescribes the patient with a higher dose of ethinyl estradiol than the CHC product contains. What is the purpose of this prescription? 1 To prevent pain 2 To prevent pregnancy 3 To enhance the effectiveness of ampicillin 4 To prevent ascorbic acid (vitamin C) deficiency

2 Ampicillin (Amoxil) is an antibiotic that interacts with combined hormone contraception (CHC) products and reduces its effectiveness; therefore, a patient needs to take a CHC with a higher dose of ethinyl estradiol to prevent pregnancy. A higher dose of ethinyl estradiol will not enhance the effectiveness of ampicillin, as it is not an antibiotic, but a contraceptive medication. The use of ethinyl estradiol does not increase the risk for a deficiency in ascorbic acid (vitamin C). A primary health care provider would not prescribe ethinyl estradiol for pain. p 768

A female patient with strep throat is taking amoxicillin with clavulanate (Augmentin) to treat the infection. Because the patient also takes an oral contraceptive (OC), the nurse will instruct the patient to use a different method of birth control for how long? 1 During the entire period the patient is taking the antibiotic 2 For at least 1 month during and after starting 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

2 Because antibiotics, especially penicillins and cephalosporins, can impair the action of OCs, the nurse instructs the patient to use another method of birth control for at least 1 month during and after starting the antibiotic. p 763, 769

The nurse is teaching a student about the functions of estrogen. Which statement by the student indicates a need for additional teaching? 1 Estrogen produces viscous cervical secretions. 2 Estrogen decreases the amount and quality of cervical mucus. 3 Estrogen stimulates the pituitary gland to release luteinizing hormone. 4 Estrogen stimulates growth of the glandular surface of the endometrium.

2 Estrogen is responsible for stimulating growth of the glandular surface of the endometrium, stimulating the pituitary to release luteinizing hormone, and affecting the mucus glands of the cervix to produce more plentiful, viscous mucus. pp 765, 780

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

2 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. pp 761-770

Which drug has abortificient properties and is avoided in pregnant women? 1 Sulindac (Clinoril) 2 Misoprostol (Cytotec) 3 Indomethacin (Indocin) 4 Diclofenac sodium (Voltaren)

2 Misoprostol is a synthetic prostaglandin E1 analogue and has abortificient properties. It is prescribed with nonsteroidal antiinflammatory drugs to prevent gastrointestinal ulcers. Sulindac, indomethacin, and diclofenac sodium are nonsteroidal antiinflammatory drugs. These are acetic acid derivatives and do not have abortifacient properties. p 774

A patient who is postmenopausal is planning to start oral estrogen-progestin therapy (EPT) for the relief of symptoms related to menopause. After further assessment of the patient, the nurse obtains a prescription for a transdermal skin patch. Which assessment finding supports the change in the prescription? 1 The patient has osteoporosis. 2 The patient has a history of peptic ulcers. 3 The patient is taking antibiotics for an infection. 4 The patient has an ascorbic acid (vitamin C) deficiency.

2 Oral estrogen-progestin therapy (EPT) increases the risk for gastrointestinal problems in patients; therefore, a patient who has a history of peptic ulcers is likely to experience the adverse effects of oral EPT. A transdermal patch bypasses the gastrointestinal tract and would be more effective for such patients. A deficiency in ascorbic acid (vitamin C) is not related to the intake of oral EPT. The use of antibiotics will indicate a need to increase the estrogen-progestin dose, but not the drug route. The use of EPT helps deliver estrogen to the patient, which will reduce the risk of osteoporosis; however, osteoporosis is not an indication to change the administration route. p 784

What is the priority nursing intervention for a patient who is taking combined hormone contraception (CHC) pills with drospirenone (DSRP)? 1 Monitoring input and output (I&O) 2 Monitoring serum potassium levels 3 Reducing salt in the patient's diet 4 Assessing for gastrointestinal problems

2 Rationale The nurse should monitor the serum potassium levels in a patient who is taking hormone contraception (CHC) pills combined with drospirenone (DSRP). This is because DSRP contains spironolactone, a potassium-sparing diuretic hormone that can increase serum potassium levels in the patient. It is not necessary to monitor the patient's input and output (I&O), because fluid imbalances do not occur with CHC pills. A decrease in dietary salt is necessary if the patient's sodium levels are high. CHC pills may cause nausea and vomiting, but not gastrointestinal problems in the patient. p 764

Which has the greatest potential to increase the risk of thromboembolic phenomena in a patient taking norethindrone and ethinyl estradiol (Loestrin)? 1 Sedentary lifestyle 2 Smoking heavily every day 3 Consumption of saturated fats 4 Increased body mass index (BMI)

2 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 due to an increase in circulating levels of clotting factors. 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. Increased BMI and sedentary living 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. p 783

Which statement should the nurse use to instruct a patient who takes a progestin-only oral contraception pill (POP)? 1 "Take the pill within a 6-hour window." 2 "Take one pill daily at the same time of day." 3 "Do not take any pills during withdrawal bleeding." 4 "There is a risk for pregnancy when taking this pill."

2 patient misses a single dose because the progestin-only oral contraception pill (POP) does not suppress the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to a great degree. The nurse should instruct a patient to take the pill within a 3-hour window. If a patient takes the pill within a 6-hour window, the patient will need a backup contraceptive method for 48 hours. There is no risk for pregnancy if a patient takes one pill every day. A patient should take the pill continuously without break during withdrawal bleeding. p 768

Which are combined hormonal contraception (CHC) products? Select all that apply. 1 Minipill 2 Biphasic pills 3 Triphasic pills 4 Monophasic pills 5 Ethinyl estradiol and norelgestromin (Ortho-Evra)

2, 3, 4 Monophasic combined hormonal contraception (CHC) pills deliver estrogen and progestin in a fixed ratio throughout the menstrual cycle. Biphasic COC pills deliver estrogen in a fixed amount; however, the amount of progestin varies. With triphasic COC pills, the amount of either estrogen or progestin varies throughout the menstrual cycle. Ortho-Evra is not a COC pill, but a transdermal patch. The minipill is a progestin-only oral contraception pill (POP).

The nurse is assessing a female patient who has osteoporosis. The nurse finds that the patient is prescribed 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 Calcitonin is derived from salmon; hence the drug is not prescribed for patients who are allergic to salmon. Medications for breast cancer would not interact with calcitonin; hence breast cancer is not a reason to prescribe bisphosphonate. Joint pain is an adverse effect of bisphosphonate; the drug needs to be changed in case there are adverse effects of calcitonin. Smoking is harmful if the patient is taking estrogen therapy, because the combination leads to thrombosis. p 787

A 41-year-old patient informs the nurse that her menstrual cycle has changed and occurs every 25 days. The patient also informs the nurse that her mood changes abruptly and she often feels anxious. Which condition is the patient most probably experiencing? 1 Menopause 2 Postmenopause 3 Perimenopause 4 Pseudomenstruation

3 A normal menstrual cycle is 28 days. During perimenopause, the menstrual cycle frequently becomes shorter. Abrupt mood changes and increased irritability are noted in the perimenopausal period as well. Menopause refers to a permanent end of the menstrual cycle, which is not consistent with the patient's report. Postmenopause is a period when there is a new hormonal environment in the body; however, it occurs after the menstrual cycle ceases to occur. Pseudomenstruation refers to the withdrawal bleeding that occurs when combined oral contraception products are taken. p 782

Which statement by a student nurse about breakthrough bleeding (BTB) indicates effective learning? 1 "Breakthrough bleeding occurs as a side effect of seasonale (Jolessa)." 2 "Breakthrough bleeding occurs when a patient does not take a contraceptive regularly." 3 "Breakthrough bleeding occurs with the use of combined oral contraception (COC) products." 4 "Breakthrough bleeding occurs because of a lack of estrogen in combined hormone contraception (CHC) products."

3 Breakthrough bleeding (BTB) refers to a bleeding episode that occurs during the active pill cycle of the combined oral contraception (COC) products. A lack of progestational activity in CHC products is likely to cause BTB as a side effect. Seasonale (Jolessa) is a continuous dosing combined hormone contraception (CHC) pill that reduces the incidence of BTB. Irregular use of contraceptives does not cause BTB, but increases the risk for pregnancy. p 763

A patient taking clomiphene citrate to increase ovulation becomes pregnant. What potential side effect might she experience? 1 Gestational diabetes 2 Breast tenderness 3 Multiple gestation 4 Subsequent infertility

3 Clomiphene citrate causes an increase in ovulation, which then increases the chances that the woman will have more than one fertilized egg, resulting in a multiple gestation/birth. Gestational diabetes is not known to be an adverse effect of this drug. Breast tenderness is more likely to occur because of pregnancy than the drug. The use of clomiphene is not associated with subsequent infertility. p 779

Which statement about emergency contraception is true? 1 It is an abortifacient. 2 It must be used within 12 hours of unprotected sex. 3 It is a combination of high doses of hormones and an antiemetic. 4 A prescription is required for all forms of emergency contraception.

3 Emergency contraception consists of higher than usual doses of hormones and an antiemetic (often an antihistamine) to prevent nausea. The regimen does not cause an abortion to occur; it prevents fertilization and implantation. The optimal time for using emergency contraception is 24 hours after unprotected sex, but it can be taken up to 72 hours after intercourse. Not all forms of emergency contraceptives are prescription; Plan B One-Step and Next Choice are sold over the counter. p 773

Which statement should the nurse use to inform a patient about the benefit of taking loestrin Fe 1.5/30 (norethindrone acetate and ethinyl estradiol and ferrous sulfate)? 1 "This pill will increase the period of withdrawal bleeding." 2 "This pill will provide high estrogen levels for ovarian suppression." 3 "This pill will prevent iron-deficiency anemia associated with menstruation." 4 "This pill will prevent the occurrence of headaches during the menstrual cycle."

3 Loestrin Fe 1.5/30 contains ferrous fumarate, an iron compound that provides iron supplementation during the period of withdrawal bleeding. As a result, loestrin Fe helps prevent menstrual-associated iron-deficiency anemia in a patient who is on birth control; therefore, the nurse should inform the patient of the benefit of taking this pill. Ovarian suppression occurs because of low estrogen levels, which is unlikely in this case, because this pill does not provide high estrogen levels. Loestrin Fe 1.5/30 is an estrogen-progestin combination pill that will reduce the period of withdrawal bleeding. Mircette (Desogestrel), not loestrin Fe 1.5/30, helps prevent the occurrence of headaches during menstruation. p 765

The nurse is instructing a patient on the use of the contraceptive NuvaRing. What information will the nurse include in the patient's teaching plan? 1 The patient should eat a low-fiber diet to prevent diarrhea. 2 NuvaRing protects against sexually transmitted infections (STIs). 3 The patient should insert the ring during the first 5 days of the menstrual cycle. 4 Backup contraception is not needed during the first 7 days after the first ring is placed.

3 NuvaRing should be inserted during the first 5 days of the menstrual cycle. Backup contraception is recommended during the first 7 days after the first ring is placed, until hormones have had the opportunity to reach an appropriate level. NuvaRing does not cause diarrhea and does not protect against STIs, including human immunodeficiency virus. p 766

Which statement about progestin is accurate? 1 Progestin is only used for contraception. 2 All progesterones are synthetic. 3 Progestin is a derivative of testosterone. 4 There is only one type of progestin.

3 Progestins are derivatives of testosterone. As such, it is used for contraception but also to balance out the effects of estrogen. Progesterones can be both natural or synthetic. There are eight different types of progestin used in oral contraceptives. pg 762

The nurse is assessing a 38-year-old patient who uses a combined hormone contraception (CHC) product. The nurse finds that the patient is a frequent smoker. Which assessment parameter is of highest priority in this case? 1 Medical history 2 Occupational detail 3 Blood pressure readings 4 Use of dietary supplements

3 Smoking increases the risk for hypertension in patients who are over 35 years old and who take CHC products; therefore, the nurse should assess the patient's blood pressure in this case. Smoking also increases the risk of endothelial damage, which is a precursor to developing deep vein thrombosis. Assessing the patient's use of dietary supplements or medical history is not a priority in this case, because it is more important to understand the immediate risks to the patient. Assessing the patient's occupational details will help to understand stress factors, which are secondary in this case. pp 770-771

Which statement should the nurse use to instruct a patient about the use of the Ortho-Evra transdermal patch? 1 "Use one patch for 3 weeks." 2 "Place the patch near the breasts." 3 "Rotate the placement site of the patch." 4 "Report the occurrence of withdrawal bleeding."

3 The nurse should instruct a patient to rotate the placement site of the Ortho-Evra transdermal patch to avoid skin irritation. The patch should be changed weekly for a period of 3 weeks, and then not worn for 1 week. The nurse should ask a patient to avoid placing the patch near the breasts, because the patch contains an estrogen component, which may increase the risk of breast cancer if the added supplementation of estrogen is in close proximity to the breasts. There is no need for a patient to report withdrawal bleeding, because it would be a normal finding. pp 788, 765

What information will 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 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. p 783

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

3 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 due to ovarian failure and 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. p 776

A 57-year-old patient who has osteoporosis after menopause is prescribed 1500 mg of calcium per day and 2000 IU per day of vitamin D for 3 months. After these 3 months, the nurse finds little improvement in the patient's condition. Which assessment finding could be a cause of the patient's condition? 1 The patient takes sedatives at bedtime. 2 The patient performs low-impact aerobics. 3 The patient smokes and consumes alcohol. 4 The patient's intake of ascorbic acid (vitamin C) is low.

3 Smoking interferes with the absorption of vitamin D and alcohol consumption interferes with the absorption of calcium; therefore, a patient's condition will not improve if the patient smokes and drinks alcohol while taking calcium and vitamin supplements. Low-impact aerobics help increase muscle mass and strengthen the bones. An increase or decrease in the intake of ascorbic acid (vitamin C) will not affect a patient who has osteoporosis after menopause, because this supplement does not help restore bone health in the patient. The use of sedatives will increase a patient's risk for falls, but will not interfere with calcium and vitamin D absorption. p 786

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

4 Endometrial cancer risk is decreased with this regimen. 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. It does not prevent ovarian, vaginal or breast cancer from occurring. p 765

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 Vaginal bleeding 4 Deep vein thrombosis

4 Increased coagulation and risk of deep vein thrombosis are side effects of estrogen hormone replacement therapy. A previous history would put the patient at increased risk for more clot formation. Vaginal bleeding, weight loss and dysmenorrhea are not contraindications for this therapy. p 769

In an assessment session, a patient tells the nurse that she became pregnant after using the contraceptive pills regularly. The nurse finds that the patient uses a Sunday start method for using contraception. Which other assessment finding could be a likely cause of the patient's pregnancy? 1 The patient is older than 35. 2 The patient smokes excessively. 3 The patient usually takes the pills an hour late. 4 The patient did not use a backup contraception method.

4 A backup method of contraception is needed when a patient uses a Sunday start method, which is when a patient begins taking a contraceptive on the Sunday after the first day of menstruation, because the patient can start the contraception later than the fifth day of the menstrual cycle. A second contraception method will ensure protection until the first method reaches its peak level of contraceptive effectiveness. Excessive smoking is likely to increase the risk for cardiovascular problems in a patient, but not pregnancy. Age does not affect the effectiveness of the contraception method. A patient should take the contraception daily within a 3-hour window each day for effectiveness. p 768

The nurse is assessing a female patient who has symptoms of venous thromboembolism (VTE). What might be a probable cause of the patient's condition? 1 The patient takes a minipill daily. 2 The patient is nearing menopause. 3 The patient engages in unsafe sex practices. 4 The patient is using the Ortho-Evra patch for contraception.

4 A patient who uses the Ortho-Evra patch for contraception is likely to develop venous thromboembolism (VTE) because the patch exposes the patient to high levels of estrogen. A patient who engages in unsafe sex practices is at a risk for pregnancy and sexually transmitted diseases, but not VTE. The use of the minipill is not associated with VTE, because it is a progestin-only oral contraception pill (POP). A patient who is nearing menopause will have low levels of estrogen, and is unlikely to develop VTE. p 763

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

4 Alendronate (Fosamax) 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. p 786

A patient taking the oral contraceptive Ortho Tri-Cyclen has developed an infection and is prescribed tetracycline. What information is essential for the nurse to teach the patient? 1 "Stop the Ortho Tri-Cyclen while on this medication." 2 "Do not drink grapefruit juice while on these medications." 3 "Take these two medications with milk to prevent stomach upset." 4 "Use an additional form of contraception while on these medications."

4 Antibiotics interact with oral contraceptives and decrease their effectiveness. An additional form of contraception is needed while taking tetracycline. p 769

Which medication is suitable therapy for oral contraception in women who cannot take estrogen? 1 Megestrol (Megace) 2 Estropipate (Ortho-Est) 3 Estrone (Estrone Aqueous) 4 Medroxyprogesterone (Provera)

4 Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers. Estropipate and Estrone are synthetic estrogens. p 776

Which problem in a patient's history would contraindicate the administration of estrogen? 1 Weight gain 2 Hypertension 3 Dysmenorrhea 4 Thrombophlebitis

4 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 hypertension, dysmenorrhea, or weight gain. p 784

How does the use of the hormone progestin help inhibit pregnancy? 1 It stabilizes the uterine endometrium. 2 It prevents changes in the endometrium. 3 It causes the surge of luteinizing hormone (LH). 4 It changes the quantity and viscosity of the cervical mucus.

4 Progestin thickens the cervical mucus, thereby making it hostile to sperm penetration, which helps inhibit pregnancy. An increase in estrogen levels would cause a luteinizing hormone (LH) surge, which would cause ovulation; however, progestin suppresses the LH surge. The estrogen component of combined hormone contraception (CHC) products, not progestin, stabilizes the uterine endometrium. Progestin changes the endometrium so that it is unfavorable for implantation of a fertilized ovum. p 763

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 Deep vein thrombosis

4 The most serious adverse effects of the estrogens are thromboembolic events. A history would put the patient at increased risk. Uterine bleeding is an indication for estrogen therapy. p 769

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

4 The patient has headaches, which are common side effects of estrogens. The cervical cap, male condom, and progestin are reasonable alternatives for the prevention of pregnancy in this patient. p 763

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

4 The use of progestin-only formulations (often referred to as the "minipill") may cause breakthrough bleeding. They have a higher incidence of ovulatory cycles. They are taken daily. It is important for the patient to take this oral contraceptive at the same time every day to maintain effective hormone serum levels. p 763