PrepU Chapter 40

After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from:

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

A client asks the nurse about a word they heard from the health care provider. The word was "andropause". The client asks what that is. Which is the nurse's <b>best</b> response?

"A gradual change, related to age, that occurs in the testes." Andropause occurs in men and the changes occur gradually. Aging changes in the male reproductive system occur primarily in the testes. Like the ovary, testicular tissue diminishes; what is different between the sexes is that the male sex hormone levels of testosterone remain relatively constant. Andropause is not a medication but a condition that occurs in the body.

A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's BEST statement?

"It works by relaxing the smooth muscle of the prostate and the bladder neck." Terazosin is an alpha adrenergic blocker and works by relaxing the smooth muscle of the prostate and the bladder neck. By blocking norepinephrine, the muscles relax, and this allows urine to flow to the bladder. Terazosin does not prevent the conversion of testosterone or stimulates the bladder to void. Terazosin does not affect the desire for sexual relations.

A patient who has come to the emergency department after being raped is given a dose of emergency contraception at 12 AM. The nurse would instruct the patient to take another dose of the drug at which time?

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

A client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time?

3 months Medroxyprogesterone, a synthetic progestin used in the treatment of abnormal uterine bleeding and secondary amenorrhea, is also used as a contraceptive. This drug is given IM every 3 months. Longer than this time frame the medication is not effective for contraception.

When explaining the potentially harmful effects of anabolic steroid abuse, the nurse should stress which related fact?

Abuse of anabolic steroids can result in addiction. Anabolic steroid abuse is associated with a wide variety of harmful effects, including addiction. The drugs increase muscle strength and size. Health care professionals do not facilitate the use of anabolic steroids for performance-enhancing purposes.

A female client asks the nurse about the use of progestins. The nurse shares with the client that clients who take this medication are at an increased risk for what serious adverse effect?

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

What nursing interventions are most important if the nurse has concerns that the client is developing fluid overload while receiving oxytocin? (Select all that apply.)

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

The nurse is caring for a female client who is taking medroxyprogesterone and the health care provider has ordered lab work. The nurse understands that which laboratory test may give inaccurate results in clients who take progestins?

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

A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately?

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

The nurse is discussing proper use of oral contraceptives with a client. The nurse should instruct the client to immediately contact a health care provider if she:

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

A client is prescribed an alpha-adrenergic blocker for treatment of BPH. When explaining the action of the drug to the client, which information would the nurse integrate into the explanation?

relaxation of the smooth muscles Alpha-adrenergic blockers block norepinephrine, allowing the smooth muscle of the prostate and bladder neck to relax and allow urine to flow from the bladder. Androgen hormone inhibitors prevent the conversion of testosterone into the androgen 5-alpha-dihydrotestosterone. Antispasmodics counteract the smooth muscle spasm of the urinary tract by relaxing the detrusor muscle and other muscles through action of the parasympathetic nerve receptors. Phosphodiesterase type 5 inhibitors facilitate the enzyme involved in an erection.

After teaching a woman using an intravaginal estrogen preparation, the nurse determines that the teaching was successful when the client states that she will remain lying for at least how long after instilling the drug?

30 minutes After an intravaginal application, the client should remain in the recumbent position for at least 30 minutes for optimal absorption. Times of 10 and 20 minutes are not the optimal time. The time of 45 minutes does not enhance medication effects.

A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client?

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

A client alerts the nurse she has been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective?

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

Oral contraceptive use would be contraindicated by what in a client's medical history?

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

Dinoprostone can be used to terminate a pregnancy after 20 weeks.

False Dinoprostone is used to terminate pregnancies ranging from 12 to 20 weeks' gestation.

A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication?

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

Estropipate is sometimes administered to postmenopausal women to prevent which condition?

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

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

Osteoporosis Medroxyprogesterone can be administered orally, intramuscularly, and subcutaneously. Long-term use may increase bone loss. Osteoporosis is associated with bone loss from medroxyprogesterone therapy. Menstrual irregularities, headaches, and nervousness are all common adverse effects of the drug therapy but do not lead to serious sequelae.

A client is started on terbutaline therapy. What would indicate that the therapy has been successful?

Premature birth is avoided for at least 24 hours. Terbutaline drug therapy is considered effective when all the following have been achieved: the premature contractions decrease in intensity and frequency; the woman and fetus do not experience adverse effects; and premature birth is avoided for at least 24 hours so that administered corticosteroids can exert their beneficial effects. Terbutaline is not to be given for labor induction but to stop preterm labor.

The nurse knows that for a client who still has her ovaries intact, estrogen must be paired with what other drug when used to treat menopausal symptoms?

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

A 7 months' pregnant woman is experiencing contractions. She is admitted to the hospital in preterm labor. What will be prescribed to stop the labor?

Tocolytics Tocolytics are uterine relaxants that are used to stop labor contractions that occur before the completion of the 37th week of gestation. Oxytocics are uterine stimulants used to initiate or augment a contractile pattern of labor. On the other hand, prostaglandins prepare the uterus for labor and delivery by ripening the cervix. Finally, estrogen may have a role in the creation of additional oxytocin receptors.

A 34-year-old woman has presented to the clinic for the first time, and the nurse learns that she has been taking medroxyprogesterone for the past 13 years. This aspect of the woman's medical history should prompt what assessment?

bone density testing There is a black box warning regarding the use of medroxyprogesterone that relates to its being associated with the loss of stored calcium from bones, which increases the risk of broken bones and osteoporosis, especially after menopause. There is a greater risk of bone loss with long-term use. Consequently, bone density testing may be warranted. There is no particular indication for this client to undergo stress testing, renal ultrasound, or triglyceride testing.

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

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

A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would most likely identify this as which condition?

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

A nurse is explaining the drug oxytocin to a client. When describing this drug, the nurse notes that oxytocin is an endogenous hormone produced by which?

posterior pituitary gland Oxytocin is an endogenous hormone produced by the posterior pituitary gland. The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. The uterus is part of the female reproductive system where the fetus grows until term, it does not produce hormones, but oxytocin stimulates the smooth muscle to contract. The corpus luteum is a temporary endocrine structure in female ovaries that is involved in the production of relatively high levels of progesterone, moderate levels of estradiol and inhibin A.

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

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

A client is menopausal and has been given a prescription for estrogen. She asks the nurse what some of the risks are in taking this medication. The nurse's best response is:

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

The nurse is aware that older men are more prone to urinary tract infections because of what physiologic change related to aging?

Enlargement of the prostate Many older men have enlarged prostate glands that compress the urethra and reduce the flow of urine, which makes men more susceptible to urinary tract infection. Reduction in renal function, loss of muscle tone in the pelvic structures, and involuntary contractions of the bladder do not lead to increased urinary tract infections in older men.

A nurse is caring for a client who is receiving magnesium. The nurse would be alert for which finding?

depressed reflexes Magnesium affects the neuromuscular system, so the nurse would assess mentation, cranial nerve function, and deep tendon reflexes. Depressed reflexes would be a cause for concern. Vasoconstriction can occur when methylergonovine (Methergine) is administered to a client who is a heavy smoker. The calcium channel blocker (nifedipine) and the beta2-adrenergic drug (terbutaline) are used to delay the delivery process for 24 to 48 hours. Sweating, hypotension, depressed reflexes, and flaccid paralysis are other adverse reactions associated with IV administration.

A postmenopausal woman is administered estradiol for the purpose of preventing which condition?

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

The nurse monitors a patient receiving oxytocin for water intoxication based on the understanding that this condition is the result of:

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

Which statements indicate that a client understands the need for a follow-up after the initial injection of medroxyprogesterone?

"I know that this injection lasts for 3 months."

A new client telephones the clinic requesting a renewal prescription for contraceptives she has been taking for 4 years. It has been more than a year since her last health care visit, but she is unable to come into the clinic until next month. She insists she is "doing fine" on this medication and must have her prescription now. Considering the circumstances and related safety issues, how should the clinic nurse respond?

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

A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications?

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

The health care provider has ordered a variety of laboratory assessments on a client who will need estrogen replacement. The follow labs are ordered: blood urea nitrogen (BUN), creatinine, and liver function tests (LFTs). What is the nurse's best statement explaining to a client the need to draw the labs?

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

A new client calls on the phone requesting a prescription for contraceptives, which she has been taking for 2 years. She has not been seen in more than a year and is unable to come into the clinic until next month. She insists she is doing fine on this medication and must have her prescription now. The nurse's best response would be:

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

The nurse performs which assessments when a female client comes to the clinic for a follow up visit while undergoing estrogen therapy? (Select all that apply.)

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

A group of students are reviewing the various fertility drugs that are available. The students demonstrate understanding when they identify which drug as being administered orally?

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

Which would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a client taking estrogen?

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

A 22-year-old woman is in the clinic to end an early pregnancy. She takes three tablets of mifepristone (Mifeprex). Two days after she takes the medication, she returns to the clinic to see if she is still pregnant or if the medical abortion is complete. It is determined that she is still pregnant. The nurse will administer which drug?

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

After teaching a patient who is prescribed estradiol vaginal cream, the nurse determines that the patient has understood the instructions when she states that she will administer the medication at which frequency?

Once a day Intravaginal estradiol is administered every day.

A nurse is caring for a patient who has been administered menotropins by the intramuscular route for the secretion of sex hormones. The patient reports pain after the drug is injected. Which intervention should the nurse perform for the patient?

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

A woman of childbearing age is diagnosed with breast cancer. She is currently taking hormonal contraceptives. What information should the woman be given regarding the hormonal contraceptives?

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

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

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

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for:

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

A 50-year-old female patient is taking progesterone therapy for dysfunctional uterine bleeding. Patient education by the nurse will include teaching the patient:

how to perform breast self-examination. The nurse should instruct the patient who is taking progesterone therapy to perform breast self-examination. An adverse effect from progesterone therapy when given in combination with estrogen in postmenopausal women is breast cancer. Patients should not alter the dosage of progesterone or self-treat minor adverse effects, because they may risk further or more severe adverse effects. The vaginal gel form of progesterone should not be taken by the patient for uterine bleeding.

A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the client's request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the client's:

vigilant adherence to the drug regimen. It is necessary to assess each client's need and desire for contraception, as well as her willingness to comply with the prescribed regimen. Compliance is essential for effective contraception. Health status, knowledge, and risk factors are all valid focuses for health education, but these do not primarily determine success of therapy.

While monitoring a woman who is receiving IV oxytocin for induction of labor, what event would cause the nurse to contact the health care provider immediately?

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

A 37-year-old woman has just experienced the end of a long-term relationship and has expressed a desire to begin using oral contraceptives. What aspect of this woman's current health status would contraindicate this treatment?

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

A client taking hormonal contraceptives will soon turn 35 years of age. She is moderately obese and has smoked for 15 years. Which action should the nurse encourage the client to take to best minimize risk for complications associated with contraception use?

beginning smoking cessation Women older than 35 years of age who smoke cigarettes are at greater risk for thromboembolic disorders. The client should be instructed on smoking cessation. The client should not begin an exercise regime unless prescribed by her health care provider. The client should not begin daily aspirin therapy unless prescribed by her health care provider. The client should not begin daily aspirin or diuretic therapy unless prescribed by her health care provider.

Which statement indicates that the client understands the follow-up needed after an injection of Depo-Provera?

"I know that this injection lasts for 3 months." Long-acting progestin contraceptive preparations such as the intramuscular depot medroxyprogesterone (Depo-Provera) last 3 months per injection; intrauterine progesterone lasts 1 year; and levonorgestrel subcutaneous implants (Norplant) last 5 years.

On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which response by the nurse is most appropriate?

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

A woman who is at 31 weeks' gestation comes to the clinic in labor. The health care provider decides to use terbutaline therapy before transferring the woman to the hospital. The client is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be:

"The drug provides sufficient time for other medications to be given to improve your baby's outcome." Delivery can be delayed with the use of a tocolytic. This delay provides sufficient time to transfer the client to an acute care facility or administer essential drugs such as corticosteroids. Corticosteroids reduce the risk of neonatal death as a result of respiratory distress syndrome. Delaying the delivery does not ensure a painless delivery. Oxytocin is administered to induce uterine contractions and mild ejection for breast-feeding and to prevent and control postpartum hemorrhage if the drug is administered via IV infusion or IM injection.

A pregnant patient has been receiving an infusion of oxytocin for the past several hours. For the past 20 minutes, the patient's contractions have been lasting in excess of 2 to 3 minutes each and there is less than 1 minute between most contractions. As well, there have been significant decelerations in fetal heart rate. The nurse has recognized the clinical characteristics of tachysystole and informed the physician, seeking an order to discontinue the oxytocin. The physician, however, wants to persist with the oxytocin infusion because the patient is "making good progress". How should the nurse best respond?

Go up the hospital chain of command to obtain assistance Making maternal and fetal assessments in the intrapartum period is challenging and raises issues of nursing conduct and patient safety. If a professional difference of opinion exists about whether the patient is experiencing tachysystole or whether the oxytocin should be slowed or stopped, the nurse should use the appropriate chain of command in the institution to seek appropriate assistance for the patient. Increased observation is indicated, but this alone is insufficient. It would be inappropriate to involve the patient and/or her family in this disagreement.

When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins?

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

A 31-year-old pregnant woman has been prescribed administration of a tocolytic drug. During which period is a tocolytic drug usually administered?

Pre-term labor Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of pre-term labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. In the postpartum period and during the second stage of normal labor, the tocolytics are not of any importance.

When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis?

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