PHARM EXAM #3-89,95,61-65

Which infections may be acquired through nonsexual transmission? (Select all that apply.) a. Chlamydia trachomatis b. Gardnerella vaginalis c. Herpes simplex d. Neisseria gonorrhea e. Treponema pallidum

ANS: A, B, C, D, E All of these organisms can be acquired through nonsexual transmission, usually from a mother to an infant either prenatally or during delivery. PTS: 1 DIF: Cognitive Level: Analysis REF:p. 1167 | p. 1170 | pp. 1170-1171 | pp. 1172-1173

A patient is being treated for infertility. An examination reveals cervical mucus that is scant, thick, and sticky. The nurse suspects that the patient has been taking which medication? a. Clomiphene [Clomid] b. Estrogen c. Follicle-stimulating hormone (FSH) d. Progesterone

ANS: A Because clomiphene has antiestrogenic actions, it can force the production of scant and viscous cervical mucus, which interferes with conception. Estrogen is given to create a favorable cervical mucous environment that is more hospitable to sperm. FSH and progesterone do not alter cervical mucus in this way. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax]

ANS: A Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. Azithromycin, metronidazole, and tinidazole are antibiotics and do not have antiviral effects. PTS: 1 DIF: Cognitive Level: Application REF: p. 1173

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to: a. clean the ring with warm water, reinsert it, and use condoms for 7 days. b. discard the ring and insert a new ring after 1 week has passed. c. discard the ring and insert a new one to begin a new cycle. d. wash the ring in hot, soapy water and reinsert it.

ANS: A If a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water. PTS: 1 DIF: Cognitive Level: Application REF: p. 760

A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to: a. decrease her risk of endometrial cancer. b. increase bone resorption to prevent fractures. c. lower her risk of myocardial infarction (MI). d. prevent deep vein thrombosis (DVT).

ANS: A In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT. PTS: 1 DIF: Cognitive Level: Application REF: pp. 742-743

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

ANS: A Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys, so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1069-1070

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

ANS: A Methenamine should not be given to patients with renal impairment, because crystalluria can occur. There is no cross-reactivity between methenamine and antibiotic agents. Methenamine is safe for use during pregnancy. There is no organism drug resistance to methenamine. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1069-1070

A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest? a. She should discard the inert pills and start a new pack during the honeymoon. b. She should discontinue the oral contraceptives and use an alternative form of birth control. c. She should discuss a prescription for an extended-cycle product with her provider. d. She should discuss DMPA (Depo-Provera) injections in addition to the OC with her provider.

ANS: A OC users can achieve an extended-cycle schedule by discarding the inert pills and beginning a new pack for up to four cycles. It is not necessary to discontinue OCs. Because this woman has already purchased a 1-year supply, using the 28-day-cycle product as described is appropriate. If this woman opts for a long-term product, she should discontinue the OC. PTS: 1 DIF: Cognitive Level: Application REF: p. 756 | p. 759

A patient has received two doses of dinoprostone [Prepidil] to initiate labor. It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe and dilated to 4 cm, but contractions are diminishing in intensity and frequency. What will the nurse expect to do? a. Administer oxytocin. b. Monitor urine output. c. Prepare for a cesarean section. d. Watch closely for fetal distress.

ANS: A Once the cervix is ripe and labor has occurred, labor should progress, with contractions increasing in duration and frequency. This woman is showing signs of stalled labor and, because the cervix is ripe, can be induced with oxytocin. Large doses of oxytocin can cause water intoxication, which is not a risk at this point in this patient. There is no indication for a cesarean section at this point. The risk of fetal distress is not increased at this point. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

ANS: A Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy, followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors, an evaluation for structural abnormalities may be warranted. Unless the infections are severe or are complicated, intravenous antibiotics are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1067-1068

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization.

ANS: A Patients with renal calculi are more likely to have complicated urinary tract infections that have less predictable microbiologic etiologies. Because the symptoms are mild, it is important first to obtain a culture and sensitivity to assist with antibiotic selection. If symptoms worsen, a broad-spectrum antibiotic may be started until sensitivity information is available. Intravenous antibiotics are indicated for severe pyelonephritis. Long-term prophylaxis is not indicated unless this patient develops frequent reinfection. PTS: 1 DIF: Cognitive Level: Application REF: p. 1067

A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient? a. Male partners should always be treated, even if they are asymptomatic. b. The applicator for the vaginal gel should be washed after each application. c. The infection is not completely eliminated with the medication. d. The medication should be taken twice daily for 2 weeks.

ANS: A The most important information the nurse can provide is that male partners should always be treated, even if they are asymptomatic. Gels are not indicated for T. vaginalis; oral medications are. T. vaginalis infection can be easily treated with a single dose of metronidazole or tinidazole. Both medications are given as a single dose. PTS: 1 DIF: Cognitive Level: Application REF: p. 1173

An infertile couple begins treatment with menotropins. To enhance the therapeutic effects of the medication, the nurse will advise the patients to have intercourse: a. before hCG injection and the following 2 to 3 days. b. the morning of the hCG injection and later that evening. c. the evening of the injection and the following day. d. the evening of the injection and the following morning.

ANS: A The nurse should advise the patients to have intercourse the evening before the injection and on the following 2 to 3 days (during the probable period of ovulation). Having intercourse the morning of the hCG injection and later that evening will not enhance the effects of menotropins. Avoiding intercourse the evening of the injection and on the following day will not enhance the effects of menotropins. Having intercourse the evening of the injection and on the following morning will not enhance the effects of menotropins. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? a. Azithromycin b. Doxycycline c. Erythromycin ethylsuccinate d. Sulfisoxazole

ANS: A The preferred treatment for C. trachomatis during pregnancy is either azithromycin or amoxicillin. Doxycycline can be used for nonpregnant patients. Erythromycin is used for infants. Sulfisoxazole is not recommended for pregnant woman near term, because it can cause kernicterus in the infant. PTS: 1 DIF: Cognitive Level: Application REF: p. 1167 | p. 1170

A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? a. Uncomplicated lower urinary tract infection treatable with short-course therapy b. Complicated lower urinary tract infection treatable with single-dose therapy c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics d. Complicated upper urinary tract infection requiring parenteral antibiotics

ANS: A These are symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is preferred. A complicated lower urinary tract infection would be associated with some predisposing factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter. Upper urinary tract infections often include severe flank pain, fever, and chills. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1066-1068

An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a. Gonorrhea b. Herpes simplex c. Nongonococcal urethritis d. Syphilis

ANS: A This patient has signs and symptoms consistent with gonorrhea. Herpes simplex manifests as vesicles on the penis or testes (or both) with a watery discharge. Nongonococcal urethritis results in ulcers on the urethral site. Syphilis is characterized by chancres and skin lesions. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1170-1171

A postpartum patient is receiving methylergonovine to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do? a. Continue to monitor and tell the patient to report increased cramping. b. Notify the provider of possible uterine hypertonicity. c. Notify the provider of the patient's blood pressure. d. Request an order to administer the methylergonovine intravenously.

ANS: A This patient is showing signs of a desired response to the drug, so the nurse should continue to monitor. Increased cramping may be a sign of overdose, so the patient should know to notify the nurse if this occurs. A firm uterus with minimal bleeding is the desired effect. The blood pressure is within normal limits. There is no indication for giving this drug intravenously, because that method poses significant risks and is indicated only with severe hemorrhage. PTS: 1 DIF: Cognitive Level: Application REF: p. 784

A nurse is caring for a woman during the perinatal and postnatal period. To stop postpartum hemorrhage, how will the nurse administer oxytocin [Pitocin] to this patient? a. 20 units in 1000 mL of IV solution after delivery of the placenta b. 20 units intramuscularly prior to delivery of the placenta c. 40 units intramuscularly after delivery of the placenta d. 60 units per rectum prior to delivery of the placenta

ANS: A To stop postpartum hemorrhage, oxytocin is administered either IV or IM following delivery of the placenta. If given IV, the dose is 10 to 40 units in 1000 mL of IV fluid. The IM dose is 10 units given as a single injection, also after delivery of the placenta. Misoprostol [Cytotec] is given rectally. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works? a. "I will need to use backup contraception if I miss a pill." b. "Irregular bleeding is an indication that I should stop using this drug." c. "The mini-pill is safer than combination OCs and is just as effective." d. "The progestin-only mini-pill will prevent me from ovulating."

ANS: A When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience. The mini-pill is slightly safer than combination OCs but not as effective. The mini-pill is a weak inhibitor of ovulation. PTS: 1 DIF: Cognitive Level: Application REF: p. 759

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring: a. the day the last pill is taken and use backup contraception for 7 days. b. 1 week before taking the last pill. c. 1 to 5 days after taking the last pill and use backup contraception for 2 days. d. within 7 days after taking the last pill.

ANS: A When patients who have been using a progestin-only OC begin using a vaginal ring, they should be instructed to insert the ring on the last day of the pill and use backup contraception for 7 days. PTS: 1 DIF: Cognitive Level: Application REF: p. 760

An infertile patient has received two 5-day courses of clomiphene [Clomid] to help her conceive. An ultrasound 1 week after the last dose reveals that follicular maturation has occurred without ovulation. The nurse expects the next step for this patient to be: a. administration of human chorionic gonadotropin (hCG). b. an order for cabergoline to be given twice weekly. c. evaluation of ovarian and pituitary function. d. repeating clomiphene once daily for 5 days.

ANS: A When treatment with clomiphene has failed to produce ovulation after two courses, hCG is used to promote ovulation after follicular maturation has occurred. Cabergoline is used to treat hyperprolactinemia when excessive prolactin secretion occurs. Ovarian and pituitary function should be evaluated before a patient begins treatment with clomiphene. If ovulation had occurred, another cycle of clomiphene would be indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771 | pp. 772-773

Which drugs are useful for preventing preterm labor? (Select all that apply.) a. Antibiotics b. Hydroxyprogesterone c. Indomethacin d. Magnesium sulfate e. Terbutaline

ANS: A, B Two drug interventions may help to prevent preterm labor: antibiotics and hydroxyprogesterone. Indomethacin, magnesium sulfate, and terbutaline are all used to stop preterm labor after it starts. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 780

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a. Acute cystitis b. Acute urethritis c. Recurrent UTI d. Severe pyelonephritis e. Acute bacterial prostatitis

ANS: A, B, C Acute cystitis, urethritis, and recurrent UTIs can be treated on an outpatient basis. Severe pyelonephritis and acute bacterial prostatitis require hospitalization and IV antibiotics. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1066-1068

Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient? (Select all that apply.) a. "Make sure you tell your prescriber if you might be pregnant." b. "If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." c. "Headaches and drowsiness can occur and are mild side effects." d. "You should not take sulfonamides while taking this medication." e. "Your urine may have a brown tinge while you are taking this drug."

ANS: A, B, C, E Nitrofurantoin is linked to serious birth defects and is not recommended during pregnancy. Tingling and numbness indicate neuropathy, which is a serious and often irreversible side effect. Central nervous system (CNS) side effects usually are mild and reversible. Sulfonamides cannot be taken with methenamine, because they can cause crystalluria. Patients' urine may have a brown tinge while they are taking this drug. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1068-1069

A pregnant patient is 1 week post-term and will receive intravenous oxytocin. Which will the nurse evaluate before starting the infusion? (Select all that apply.) a. Cervical ripening b. Fetal monitoring c. Renal function d. Respiratory function e. Uterine activity

ANS: A, B, E Before labor can be safely induced, cervical ripening must occur. Baseline data must include full maternal and fetal status. Maternal renal function and respiratory function are not part of the baseline assessment. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 783 | p. 786

Which are indications for early induction of labor? (Select all that apply.) a. Abruptio placentae b. Active genital herpes infection c. Gestational hypertension d. Premature rupture of the membranes e. Umbilical cord prolapse

ANS: A, C, D Indications for early induction of labor include abruptio placentae, gestational hypertension, and premature rupture of the membranes. Active genital herpes infection and umbilical cord prolapse are contraindications to induction, even at term, because they can involve significant harm to the fetus. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 781

A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what? (Select all that apply.) a. Intrauterine devices (IUDs) b. Spermicides c. Intramuscular medroxyprogesterone acetate d. Etonogestrel subdermal implants e. Male or female sterilization

ANS: A, C, D, E The most effective methods of birth control are IUDs, intramuscular medroxyprogesterone acetate [Depo-Provera], implants, and sterilization. Spermicides are not one of the most effective methods of birth control. PTS: 1 DIF: Cognitive Level: Application REF: p. 751

A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do? a. Change to condoms instead of oral contraceptives. b. Discuss an oral contraceptive with increased estrogen. c. Request a decreased dose of carbamazepine. d. Stop taking the oral contraceptive immediately.

ANS: B Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symptom may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing the dose of carbamazepine is not correct. Discontinuing the OC immediately is not correct. PTS: 1 DIF: Cognitive Level: Application REF: p. 756

A nurse is explaining to a nursing student how clomiphene [Clomid] works to improve fertility. Which statement by the student indicates a need for further teaching? a. "Clomiphene blocks estrogen receptors to cause increased secretion of gonadotropins." b. "Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation." c. "If follicular maturation is the only result of clomiphene therapy, human chorionic gonadotropin may be given." d. "If the pituitary gland cannot produce LH and FSH, clomiphene will not be effective."

ANS: B Clomiphene blocks receptors for estrogen; it does not directly stimulate the ovary. When estrogen receptors are blocked, the pituitary increases production of the gonadotropins LH and FSH. Clomiphene may produce follicular maturation without ovulation, and hCG will be given to produce ovulation. Without a pituitary capable of producing LH and FSH, clomiphene will not be effective. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771

A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition? a. Chlamydia trachomatis b. Gardnerella vaginalis c. Haemophilus ducreyi d. Trichomonas vaginalis

ANS: B Gardnerella vaginalis causes bacterial vaginosis and is treated with metronidazole gel. C. trachomatis is treated with systemic antibiotics. H. ducreyi, which causes chancroid, is treated with systemic antibiotics. T. vaginalis is treated with oral metronidazole. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1172-1173

A patient receives an injection of human chorionic gonadotropin after follicular maturation has been induced with another agent. The patient comes to the clinic 2 days later complaining of headache, irritability, and fatigue. What will the nurse do? a. Perform a urine pregnancy test. b. Reassure the patient that these are known adverse effects. c. Request an order for a serum estrogen level. d. Review the patient's abdominal ultrasound.

ANS: B Headache, irritability, and fatigue are known adverse effects of hCG. A urine pregnancy test is not indicated, because it is too soon for the patient to be pregnant. A serum estrogen level and an abdominal ultrasound are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 772-773

A patient who has experienced preterm births with her previous two pregnancies will begin receiving hydroxyprogesterone caproate [Makena] to prevent preterm delivery with her current pregnancy. Which statement by the patient indicates a need for further teaching about this drug? a. "I should report any calf pain immediately." b. "I will eventually learn to administer the injections of this drug myself." c. "This drug may cause fluid retention and glucose intolerance." d. "This medication must be given once a week until 37 weeks' gestation."

ANS: B Hydroxyprogesterone caproate is given IM and must be given by a healthcare provider and not by the patient. Although serious side effects are rare, thrombosis and thromboembolism may occur, so the patient should report signs of thrombosis immediately. Fluid retention and glucose intolerance may occur. The medication is given weekly from 16 to 21 weeks' gestation up to 37 weeks or delivery of the baby. PTS: 1 DIF: Cognitive Level: Application REF: pp. 780-781 TOP: Nursing Process: Planning

A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin [Pitocin]. The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs? a. Contractions occur every 2 to 3 minutes. b. Individual contractions last 2 minutes. c. Mild to moderate pain occurs with uterine contractions. d. Resting intrauterine pressure is greater than 10 to 15 mm Hg.

ANS: B Induction of labor in patients of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin infusions should be interrupted for contractions that last longer than 1 minute. Contractions that occur more often than every 2 to 3 minutes are a concern. Mild to moderate pain is normal with contractions. A resting intrauterine pressure greater than 15 to 20 mm Hg is a concern. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

A patient receiving menotropins [Repronex] for infertility comes to the clinic for evaluation on the ninth day of treatment. Her serum estrogen level is 200 pg/mL per maturing follicle. An ultrasound reveals that follicles have enlarged to 22 mm. The patient complains of left lower abdominal pain. What will the nurse do? a. Administer human chorionic gonadotropin, because the ovary has ripened. b. Assess for abdominal fullness and distension and auscultate lung sounds. c. Inform the patient that the pain is associated with ovulation. d. Recommend ibuprofen for pain and administer the next dose of menotropins.

ANS: B Menotropins can cause ovarian hyperstimulation syndrome, which can cause sudden enlargement of the ovaries. When it occurs rapidly and is accompanied by ascites, pleural effusion, and pain, the patient should be hospitalized and the menotropins should be withdrawn. Although the follicular size and estrogen level indicate a ripened ovary, the first priority is to assess for ovarian hyperstimulation syndrome, because this patient reports pain. Ovulation will not occur until hCG is given, so this pain is not associated with ovulation. Until ovarian hyperstimulation syndrome has been ruled out, it is not appropriate to administer the next dose of menotropins. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient? a. The patient should ask her provider about an OC with less progestin. b. The patient should discuss an alternate method of birth control prior to surgery. c. The patient should request an OC containing less estrogen after surgery. d. The patient should take the OC at bedtime after her surgery to reduce side effects.

ANS: B Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk. PTS: 1 DIF: Cognitive Level: Application REF: pp. 753-754

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will: a. question the patient about any possible missed doses of the pill. b. reassure the patient that this is normal with this form of contraception. c. recommend that she take a pregnancy test to rule out pregnancy. d. suggest that she use a backup form of contraception until these symptoms resolve.

ANS: B Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception. PTS: 1 DIF: Cognitive Level: Application REF: p. 759

An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)? a. Azithromycin [Zithromax], 1 gm PO once, and doxycycline [Vibramycin], 100 mg PO twice daily for 7 days b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once c. Ceftriaxone [Rocephin], 125 mg IM once d. Doxycycline [Vibramycin], 100 mg IV twice daily for 12 days

ANS: B The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Ceftriaxone is recommended over cefixime because of antibiotic resistance to cefixime. Because a high percentage of patients with gonorrhea also have chlamydial infections, they should be treated with either doxycycline or azithromycin until a chlamydial infection has been ruled out. Azithromycin combined with doxycycline would not treat gonorrhea. Ceftriaxone would treat gonorrhea only. Doxycycline would treat chlamydia only. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1170-1171

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider? a. An intrauterine device with a spermicide b. DMPA (Depo-Provera) and condoms c. Tubal ligation and condoms d. Progestin-only oral contraceptives

ANS: B This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her; patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and should not be used by young women, because it is irreversible. Progestin-only oral contraceptives must be taken every day. PTS: 1 DIF: Cognitive Level: Application REF: pp. 751-752

A pregnant patient is being induced with oxytocin, which has been infusing for 1 hour. The initial rate was 6 milliunits/min, and the rate now is 18 milliunits/min. The nurse notes regular contractions occurring every 3 minutes, each lasting 35 seconds. The nurse will: a. increase the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes. b. increase the rate of infusion by 3 to 6 milliunits/min every 15 to 40 minutes. c. interrupt the infusion and continue to monitor the patient before restarting. d. interrupt the infusion and notify the provider of potential oxytocin toxicity.

ANS: B This patient is being induced with a high-dose regimen of oxytocin, which starts at 6 milliunits/min and is increased by 3 to 6 milliunits/min every 15 to 40 minutes. The frequency and rate of her contractions are within normal limits, so the nurse can continue to increase the rate by 3 to 6 milliunits/min every 15 to 40 minutes until contractions last longer than 1 minute or occur more frequently than every 2 to 3 minutes. Increasing the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes is part of the low-dose regimen. Because the frequency and duration of contractions have not reached optimum level, there is no need to interrupt the infusion. There are no signs of oxytocin toxicity. PTS: 1 DIF: Cognitive Level: Application REF: p. 783 | p. 786

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what? a. Begin taking the new product immediately. b. Change products at the beginning of her next cycle. c. Stop taking the old OC 1 week before starting the new OC. d. Use an alternate method of contraception for 1 month before starting the new OC.

ANS: B When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately; to stop the old product 1 week before starting the new product; or to use an alternate method of birth control between regimens. PTS: 1 DIF: Cognitive Level: Application REF: p. 755

According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.) a. Cardiovascular protection in older patients b. Decreased osteoporosis risk c. Glycemic control d. Improved wound healing e. Prevention of colorectal cancer

ANS: B, C, D EPT can lower osteoporosis risk, improve glycemic control, and aid in wound healing. Preparations with estrogen alone can provide cardiovascular protection or help prevent colorectal cancer, but not preparations containing progestin. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 741-742

The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.) a. Increased colon cancer b. Stroke c. Deep vein thrombosis d. Ovarian cancer e. Decreased bone density

ANS: B, C, D Risk factors for EPT include stroke, deep vein thrombosis, and ovarian cancer. A decreased risk of colon cancer is associated with EPT. EPT preserves bone mineral density. PTS: 1 DIF: Cognitive Level: Application REF: pp. 742-743

A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching? a. "I can continue to take the medication if I get pregnant." b. "I can expect the medication to cure my symptoms." c. "I may have menopausal-like symptoms when taking this medication." d. "I will need to take the medication for several years."

ANS: C Because the GnRH agonists deprive the ovary of the stimulation to produce estrogen, women may experience symptoms associated with menopause, including hot flashes, vaginal dryness, decreased libido, mood changes, and headache. GnRH agonists are teratogenic and should not be used during pregnancy. The medication does not produce a cure; symptoms return in up to 50% of women after discontinuation of the drug. GnRH agonists should be discontinued after 6 months of treatment because of the risk of osteoporosis. PTS: 1 DIF: Cognitive Level: Application REF: p. 774

A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend? a. The patient should ask her provider about an OC with less progestin. b. The patient should discuss an alternate method of birth control. c. The patient should request an OC containing less estrogen. d. The patient should take the OC at bedtime to reduce side effects.

ANS: C Breast tenderness, edema, and nausea are associated with estrogen; women experiencing these side effects may benefit from an OC with a lower estrogen dose. Lowering the progestin will not decrease these symptoms. It is not necessary to change birth control methods if side effects can be managed by altering the estrogen dose. Taking the OC at bedtime will not affect the symptoms. PTS: 1 DIF: Cognitive Level: Application REF: p. 755

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

ANS: C Children with recurrent urinary tract infections should be assessed for underlying urinary tract abnormalities to help determine a possible cause for recurrence. This child has mild fever and therefore may not require hospitalization. Urine cultures are important when treating patients with recurrent UTI prophylactically, but this is not the most important consideration. Urinary tract antiseptics are used to treat uncomplicated lower urinary tract infections. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1067-1069

A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching? a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely." b. "I can take estrogen to reduce my risk of cardiovascular disease." c. "I should take the lowest effective dose for the shortest time needed." d. "I will need a progestin/estrogen combination since I have had a hysterectomy."

ANS: C For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens. PTS: 1 DIF: Cognitive Level: Application REF: p. 741

The nurse counseling a couple who cannot conceive learns that female infertility problems have been ruled out. What will the nurse expect to tell this couple? a. "If medication is necessary for male infertility, treatment will last a few months." b. "Male infertility is usually treatable with a combination of medications." c. "Most male infertility is not linked to known endocrine disorders." d. "Treatment with sildenafil [Viagra] will be necessary to improve fertility."

ANS: C In most cases, infertility in males in not associated with an identifiable endocrine disorder, and with the exception of infertility associated with erectile dysfunction, male infertility is generally unresponsive to drugs. In rare cases, failure to produce sperm is related to insufficient gonadotropin secretion and hCG may be used, but therapy is prolonged and may be required for up to 3 to 4 years. Treatment with sildenafil is necessary only when ED has been identified. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 769

A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? a. "The erythromycin ointment will prevent your baby from developing conjunctivitis." b. "Without additional treatment, your baby could develop blindness." c. "Your baby will need to be treated with oral erythromycin." d. "Your baby will need to take doxycycline [Vibramycin] for 10 days."

ANS: C Infants born to women with cervical C. trachomatis are at risk for conjunctivitis and pneumonia. Topical erythromycin may help prevent conjunctivitis, but it is not completely effective and does not prevent pneumonia; therefore, this infant will need treatment with oral erythromycin. Blindness will not occur as a result of C. trachomatis conjunctivitis. Doxycycline is contraindicated, because it causes staining of the teeth in children under 8 years of age. PTS: 1 DIF: Cognitive Level: Application REF: p. 1167

A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient? a. Azithromycin [Zithromax], 1 gm PO once, and cefoxitin, 2 gm IM once in the clinic b. Ceftriaxone [Rocephin], 250 mg IM once, with doxycycline [Vibramycin], 100 mg PO twice daily for 14 days as an outpatient c. Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital d. Doxycycline [Vibramycin], 100 mg PO twice daily for 14 days, and metronidazole [Flagyl], 500 mg PO twice daily for 14 days in the hospital

ANS: C Many experts recommend that all patients with PID receive IV antibiotics in the hospital to minimize the risk of sterility and other complications. Medications used intravenously can be cefoxitin or cefotetan combined with doxycycline; when symptoms resolve, IV therapy may be discontinued but must be followed by PO doxycycline. Outpatient regimens are not recommended. Oral medications are not recommended for initial treatment. PTS: 1 DIF: Cognitive Level: Application REF: p. 1171

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

ANS: C Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross-reactivity with amoxicillin. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1069-1070

A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it: a. before the first missed menstrual period." b. the day after unprotected intercourse." c. within 7 weeks of conception." d. immediately after ovulation."

ANS: C Mifepristone is most effective if it is used within 7 weeks of conception. The timing specified in the other responses is incorrect. PTS: 1 DIF: Cognitive Level: Application REF: p. 764

A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

ANS: C Secondary syphilis occurs when the organism spreads to the bloodstream, causing systemic symptoms such as fever, headache, reduced appetite, and general malaise, along with enlarged lymph nodes and joint pain. Congenital syphilis occurs when infants are exposed to T. pallidum in utero; early symptoms include sores, rhinitis, and point tenderness over bones. Primary syphilis is characterized by a primary lesion, called a chancre, at the point of entry, along with enlarged lymph nodes. Tertiary syphilis develops 5 to 40 years after the initial infection and can involve the brain, heart, and other sites. PTS: 1 DIF: Cognitive Level: Application REF: p. 1172

A nurse provides teaching to a woman who is taking tranexamic acid [Lysteda] for menorrhagia. Which statement by the patient indicates a need for further teaching? a. "I may experience back pain or muscle cramps while taking this drug." b. "I may take two tablets 3 times daily for up to 5 days with each period." c. "I should take an oral contraceptive to prevent pregnancy while taking this drug." d. "I should take this medication with food to improve absorption of the drug."

ANS: C The greatest concern with tranexamic acid (TA) is venous or arterial thrombosis. Women taking TA should not take oral contraceptives, which would increase the risk of thrombosis. Back pain and muscle cramps are known adverse effects. Women may take up to two tablets 3 times a day for up to 5 days with each period. The medication can be taken with or without food, but bioavailability increases in the presence of food. PTS: 1 DIF: Cognitive Level: Application REF: p. 785

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: C The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms but not by severe flank pain. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1066-1068

A patient is in preterm labor, and the prescriber orders magnesium sulfate for its neuroprotective effect on the fetus. The order calls for 4 gm given as an intravenous bolus over 20 minutes, followed by a maintenance infusion of 2 gm/hr. What will the nurse do? a. Administer the drug as ordered. b. Question the bolus amount. c. Question the bolus rate. d. Question the maintenance amount.

ANS: D For fetal neuroprotective uses, magnesium sulfate should be given using a low-dose protocol, which is a 4-gm IV loading bolus over 20 minutes, followed by a maintenance infusion of 1 gm/hr. A high-dose protocol would have a maintenance infusion of 2 to 3 gm/hr. The nurse should question the maintenance amount. The bolus amount and rate are correct. PTS: 1 DIF: Cognitive Level: Application REF: p. 780

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

ANS: C This patient has reinfection of his urinary tract at a rate of more than three per year, which is an indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection rate is less than three per year. Long-term treatment for individual infections is recommended if relapse occurs or if infections do not clear with shorter-term therapy. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1067-1068

A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics: a. are given until term to reduce fetal mortality. b. are used to help the fetal lungs mature. c. help delay delivery while glucocorticoids are given. d. help treat the infections that cause preterm labor.

ANS: C Tocolytic agents are used to postpone premature labor and, on average, for only 48 hours. During this time, glucocorticoids are given to help the fetal lungs mature. Tocolytic agents do not suppress labor long term. They do not directly help the fetal lungs to mature; they help by allowing time for glucocorticoids to be given. They do not treat infection. PTS: 1 DIF: Cognitive Level: Application REF: pp. 777-778

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient? a. "If breakthrough spotting occurs, you should begin taking a new pack of pills." b. "Protection from pregnancy will begin immediately." c. "Use another form of contraception for the next month." d. "You may take the pills at different times of day."

ANS: C When beginning oral contraceptives, it is important that the patient use another form of contraception for the first month, because protection is not immediate. Breakthrough spotting is common and is not an indication for starting a new cycle. Protection from pregnancy is not immediate. It is important to take the pills at the same time each day. PTS: 1 DIF: Cognitive Level: Application REF: p. 756

A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception? a. A 45-year-old married woman with four children b. A 30-year-old monogamous married woman c. An 18-year-old woman with multiple sexual partners d. A 35-year-old woman with a history of rosacea

ANS: C Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD. PTS: 1 DIF: Cognitive Level: Application REF: pp. 751-752

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? a. "Estrogen can help reverse bone loss." b. "Hormone therapy increases bone resorption." c. "Hormone therapy does not decrease fracture risk." d. "When hormone therapy is discontinued, bone mass is quickly lost."

ANS: D Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount. PTS: 1 DIF: Cognitive Level: Application REF: p. 742

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? a. "C. trachomatis conjunctivitis in newborns can result in blindness." b. "The CDC recommends screening for chlamydial infections in all sexually active men." c. "Treatment for C. trachomatis should be initiated when infections are symptomatic." d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

ANS: D Chlamydial infections are frequently asymptomatic in women and may be asymptomatic in men; they can cause sterility in women. C. trachomatis conjunctivitis in newborns does not result in blindness. The Centers for Disease Control and Prevention (CDC) recommends routine screening for sexually active women under age 25 and for those over age 25 with new partners or multiple partners. Treatment should begin when infections are identified, regardless of whether they are symptomatic. PTS: 1 DIF: Cognitive Level: Application REF: p. 1167 | p. 1170

A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching? a. "ET can provide protection against coronary heart disease and reverse osteoporosis." b. "EPT is generally safer than ET, especially in women who have undergone hysterectomies." c. "In women with established coronary heart disease, EPT can protect against myocardial infarction." d. "Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss."

ANS: D ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease. PTS: 1 DIF: Cognitive Level: Application REF: p. 741

A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn't want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: a. Depo Provera. b. Estraderm. c. low-dose estrogens. d. Premarin vaginal.

ANS: D Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects. Depo Provera is a progesterone and is not indicated. Transdermal estrogen is used to treat hot flushes. Low-dose estrogens still have systemic effects. PTS: 1 DIF: Cognitive Level: Application REF: p. 736

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to: a. continue the pack, skip the inert pills, and use an additional form of contraception for 7 days. b. not to worry, because up to 7 days can be missed without an increased risk of pregnancy. c. take a pill immediately, continue the pack, and use an additional form of contraception for 1 month. d. take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.

ANS: D If one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases. PTS: 1 DIF: Cognitive Level: Application REF: p. 756 | p. 759

A patient with infertility will begin taking menotropins [Repronex]. The nurse will evaluate this patient's history to determine whether the: a. patient has a history of hyperinsulinemia. b. patient has excessive prolactin secretion. c. patient's pituitary can produce LH and FSH. d. patient's ovaries are capable of responding to gonadotropins.

ANS: D Menotropins are used when gonadotropin secretion by the pituitary is insufficient to provide adequate ovarian stimulation. Candidates must have ovaries capable of responding to FSH and LH. Metformin is used for hyperinsulinemia. Women with excessive prolactin secretion are treated with cabergoline. Menotropins contain equal amounts of LH and FSH and act directly on the ovaries, so the pituitary's inability to produce these hormones is not a factor for beginning treatment with this drug. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772 | p. 773

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication? a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug.

ANS: D Raloxifene can induce hot flashes in patients taking the drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer. PTS: 1 DIF: Cognitive Level: Application REF: pp. 736-737

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

ANS: D Short-course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections. The short course is more effective than a single dose, and compared with longer-course therapies, it is less costly, has fewer side effects, and is more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients with drug allergies. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1066-1067

A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to: a. human papillomavirus (HPV) infections. b. spontaneous abortions. c. endometrial cancer. d. increased transmission of the human immunodeficiency virus (HIV).

ANS: D Spermicides that contain nonoxynol-9 have been linked to the increased transmission of HIV. Spermicides containing nonoxynol-9 have not been linked to HPV infections, spontaneous abortions, or endometrial cancer. PTS: 1 DIF: Cognitive Level: Application REF: p. 761

A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching? a. "Clomiphene will help induce ovulation but will not treat the other symptoms of polycystic ovarian disease." b. "If I lose weight, my infertility and irregular periods could resolve without medications." c. "Metformin improves insulin sensitivity and reduces male hormone levels." d. "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

ANS: D Spironolactone is antiandrogenic; it can reduce hirsutism and acne, but it also can harm the fetus and should not be used in patients trying to conceive. Clomiphene helps induce ovulation but does not treat symptoms of PCOS. Patients who lose weight might experience a reversal of symptoms without medications, although weight loss may be difficult to achieve. Metformin reduces serum insulin levels by increasing insulin sensitivity and indirectly lowers androgen levels. PTS: 1 DIF: Cognitive Level: Application REF: p. 770

A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? a. Combination oral contraceptives are effective for improving fertility. b. Gonadotropin-releasing hormone agonists are used for long-term treatment. c. Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. d. Pharmacologic agents used to treat endometriosis do not enhance fertility.

ANS: D Surgery reduces symptoms of endometriosis and improves fertility; drugs used to treat endometriosis only reduce discomfort. Combination oral contraceptives only treat symptoms; they do not improve fertility. Gonadotropin-releasing hormone agonists cannot be used long term because of side effects of osteoporosis and hot flashes. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line agents for endometriosis pain. PTS: 1 DIF: Cognitive Level: Application REF: p. 770

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: D The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1066-1068

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

ANS: D The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics. The other three patients show signs of uncomplicated urinary tract infections that are not severe and can be treated with oral antibiotics. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1067

The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my: a. waistline and shoulders." b. abdomen and arms." c. breasts and abdomen." d. thighs and calves."

ANS: D The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen. PTS: 1 DIF: Cognitive Level: Application REF: p. 736

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

ANS: D Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible side effect of nitrofurantoin. The other side effects are not serious and can be reversed. PTS: 1 DIF: Cognitive Level: Application REF: pp. 1068-1069

A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do? a. Administer the injection today and counsel backup contraception for 7 days. b. Administer the injection today and tell her that protection is immediate. c. Obtain a pregnancy test to rule out pregnancy before administering the drug. d. Schedule an appointment for her to receive the injection in 3 weeks.

ANS: D To ensure that patients are not pregnant when they receive DMPA, the first injection should be given during the first 5 days of a normal menstrual period. PTS: 1 DIF: Cognitive Level: Application REF: pp. 760-761

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that: a. an estrogen-progesterone product will reduce side effects. b. an intravaginal preparation may be best for her. c. side effects of ET are uncommon among women her age. d. transdermal preparations have fewer side effects.

ANS: D Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET. PTS: 1 DIF: Cognitive Level: Application REF: p. 736