PrepU Chapter 41

A male clent has been diagnosed with impotence and is started on a regimen of androgens. Which statement by the client indicates that he has understood the teaching?

"If my skin appears yellow or my urine turns dark, I will contact my health care provider." Clients taking anabolic steroids can experience jaundice. It is important for the client to notify his health care provider of this condition. The normal effect of the medication is an increase in hair growth, which indicates he would need additional teaching. The clotting factor will increase as a result of anabolic steroids. The client is at risk for cerebrovascular accident related to anabolic steroids and increased clotting factor.

A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him:

"You might find that your face becomes flushed or you get a headache after you take Viagra." Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider.

The nurse is instructing the parents of an 11-year-old male who has testosterone deficiency. Which symptom, if found in this child, would cause the discontinuation of this medication?

Enlarged penis Testosterone therapy would be discontinued if the child demonstrated signs of precocious sexual puberty such as enlargement of the penis. It would also be discontinued if the epiphyseal plate showed signs of early closure.

A client has been receiving long-term testosterone therapy. The nurse would expect to monitor:

Liver function studies A potentially life-threatening effect associated with long-term testosterone use is hepatocellular cancer. Clients should have liver function studies monitored regularly, before beginning therapy and every 6 months during therapy.

Which would be most important to assess in a client receiving testosterone for a prolonged period of time?

Liver function studies Clients on long-term therapy with androgens should have hepatic function tests monitored regularly because of the increased risk for hepatocellular cancer.

A woman who has been prescribed high doses of anabolic steroids should be instructed on which effects?

Masculinization The patient will need to be instructed on masculinization. The patient should have increased joint mobility. Obesity is not a reaction to the anabolic steroids. The patient is at risk for hypertension, not hypotension.

A nurse is reviewing the medication history of a client. The nurse understands that a PDE5 inhibitor would be inappropriate for a client taking:

Nitroglycerin The PDE5 inhibitors cannot be taken in combination with any organic nitrates or alpha-adrenergic blockers because serious cardiovascular effects may occur, including death. Increased PDE5 inhibitor levels and effects may be seen with ketoconazole, indinavir, and erythromycin; the dosage of the inhibitor would need to be reduced.

A teenage client who is using testosterone to treat a hormone deficiency calls the clinic to report acne-like skin eruptions on the face. How should the nurse counsel this client?

Practice frequent and thorough skin cleansing. Teenage clients who use testosterone often report acne. The best practice is for clients to practice frequent and thorough skin cleansing. It is not necessary to see the dermatologist again but the client should not stop or decrease the dosage of the medication without first having a discussion with the dermatologist.

A group of students are reviewing the drugs available for treating penile erectile dysfunction. The students demonstrate understanding when they identify which drug as a PDE5 inhibitor?

Sildenafil Sildenafil is a PDE5 inhibitor used to treat penile erectile dysfunction. Alprostadil is a prostaglandin. Oxandrolone is an anabolic steroid. Danazol is an androgen.

A woman is diagnosed with pulmonary hypertension. The nurse explains the drug prescribed and the patient states, "That's a drug that used to treat erectile dysfunction." Which drug would this most likely be?

Sildenafil Sildenafil is used to treat pulmonary hypertension in females.

A female client expresses the desire to suppress her female sex characteristics to facilitate a transition to being male. Which androgen does the nurse anticipate the provider will prescribe?

Testosterone Prescribers may order male sex hormones for women to antagonize or reduce the effect of female sex hormones. Administration of androgen (DHT) or anabolic steroids to women causes suppression of menstruation and atrophy of the endometrial lining of the uterus. Progesterone and estrogen are common androgens of the female client and so would not facilitate transition to male sex characteristics.

On the advice of his brother, a 53-year-old man has made an appointment to request a prescription for sildenafil. The nurse who works at the clinic is reviewing the man's medical history and would recognize what health problem as being prohibitive to this treatment?

angina, treated with nitroglycerin Prescribers should not order sildenafil for men who also take organic nitrates, commonly used to treat angina, because the sildenafil-nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. Metformin, metoprolol, and simvastatin are not likely to cause adverse effects.

An older adult client's current medication regimen includes tamsulosin and sildenafil. The combination of these two medications should prompt what action by the nurse?

assessing the client regularly for signs of orthostatic hypotension Combining an alpha1-adrenergic blocker with a phosphodiesterase type 5 inhibitor creates a risk for orthostatic hypotension. There is no particular need for tests of hemostasis, cystoscopy, or the insertion of a urinary catheter.

An adult client is suspected of having an androgen deficiency and has spoken with his primary care provider about the possibility of treatment with testosterone. The use of testosterone would be most complicated by the presence of what preexisting health problem?

benign prostatic hypertrophy Disorders of the prostate contraindicate testosterone use because men with an enlarged prostate may have additional enlargement. Incontinence, diabetes, and kidney disease are not absolute contraindications to the use of testosterone.

Anabolic steroid use causes an increase in muscular work capacity, which is what makes these agents popular as performance-enhancing drugs. They are dangerous specifically to teens because they:

can damage the heart, liver, and kidneys. Anabolic steroids are considered even more dangerous for teens because teens are still growing. Anabolic steroids can stop bone growth and damage the heart, kidneys, and liver of adolescents.

Androgens may be prescribed to women to treat conditions related to the effects of the female sex hormones. Danazol is prescribed to prevent or treat fibrocystic breast disease and:

endometriosis Danazol may be used in women to prevent or treat endometriosis and fibrocystic breast disease.

An older adult man has moved to a long-term care facility and the nurse is performing a medication reconciliation. The resident's current medication regimen includes alfuzosin. After considering the most likely indication for this drug, the nurse should include what potential problem in the resident's interdisciplinary plan of care?

impaired urinary elimination Alfuzosin is classed as a nonreceptor subtype selective alpha1-adrenergic blocker also used to treat BPH. Impaired urinary elimination is the hallmark of BPH. Incontinence may result from BPH, but it is less commonly the functional subtype. There is no known relationship between the use of alfuzosin and instances of either sexual dysfunction or functional urinary incontinence.

A male client has been prescribed testosterone for cryptorchidism. Which statement indicates that the client teaching was effective?

"My body hair will increase." The administration of testosterone will cause an increase in body hair. It will not decrease sexual desire, but increase it. The client's voice will deepen and skin will likely have acne-related reactions.

A nurse is teaching a class at the local high school on the abuse of anabolic steroids. Which potential adverse reaction should the nurse cite regarding the long-term use of these hormones?

liver tumors. Abuse of anabolic steroids may cause a wide range of potentially serious adverse effects, including hepatic neoplasms (liver tumors), hypertension, diminished testicular size and function, and aggression.

A client diagnosed with erectile dysfunction has been advised to take Viagra. For up to how many hours does the action of the drug persist?

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

A 24-year-old female athlete is using high doses of anabolic steroids to enhance her performance. She may be at risk for which condition?

Acne Virilization in a woman is the most common reaction associated with anabolic steroids, especially when higher doses are used. Acne occurs frequently in all age groups and both sexes. Nausea, vomiting, diarrhea, fluid and electrolyte imbalances (the same as for the androgens, discussed previously), testicular atrophy, jaundice, anorexia, and muscle cramps may also be seen. Fluid retention, not deficiency, is a common side effectof anabolic steroid use. Sedation and hypotension are not adverse reactions to this hormone.

A client is prescribed testosterone gel. Which would the nurse include in the teaching plan? Select all that apply.

Allowing the application site to dry before getting dressed. Applying the gel once daily in the morning. Washing hands with soap and water after applying. The nurse would instruct the client to apply the gel once daily in the morning to clean, dry, intact skin of the shoulders and upper arms or abdomen. After the packet is opened, the contents are squeezed into the palm of the hand and immediately applied to the sites. The sites are allowed to dry before the client gets dressed. The gel is not applied to the genitals. The client should wash his hands well with soap and water after applying.

The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil?

Antidysrhythmics Vardenafil is the only PDE5 inhibitor that prolongs the QT interval and should not be used with other drugs with similar effect, particularly class I and II antidysrhythmics.

Which agent would a client most likely be prescribed for penile erectile dysfunction if the client is very sexually active and the timing of sexual stimulation is not known?

Avanafil Avanafil, the newest PDE5 inhibitor, is a fast-acting and highly selective member of the class. The drug reaches its peak in 30 minutes, with a duration of 6 hours. Sildenafil and vardenafil must be taken approximately 1 hour before sexual stimulation. Tadalafil reaches its peak in 2 hours,

A man in his early 70s has prided himself in maintaining good health for his entire adult life. For this reason, his recent diagnosis of benign prostatic hypertrophy (BPH) is a source of frustration, and he asks, "I don't understand why I got this because I've always taken such good care of my body." What fact should be the basis for the nurse's response to the client?

BPH is thought to be a normal part of the male aging process. It is thought that BPH is a normal element of the male aging process. Stress, hypertension, high cholesterol levels, and genetic factors are not usually implicated in the etiology of BPH.

The health care provider has prescribed testosterone for a 77-year-old client with a low testosterone level. The nurse will evaluate this client for what condition that may develop in this client in response to this medication?

Benign prostatic hypertrophy Older adults who receive testosterone should be evaluated for the development of benign prostatic hypertrophy.

An 8-year-old boy is being administered testosterone injections for treatment of hypogonadism. What should be measured every 6 months?

Hand and wrist epiphyseal growth plates Because androgens can cause epiphyseal closure, hands and wrists should undergo radiographic examination every 6 months to detect bone maturation and prevent the loss of adult height. No evidence exists that suggests that the electrocardiogram, electroencephalogram, or visual acuity need to be assessed.

When teaching a group of high school students about using anabolic steroids, the nurse would include information that these drugs are classified as which class of controlled substances?

III Anabolic steroids are classified as a class III controlled substance.

In older adult men, anabolic steroids may be prescribed for a deficiency condition. If hypertensive, what might be the cause for an increase in blood pressure?

Increased fluid and sodium retention Sodium and water retention are associated with androgen and anabolic steroid use, which aggravates hypertension.

What is most important to tell the client who will be taking adrenergic blocking drugs for benign prostatic hypertrophy?

Take the medication at the same time each day. The client should take the medication at bedtime every day because it can cause dizziness. The important issue, however, is to take the medication at about the same time each day. The drug should not be stopped and started because after the first dose, orthostatic hypotension may occur if the drug is stopped and started a week or more later. The client is at risk for constipation if the client reduces the amount of liquid he drinks.

A 17-year-old boy has been admitted to the emergency department after suffering a knee sprain during a football practice. The nurse notes that the client has exceptional muscle mass, and the boy quietly admits that this is mostly attributable to the use of steroids, which he obtains from a teammate. What should the nurse teach the boy about anabolic steroid abuse?

Anabolic steroids are universally dangerous but are especially harmful to adolescents. Although steroids have a reputation for being dangerous to adult athletes, such as body builders and football players, they are considered even more dangerous for teens because teens are still growing. These drugs do not necessarily require increasing doses to be effective. They carry numerous health consequences later in life, but reduced weight bearing is not among the most common consequences.

A client has begun treatment for penile erectile dysfunction. What explanation should the nurse provide regarding the primary effect a prescribed phosphodiesterase type 5 inhibitor will have on this condition?

Blood flow to the penis will be improved Phosphodiesterase type 5 inhibitors are drugs used in the treatment of erectile dysfunction that cause smooth muscle relaxation, allowing the flow of blood into the corpus cavernosum. While it is true the medication is administered orally, that is not the address the effect it has on the function of the penis. Neither of the remaining options provide accurate information about the medication or it's affect on the penis.

A young male patient, age 14, has been prescribed testosterone for delayed onset of puberty. Follow-up care includes a visit to the clinic at least every 6 months for ongoing assessment. It will be most important for the nurse to monitor:

Bone growth When testosterone is used in prepubescent boys to treat hypogonadism or delayed onset of puberty, the premature closure of the long bones may lead to stunted growth. To monitor the action of testosterone on the patient, radiographs should be taken every 6 months to assess bone age. Radiographs help document bone maturation and the effect of testosterone on the epiphyseal centers. Although it is important to assess a patient's fluid intake and output, hemoglobin and hematocrit levels, and sodium and potassium levels, in this situation assessing bone growth would be the most important.

The nurse receives a call from a male client who takes finasteride (Proscar) for treatment of BPH, and tells the nurse that his wife may be pregnant. What does the nurse expect the health care provider to do?

Discontinue the medication. A client who takes an androgen hormone inhibitor will need to have the drug discontinued if a sexual partner is (or may become) pregnant, because pregnant women should not handle this medication. The provider would not increase or decrease the dose, nor would the provider change the drug to dutasteride.

A female patient receiving fluoxymesterone, an androgenic drug, for metastatic breast cancer is disturbed by the physical changes seen in her body. Which feature of virilization may be seen in the patient receiving this therapy?

Deepening of the voice Deepening of the voice may be seen as a feature of virilization following male hormone therapy in a female patient. Virilization is the acquisition of male characteristics in the female. Other features of virilization include pigmentation, and not hypopigmentation, of the skin, and increase, not decrease, in the size of the clitoris. Increase in body weight is not a sign of virilization. It may occur due to impaired nutrition of the body.

A 70-year-old man has enjoyed good overall health for all of his adult life, but he has been experiencing urinary frequency and dribbling that has culminated in a diagnosis of benign prostatic hypertrophy (BPH). As a result, the client has been prescribed finasteride. When teaching the client about the potential adverse effects of the drug, the nurse should ensure that he knows about the possibility of:

sexual dysfunction. Adverse effects of finasteride include various sexual dysfunctions, such as impotence, gynecomastia, reduced libido, and ejaculatory disorders. Urethral burning, kidney stones, and visual disturbances are not common adverse effects of finasteride.

A 52-year-old has made an appointment with his primary care provider and has reluctantly admitted that his primary health concern is erectile dysfunction (ED). He describes the problem as increasing in severity and consequent distress. Which of the nurse's assessment questions is most likely to address a common cause of ED?

"Are you taking any medications for high blood pressure?" Causes of ED may include drugs such as antidepressants, antihypertensive agents, and histamine receptor antagonists. Injuries are a rare cause. Addressing the impact of the problem and the client's perceptions of health are important, but neither question addresses causation.

A client with a history of benign prostatic hypertrophy (BPH) is seeking androgenic medication treatment for penile erectile dysfunction. What information should the nurse provide the client regarding this therapy?

It increases the risk for prostate cancer Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. None of the other options present accurate information regarding this therapy.

What aspect of a client's current health status may contraindicate the use of a PDE5 inhibitor?

The client has a history of unstable angina pectoris. Clients who are not sufficiently healthy to engage in sex should not be prescribed PDE5 inhibitors. Unstable angina may preclude the exertion necessary for sexual activity, and it is often treated with nitrates, contraindicating the use of PDE5 inhibitors. Obesity, diabetes, seizures, and the use of antiseizure medications do not contraindicate PDE5 inhibitors.

Sildenafil has been prescribed to a client in his 60s, and the nurse is providing health education about the safe and effective use of the drug. The nurse should teach the client to:

avoid taking the drug more than once in any 24-hour period. It is important not to take sildenafil more than once in a 24-hour period. A recent high-fat meal may delay drug action, but it is not essential to take it on an empty stomach. Heartburn is not a common adverse effect and would not necessarily require discontinuing treatment.