Wk 15- Reproduction

A patient with hypogonadism describes application of a testosterone transdermal patch [Androderm]. Which statement indicates the need for additional teaching?

"I will apply the patch to my scrotum." When the patient says he will place the patch [Androderm] on the scrotum, additional teaching is needed. The places to apply the patch include the arm, back, abdomen, or thigh but not the scrotum. All the other behaviors are correct. The patch is replaced every day. The skin should be clean and dry for easy application. The old patch should be removed and the new one applied.

A nurse is administering 5-alpha-reductase inhibitor, and the patient asks when this will achieve its full effect. What is the nurse's best response?

"In about 6 to 12 months" In men with benign prostatic hyperplasia (BPH), beneficial effects of the alpha1 blockers develop quickly (in days to weeks), whereas benefits of 5-alpha-reductase inhibitors develop more slowly (over several months). Be aware that prostate shrinkage occurs slowly—over a period of 6 to 12 months.

A patient with benign prostatic hyperplasia asks how long an alpha1 blocker prescribed for benign prostatic hypertrophy will need to be taken. How should the nurse respond?

"It will be for the rest of your life." To maintain benefits, alpha blockers must be taken lifelong. Unlike the 5-alpha-reductase inhibitors, the alpha1 blockers do not reduce prostate size. Two to 4 weeks is too short, as is "until you go home."

A patient taking sildenafil [Viagra] asks the nurse what action to take if an erection does not resolve following ejaculation. Which response should the nurse make?

"Seek emergency help if an erection lasts longer than 4 hours, because permanent damage can occur." Sildenafil [Viagra] is a phosphodiesterase type 5 (PDE5) inhibitor that can cause priapism, which is a painful erection lasting more than 6 hours. Patients are advised to seek medical attention for an erection that lasts longer than 4 hours, because left untreated, priapism can damage penile tissue, causing permanent loss of potency. Increasing the dose or waiting to seek help would do more harm.

Which statement by the nursing student regarding testosterone indicates effective learning?

"Testosterone is made by the Leydig cells of the testes." Testosterone is made by the Leydig cells of the testes. This is a correct statement and indicates effective learning. All the rest are incorrect statements. Testosterone peaks at 17. Testosterone is found in both males and females. Testosterone decreases after menopause.

Which application instruction is the priority for a nurse to provide to a patient starting to use AndroGel testosterone gel?

"Wash your hands after applying the gel to prevent transfer to others." The principal disadvantage of the testosterone gel is that it can be transferred to others by skin-to-skin contact. Ninety percent of the applied dose remains on the skin after the gel dries. Blood levels of testosterone have been shown to double in the female partners of gel users after intimate contact. The total package of gel should be applied to clean, dry skin of the shoulders, upper arms, or abdomen. Patients should wait 6 hours until showering.

Which statement should a nurse include when teaching a patient who is scheduled to start taking dutasteride [Avodart]?

"You cannot donate blood while on this medication or for 6 months after stopping it." Dutasteride [Avodart] is harmful to a developing male fetus. To avoid transmission to women by way of infusion, men should not donate blood while using this medication and for 6 months after stopping it. Beneficial effects on the symptoms of benign prostatic hyperplasia (BPH) occur over time. Dutasteride [Avodart] reduces ejaculate volume and libido. Photosensitivity is unrelated.

A patient is prescribed sildenafil [Viagra] for erectile dysfunction. Which information should the nurse share about the best time to take the dose?

1 hour before sexual intercourse The recommended timing is to take this drug 1 hour before sexual activity because this is when peak levels occur.

A nurse completed a history on a patient who is taking testosterone gel [Fortesta]. Which patient statement will cause the nurse to intervene?

'I smoke when I apply Fortesta." Fortesta is a flammable, alcohol-based formulation, and hence patients should avoid flames or smoking until the gel has dried. Therefore, the nurse should intervene to correct this behavior. All the rest are correct and need no follow-up. Hands should be washed after applying Fortesta. Fortesta is applied to the front and inner thigh. Swimming and showering should be avoided for at least 2 hours after applying Fortesta.

A nurse is checking lab values to determine the effectiveness of androgen replacement therapy. Which testosterone level indicates a therapeutic effect?

350 ng/dL Testosterone dosage (1) (2) should be adjusted to achieve serum testosterone levels in the mid-normal range (300-450 ng/dL); 200 is too low, and 500 and 650 are too high.

A patient has benign prostatic hyperplasia (BPH). Which classes of drugs does the nurse anticipate administering for this condition? Select all that apply.

5-alpha-reductase inhibitors Alpha1-adrenergic antagonists Drugs for BPH include 5-alpha-reductase inhibitors and alpha1-adrenergic antagonists. Cardiac glycoside, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors are not given for BPH but can cause erectile dysfunction.

To which patient did the nurse most likely administer doxazosin [Cardura]?

A hypertensive patient with benign prostatic hyperplasia Because of their impact on blood pressure, the nonselective alpha1 blockers (doxazosin [Cardura] and terazosin [Hytrin]) are especially useful for patients who have hypertension in addition to benign prostatic hyperplasia, but may be dangerous for men with reduced blood pressure. Doxazosin [Cardura] is not used to treat erectile dysfunction.

The nurse is planning to administer vardenafil [Levitra] to a patient with a history of myocardial infarction 2 years ago. Which intervention will the nurse perform first?

Assess for interactions with other drugs taken. The nurse's primary responsibility is to assess medications the patient is receiving prior to administration. While blood pressure is important, it is not the first action to take. Instructing the patient to take all cardiac medications first is inappropriate. Calling the provider should occur after the assessment if new information would create problems. Vardenafil [Levitra], tadalafil [Cialis], and avanafil [Stendra] are very similar to sildenafil [Viagra]. Sildenafil [Viagra] and vardenafil [Levitra] should be used with caution by men with the following conditions: myocardial infarction, stroke, or life-threatening dysrhythmia within the past 6 months.

Which assessment should a nurse monitor more frequently in a patient who takes both an alpha blocker for benign prostatic hyperplasia (BPH) and metoprolol [Lopressor]?

Blood pressure Caution must be exercised in combining an alpha blocker—terazosin [Hytrin], doxazosin [Cardura], Tamsulosin [Flomax], alfuzosin [Uroxatral]—with an antihypertensive medication such as metoprolol [Lopressor], because severe hypotension could result. Hemoglobin, blood glucose, and urine output are not affected by combining an alpha blocker and a hypertensive medication.

A patient in the emergency department reports taking sildenafil [Viagra] and nitroglycerin 1 hour before sexual activity. Which finding should the nurse recognize as the result of this drug interaction?

Blood pressure 70/50 mm Hg When taken in conjunction with nitroglycerin, sildenafil [Viagra] can cause severe hypotension that is unresponsive to treatment. At least 24 hours should elapse between the last dose of sildenafil [Viagra] and a nitrate. A white blood cell count of 3200 units/L, a respiratory rate of 26 breaths/min, and a body temperature of 100.4° F are abnormal findings and must be reported. However, they are not as important to report as the blood pressure of 70/50 mm Hg, which is directly related to sildenafil and nitroglycerin.

A patient has been diagnosed with benign prostatic hyperplasia (BPH). Which therapies would the nurse expect the patient to be prescribed? Select all that apply.

Botulinum [Botox] Tolterodine [Detrol] Alfuzosin [Uroxatral] Botulinum [Botox] (by single injection into the prostate), tolterodine [Detrol] (a muscarinic antagonist), and alfuzosin [Uroxatral] (an alpha blocker) are newer drug therapies used to relieve urinary symptoms associated with benign prostatic hyperplasia (BPH). Sildenafil [Viagra] is used to treat erectile dysfunction. Saw palmetto, an herbal preparation, has been widely used to treat BPH, but recent research has shown it is not effective.

When assessing a patient who takes finasteride [Proscar], a nurse should monitor for which adverse effect?

Ejaculatory dysfunction Common adverse effects of finasteride [Proscar] include impotence, decreased libido, and decreased volume of ejaculate. The drug also is used to treat male pattern baldness; therefore, it would cause hair growth, not hair loss. Muscle weakness is unrelated.

A patient is taking tadalafil [Cialis] for erectile dysfunction. A nurse is monitoring for nonarteritic ischemic optic neuropathy (NAION). Which area will the nurse assess?

Eye NAION is irreversible blurring or loss of vision, so the eye must be assessed. While hearing loss can occur, it is not the area to assess for NAION. The heart is not involved in NAION. While hypotension may occur, it is not in relation to NAION.

A patient takes finasteride [Proscar] for treatment of an enlarged prostate gland. Which adverse effects will the nurse monitor for in this patient? Select all that apply.

Gynecomastia Reports of decreased ejaculate volume Finasteride [Proscar] is generally well tolerated. However, in 5% to 10% of patients, it decreases ejaculate volume and libido. In addition, gynecomastia (breast enlargement) develops in some men. Hypotension is associated with nonselective alpha1 blockers. Bradycardia does not occur with finasteride use.

The nurse is educating a patient about sildenafil [Viagra]. Which adverse effect would be a priority for the patient to report to the prescriber?

Hearing loss In rare cases, sildenafil [Viagra] has caused sudden hearing loss, usually in one ear, which may be partial or complete. The medication should be discontinued if it is being taken for erectile dysfunction. Flushing, diarrhea, and dyspepsia are other, less serious adverse effects.

Upon completion of a patient history, which information obtained from the patient with erectile dysfunction will cause the nurse to intervene?

I take my erectile medication with grapefruit juice. The nurse should intervene if the patient is taking erectile medication with grapefruit juice. Agents that inhibit CYP3A4 (eg, ketoconazole, ritonavir, grapefruit juice) can raise phosphodiesterase type 5 (PDE5) inhibitor levels. To avoid harm, dosage of the PDE5 inhibitor should be reduced. All the rest are correct and do not require the nurse to intervene. A low-fat diet should be used. Dosing may be done with or without food.

A nurse is administering androgens (testosterone) to a male patient with hypogonadism. Which Schedule controlled drug is the nurse giving?

III Because of their abuse potential, androgens (testosterone) are regulated as Schedule III controlled substances. Androgens are not Schedule I, II, or IV.

A patient is taking 17-alpha-alkylated androgens [Androxy] for replacement therapy. Which assessment findings will cause the nurse to follow up? Select all that apply.

Malaise Anorexia Jaundice Inform patients about signs of liver dysfunction (jaundice, malaise, anorexia, fatigue, nausea), and instruct them to notify the prescriber if these occur. The 17-alpha-alkylated androgens [Androxy] can cause cholestatic hepatitis, jaundice, and other liver disorders. Rarely, liver cancer develops. Obtain periodic tests of liver function. When giving androgens, male voices should deepen and testosterone levels should increase.

After reviewing the chart of a patient taking tadalafil [Cialis], which finding will cause the nurse to notify the provider?

Nitroglycerin The major contraindication to the use of tadalafil [Cialis] is concurrent nitrate therapy because this can result in severe hypotension. Ibuprofen [Advil] and furosemide [Lasix] are not contraindicated in patients taking tadalafil [Cialis]. Tadalafil [Cialis] is given for erectile dysfunction. Blood pressure 134/74 mm Hg does not pose a problem.

A patient has to have blood aspirated from the corpus cavernosum followed by irrigation with a vasoconstrictor. Which condition will the nurse observe written in the chart?

Priapism This is treatment for priapism (painful erection). Tinnitus is ringing in the ears. Impotence is inability to sustain an erection. Dyspepsia is heartburn.

A patient with anemia asks why an androgen has been prescribed. Which best describes androgen use in the treatment of anemia?

Promoting synthesis of erythropoietin Androgens may be used in men and women to treat anemias that have been refractory to other therapy. Androgens help relieve anemia by promoting synthesis of erythropoietin, the renal hormone that stimulates production of red blood cells. Androgens may also stimulate production of white blood cells and platelets. Anemias that may respond include aplastic anemia, anemia associated with renal failure, Fanconi's anemia, and anemia caused by cancer chemotherapy.

The nurse informs a male patient that testosterone therapy may promote cancer growth in which organ?

Prostate Although testosterone does not cause cancer (1) (2), it can promote the growth of prostate cancer cells. Testosterone does not affect the bladder, kidney, or intestine cancers.

The nurse is caring for a patient who has benign prostatic hyperplasia (BPH) and is prescribed finasteride [Proscar]. After continuing the medication for a few months, the patient's prostate-specific antigen (PSA) value decreased by 35%. How should the nurse interpret this finding?

The patient is responding effectively to the treatment. Finasteride [Proscar] decreases serum levels of PSA. The expected decline is 30% to 50%. This indicates that the patient is effectively responding to the medication. PSA levels do not indicate that the patient has hypersensitivity (allergic reaction). If the patient is not taking the medication as prescribed, the PSA value would be less than 30% decrease. The PSA values do not help the nurse to infer that the patient has an increased risk of liver failure; a liver function test could help with that determination.

The nurse is asked to administer medications to several patients. Which patient prescription is correct and safe to administer?

Transdermal testosterone [Androderm] patch 4 mg/day applied to the back Transdermal testosterone [Androderm] patch 4 mg/day applied to the back is correct and safe. Transdermal testosterone [AndroGel] gel is not taken by mouth; instead, it is applied to the upper arm, shoulder, abdomen, or thigh for Fortesta. Implantable testosterone pellet [Testopel] is placed under the skin in the hip area or abdominal wall lateral to the umbilicus. Buccal testosterone [Striant] is administered every 12 hours.

A woman who is pregnant tells the nurse, "My husband chokes easily, so I have been crushing his finasteride [Proscar] pills daily." Which test should the nurse discuss with the provider for the patient's wife?

Ultrasonography of the fetus The nurse should ask the patient to undergo an ultrasound scan of the fetus to check for fetal abnormalities because finasteride [Proscar] can be absorbed through the skin. Pregnant women should not handle tablets that have been broken or crushed. Finasteride [Proscar] is classified under FDA Pregnancy Risk Category X because it is teratogenic to the male fetus. Finasteride [Proscar] is contraindicated for women who are pregnant or may become pregnant. Finasteride [Proscar] does not affect the lipid levels in the patient. Therefore, the nurse need not refer the patient for a lipid profile. Finasteride [Proscar] does not affect liver function; therefore, the nurse need not refer the patient for a liver function test. Finasteride [Proscar] does not affect cardiac function. Moreover, an exercise tolerance test is not advised in pregnant women.