ATI-Pharm Made Easy 4.0 Reproductive and Genitourinary

A nurse is teaching a client who has a new prescription for a testosterone transdermal patch. Which of the following statements made by the client indicates an understanding of the teaching?

"I should have pancreatic function tests obtained while taking this drug."Liver function, rather than pancreatic function, testing should be performed when a client takes a 17-alpha-alkylated androgen such as testosterone. "I should have my white blood cell count checked annually."The client should have hemoglobin and hematocrit levels, rather than white blood cells, monitored routinely when using testosterone treatment. "I should take off the patch to shower."The client does not need to remove the patch before showering or swimming. When using testosterone cream, the client should wait for several hours after applying the medication to bathe to prevent the medication from being washed away. "I should apply the medication to a different site each time." The client should rotate the application sites with each application to prevent skin irritation.

A nurse is caring for a client who is taking combination now contraceptive as a meal estradiol and drospirenone it is about to begin taking rifampicin to treat tuberculosis. Which of the following instructions should the nurse give the client due to a possible drug interaction? "Increase the rifampin dose." "Increase the oral contraceptive dose." "Wait 2 hours between taking each drug." "Use additional birth control methods."

-"Increase the rifampin dose." Oral contraceptives do not reduce the effects of rifampin. They can, however, reduce the effects of warfarin and hypoglycemic drugs. -"Increase the oral contraceptive dose." Taking additional oral contraceptives can increase the risk of serious adverse effects. -"Wait 2 hours between taking each drug." Allowing 2 hr between taking the oral contraceptive and rifampin will not reduce the drug interaction. -"Use additional birth control methods." MY ANSWER Rifampin can increase the metabolism of oral contraceptives, reducing the effectiveness. Clients who are taking oral contraceptives and rifampin should use additional contraceptive methods to prevent an unwanted pregnancy. Other drugs that can reduce the effects of oral contraceptives include some antifungal agents and anticonvulsants.

A nurse is caring for a client who has benign prostatic hypertrophy and is taking tamsulosin. The nurse should question the use of the drug if the client also has which of the following?

-A seizure disorder for which he takes carbamazepine Clients who have a seizure disorder and take carbamazepine can also take tamsulosin. They should not, however, take erythromycin because it increases carbamazepine levels and puts them at risk for serious adverse effects. -Erectile dysfunction for which he takes sildenafil Drugs that lower blood pressure, such as sildenafil, can exacerbate hypotension in combination with tamsulosin. Clients who take sildenafil should not take tamsulosin. -Diabetes mellitus for which he takes glyburide Clients who have diabetes mellitus and take glyburide can also take tamsulosin. They should not, however, take cimetidine because taking the two together increases hypoglycemic effects. -Angle-closure glaucoma for which he takes pilocarpine Clients who have glaucoma and take pilocarpine can also take tamsulosin. They should not, however, take atropine preparations because pilocarpine and atropine have antagonizing effects.

A nurse is assessing a client who has a new prescription for the combination oral contraceptive ethinyl estradiol and drospirenone. Which of the following findings should the nurse identify as a contraindication to use of this medication? -Drinks a glass of wine each night -Smokes half a pack of cigarettes a day -Runs marathons regularly -Drives a school bus

-Drinks a glass of wine each night Mild to moderate alcohol use is not a contraindication for taking combination oral contraceptives, such as ethinyl estradiol and drospirenone. Drinking grapefruit juice can increase the risk for toxicity and should be avoided. -Smokes half a pack of cigarettes a day Smoking increases the risks of thromboembolic events, hypertension, and cardiovascular disease for clients who are taking combination oral contraceptives, especially for those clients who are older than 35 years. Clients should quit smoking before starting this drug therapy. -Runs marathons regularly Clients who take combination oral contraceptives, such as ethinyl estradiol and drospirenone, should exercise regularly. They should also consume a healthy, low-fat diet, and drink plenty of fluids. -Drives a school bus The combination of ethinyl estradiol and drospirenone is unlikely to affect alertness. Driving is appropriate for clients who take the drug.

After administering terbutaline to a client to inhibit preterm labor, the nurse should assess which of the following? -Peripheral pulses -Temperature -Vision -Heart rate

-Peripheral pulses Terbutaline is unlikely to affect peripheral pulses. It can, however, cause hypokalemia and muscle weakness. -Temperature Terbutaline is unlikely to affect temperature. Dinoprostone, an oxytocic drug, can cause a fever. -Vision Terbutaline is unlikely to affect vision. Oxybutynin, an anticholinergic drug, can cause dilated pupils and blurred vision. -Heart rate Terbutaline can cause tachycardia, chest pain, and palpitations. The nurse should monitor the client's ECG for tachycardia and other dysrhythmias and monitor fetal heart rate and rhythm.

A nurse is preparing to administer finasteride to a client who has benign prostatic hypertrophy (BPH). Which of the following precautions should the nurse take when administering this drug?

Administer medication while client is sitting or reclining.The drug does not affect blood pressure or cause orthostatic hypotension. It can be administered without regard to the client's positioning. Withhold the medication if the client doesn't eat.The drug does not cause gastric irritation and can be administered regardless of food consumption. Wear gloves when handling the tablet.MY ANSWERThe nurse should avoid touching the drug because it can be absorbed through the skin. For women, this can potentially cause harm if they are pregnant and have a male fetus. Women should also avoid exposure to semen from individuals who are taking finasteride. Monitor heart rate prior to administration.The drug does not affect the heart rate and can be administered without regard to the client's heart rate.

A nurse is providing teaching to a client who is taking bethanechol for urinary retention. Which of the following instructions should the nurse include? (Select all that apply.) Avoid driving and activities that require alertness. Increase fluid intake. Take the drug with food. Stay close to a bathroom after taking the drug. Increase weight-bearing activities.

Avoid driving and activities that require alertness is correct. Bethanechol, a muscarinic agonist, can cause dizziness and fainting. Clients who take the drug should use caution with activities that require alertness until they know how the drug will affect them.Increase fluid intake is correct. Bethanechol can cause diarrhea and increased salivary and gastric secretions. Clients who take the drug should maintain hydration by increasing their fluid intake.Take the drug with food is incorrect. Clients should take bethanechol on an empty stomach, 1 hr before or 2 hr after meals.Stay close to a bathroom after taking the drug is correct. Bethanechol can cause rapid relief of urinary retention or diarrhea, with fecal incontinence. Clients who take the drug should stay near a bathroom or have a bedpan or urinal ready.Increase weight-bearing activities is incorrect. Bethanechol is unlikely to cause bone loss. Leuprolide is a drug that can cause bone loss.

A nurse is caring for a client who is about to begin clomiphene therapy to treat infertility. The nurse should monitor the client for which of the following adverse effects?

Breast cancerClomiphene is unlikely to cause breast cancer. Using a combination of estrogen and progestin for hormone replacement, however, can increase the risk for breast cancer. Clients who are taking hormone replacement drugs should perform self-breast examinations and have mammograms at the recommended intervals. Deep-vein thrombosisClomiphene is unlikely to cause deep-vein thrombosis. Combination oral contraceptives and estrogens can, however, cause this adverse effect. Ovarian hyperstimulation syndrome Pelvic pain can indicate ovarian hyperstimulation and can lead to ovarian cyst rupture. The nurse should monitor a client who is taking clomiphene for ovarian enlargement and advise them to seek medical attention immediately for sudden or severe pelvic pain. Restless leg syndromeClomiphene is unlikely to cause restless leg syndrome. It can, however, cause hot flashes, nausea, and headache.

A nurse is providing safety education to a client who is scheduled to begin treatment with tamsulosin for benign prostatic hypertrophy (BPH). Which of the following instructions should the nurse include in the teaching?

Change positions slowly. Alpha adrenergic blockers such as tamsulosin are also used to treat hypertension. These drugs can cause the blood pressure to drop, leading to orthostatic hypotension. Therefore, the nurse should instruct the client to change positions slowly to prevent harm. Crush the medication. Tamsulosin comes in a capsule form and should be swallowed whole, not crushed or chewed. Take the medication on an empty stomach. The client should take the drug at the same time each day, 30 min after the same meal. Report increased urinary output immediately. Tamsulosin should improve urinary flow for a client who has BPH. The client should experience an increase in the amount of urine they are able to void. The client should report indications of fluid retention, such as edema or weight gain.

A nurse is assessing a client who has a new prescription of oxybutynin to treat neurogenic bladder. Which of the following assessment findings should the nurse identify as an adverse effect of the drug? (Select all that apply.) Diaphoresis Dilated pupils Dizziness Distended bladder Fever

Diaphoresis is incorrect. Oxybutynin, an anticholinergic, can suppress sweating and is unlikely to cause diaphoresis.Dilated pupils is correct. Oxybutynin can cause mydriasis or dilated pupils, dry eyes, and blurred vision. Clients who take the drug should use lubricating eye drops to help reduce dryness.Dizziness is correct. Oxybutynin can cause dizziness and drowsiness. Clients who take the drug should use caution with activities that require alertness until they know how the drug will affect them.Distended bladder is correct. Oxybutynin can cause urinary retention and bladder distention.Fever is correct. Oxybutynin can cause heat exhaustion and fever. Clients who take the drug should use it with caution in hot weather.

A provider has prescribed a dinoprostone vaginal insert to promote cervical ripening in a client who is at 40 weeks of gestation. When administering dinoprostone, which of the following actions should the nurse take? (Select all that apply.) Encourage the client to urinate prior to insertion. Remove the pouch when active labor begins. Monitor for uterine hyperstimulation. Encourage the client to walk after insertion. Monitor the client's temperature.

Encourage the client to urinate prior to insertion is correct. The client should urinate prior to the insertion of the dinoprostone pouch. This action does not specifically relate to the therapeutic effects of the drug, but it promotes comfort and prevents interruption of the administration protocol.Remove the pouch when active labor begins is correct. The nurse should remove the pouch when active labor begins or 12 hr after the insertion of the dinoprostone, whichever is sooner.Monitor for uterine hyperstimulation is correct. Uterine stimulation can cause fetal distress. The nurse should monitor uterine activity and fetal heart rate and remove the insert for fetal distress or uterine hyperstimulation.Encourage the client to walk after insertion is incorrect. The client should lie supine for at least 2 hr while the pouch slowly releases the drug.Monitor the client's temperature is correct. Dinoprostone can cause a fever. The nurse should monitor the client's temperature and report any changes to the provider.

A nurse is caring for a client who has a new prescription for conjugated equine estrogen. The nurse should instruct the client to report which of the following indications of a serious adverse reaction?

Hot flashesEstrogen hormone replacement therapy helps suppress vasomotor reactions, relieving hot flashes and diaphoresis. Urinary tract infectionEstrogen hormone replacement therapy is unlikely to cause a urinary tract infection. It can, however, cause hypertension, dizziness, and fluid retention. ​Vaginal bleeding Estrogen hormone replacement therapy increases the risk of endometrial cancer. The nurse should instruct clients using the drugs to report recurrent or persistent vaginal bleeding and pelvic pain. Bone painEstrogen hormone replacement therapy is unlikely to cause bone pain. Bisphosphonates, such as alendronate, are reproductive-system drugs that can cause bone pain.

A nurse should question the use of ethinyl estradiol and drospirenone by a client who has renal disease due to the increased risk of which o the following?

Hyperkalemia Ethinyl estradiol and drospirenone can cause potassium retention, so a client who has renal, adrenal, or liver disease should not take the drug combination. The nurse should monitor the serum potassium levels of a client taking the drug and use it with caution with other drugs that can increase serum potassium, such as potassium-sparing diuretics. -Hyponatremia A client who has renal disease can develop hypernatremia; however, the combination of ethinyl estradiol and drospirenone is unlikely to cause hyponatremia. -Hypoglycemia Ethinyl estradiol and drospirenone can cause reduced glucose tolerance and hyperglycemia. The nurse should monitor glucose levels carefully, especially for clients who have diabetes and take the drug. Ethinyl estradiol and drospirenone is unlikely to cause hypoglycemia. -Respiratory alkalosis Clients who have renal disease can develop metabolic acidosis; however, the combination of ethinyl estradiol and drospirenone is unlikely to cause respiratory alkalosis.

A nurse is teaching a client who has a new prescription for transdermal testosterone gel to treat delayed puberty. Which of the following instructions should the nurse include? (Select all that apply.) "Apply the gel to the scrotum." "Cover the area of application with clothing." "Wash your hands after applying the gel." "Do not shower for several hours after applying the gel." "Apply the gel to the gums above an upper incisor."

MY ANSWER "Apply the gel to the scrotum" is incorrect. A client should apply transdermal testosterone to the upper arm, shoulders, or abdomen, not on the genitalia. Previously available patches required application to the scrotum, but these were inconvenient because of the need to shave the area."Cover the area of application with clothing" is correct. Clothing helps to prevent exposing others to the drug. Clients should let the gel dry before covering the application site with a shirt."Wash your hands after applying the gel" is correct. Clients should wash their hands after application to prevent exposing others to the drug."Do not shower for several hours after applying the gel" is correct. Clients should not shower or swim for several hours following application of transdermal testosterone gel to avoid washing off the gel."Apply the gel to the gums above an upper incisor" is incorrect. A client who is using the drug's buccal form, not the transdermal gel, should apply the buccal tablet to the gums above an upper incisor.

A nurse is teaching a client about conjugated estrogen and medroxyprogesterone. Which of the following instructions should the nurse include?

Monitor for rectal bleeding. Conjugated estrogen and medroxyprogesterone can help reduce the risk for colorectal cancer. The combination of estrogen and progestin is unlikely to cause rectal bleeding. Avoid drinking alcoholic beverages. Conjugated estrogen and medroxyprogesterone, a combination of estrogen and progestin for hormone replacement, is unlikely to interact with alcohol. Clients should avoid taking St. John's wort while taking the drug combination because it reduces the effectiveness. ​Have blood pressure checked regularly. ​Using conjugated estrogen and medroxyprogesterone, a combination of estrogen and progestin for hormone replacement, can cause hypertension. Clients taking the drug combination should have their blood pressure checked regularly and report headache or edema. -Sit up for 30 min after taking the drug. It is not necessary to sit up or stand for 30 min after taking conjugated estrogen and medroxyprogesterone. Bisphosphonates, such as alendronate, can cause esophagitis, which can be avoided by sitting up or standing for 30 min after taking the drug.

A nurse should question the use of conjugated equine estrogen by a client who has a history of which of the following?

OsteoporosisEstrogen replacement therapy treats or prevents osteoporosis by increasing bone mass. Clients who have osteoporosis can use the drug. It is contraindicated, however, for clients who have liver disease, uncontrolled vaginal bleeding, or suspected or confirmed breast, vaginal, cervical, or endometrial cancer. Peptic ulcer diseaseClients who have peptic ulcer disease can use estrogen replacement therapy. It is contraindicated, however, for clients who have liver disease, uncontrolled vaginal bleeding, or suspected or confirmed breast, vaginal, cervical, or endometrial cancer. Rheumatoid arthritisClients who have rheumatoid arthritis can use estrogen replacement therapy. It is contraindicated, however, for clients who have liver disease, uncontrolled vaginal bleeding, or suspected or confirmed breast, vaginal, cervical, or endometrial cancer. Blood clots Clients who have a history of thromboembolic disease should not use estrogen replacement therapy because of the risks of thrombophlebitis, myocardial infarction, pulmonary embolism, and cerebrovascular accident.

A nurse is providing teaching to a client about using leuprolide to treat endometriosis. Which of the following instructions should the nurse include?

Perform weight-bearing activities. Leuprolide suppresses estrogen and can cause bone loss. The nurse should instruct the client to perform weight-bearing activities and increase their intake of calcium and vitamin D. Wear sunscreen or protective clothing. Although all clients should protect their skin from sun exposure, leuprolide is unlikely to make a client any more vulnerable to damage from ultraviolet radiation. Some antipsychotics, such as chlorpromazine, can cause photosensitivity. Take the drug with food to increase absorption. Leuprolide is available via IM administration only, monthly or every 3 to 4 months. Avoid drinking grapefruit juice. Grapefruit juice interacts with many different drugs, including sildenafil, cyclosporine, midazolam, and lovastatin, but it is unlikely to affect the metabolism of leuprolide.

A nurse is caring for a client who is about to begin taking cabergoline to treat infertility. The nurse should explain to the client the need to monitor which of the following laboratory values? -Potassium -Glucose -BUN and creatinine -Prolactin level

Potassium Cabergoline should not alter serum potassium levels. Ethinyl estradiol and drospirenone is a reproductive-system drug combination that can cause hyperkalemia. -Glucose Cabergoline should not alter serum glucose. Terbutaline is a reproductive-system drug that can cause hyperglycemia. -BUN and creatinine Cabergoline should not alter serum BUN and creatinine or renal function. Celecoxib is a drug that can cause elevations in BUN and creatinine. -Prolactin level Cabergoline inhibits the secretion of prolactin. The provider should monitor prolactin levels to determine the appropriate dosage.

A nurse is caring for a client who received human menopausal gonadotropin (hMG). Which of the following findings should the nurse expect?

Prolactin secretionCabergoline inhibits prolactin secretion; hMG does not promote prolactin secretion. Estrogen releaseClomiphene blocks estrogen receptors, causing the pituitary gland to secrete LH and FSH; hMG does not promote estrogen release. Follicular maturation Before a client receives human chorionic gonadotropin (hCG) to stimulate ovulation, they must receive a drug that induces follicular maturation, such as hMG, which is a mixture of LH and FSH, clomiphene, or follitropin. Clients receive hCG 1 day after the last dose of hMG or follitropin or 7 to 9 days after the last clomiphene dose. Oxytocin secretionOxytocin promotes uterine contractions; hMG does not promote oxytocin secretion.

A nurse is caring for a client who has a new prescription for transdermal conjugated estrogen and medroxyprogesterone to treat postmenopausal symptoms. The nurse should explain to the client that this drug combination includes which of the following therapeutic effects? (Select all that apply.) Reduces the risk of ovarian cancer Relieves hot flashes Prevents osteoporosis Reduces the risk of breast cancer Reduces the risk of thromboembolism

Reduces the risk of ovarian cancer is correct. Drug therapy with an estrogen and progesterone combination reduces the risk of ovarian cancer. However, the use of estrogen alone without progesterone can increase the risks of endometrial and ovarian cancer. Relieves hot flashes is correct. Drug therapy with an estrogen and progesterone combination or estrogen alone reduces hot flashes and the sweating and sleep disturbances they cause. Prevents osteoporosis is correct. Drug therapy with an estrogen and progesterone combination or estrogen alone increases bone density and prevents osteoporosis. Reduces the risk of breast cancer is incorrect. Drug therapy with an estrogen and progesterone combination increases the risk of breast cancer. Clients taking the drug combination should perform self-breast examinations and have mammograms at the recommended intervals. Reduces the risk of thromboembolism is incorrect. Drug therapy with an estrogen and progesterone combination or estrogen alone increases the risk of thromboembolism. Clients taking the drugs should report a swollen calf, erythema of the skin, shortness of breath, slurred speech, headache, or disorientation.

A nurse is caring for a male client who has hyperthyroidism and is not responding to treatment. The nurse should identify that hyperthyroidism is a contraindication for which of the following drugs?

Sildenafil Clients who have hyperthyroidism can take sildenafil. It is contraindicated, however, for clients who also take nitroglycerin. Bethanechol Bethanechol, a cholinergic drug, can cause cardiac dysrhythmias in clients who have hyperthyroidism by triggering the release of norepinephrine. This reaction does not occur in clients who do not have hyperthyroidism. Tamsulosin Clients who have hyperthyroidism can take tamsulosin. It is contraindicated, however, for clients who also take erectile dysfunction drugs. Finasteride Clients who have hyperthyroidism can take finasteride. It is contraindicated, however, for women and children.

A nurse is caring for a client who missed a dose of her oral contraceptive. Which of the following instructions should the nurse give the client?

Take a pregnancy test.Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. It is not necessary to take a pregnancy test. Double up on pills for remainder of the pack.Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. Increasing the dosage for the remainder of the month is not advisable and could increase the risk for adverse effects. Take the missed dose as soon as possible. The nurse should tell the client to take the missed dose along with the next dose. Should the client miss two doses, she should take an additional dose each day for the next 2 days and add an additional method of birth control for the remainder of the cycle. Stop the oral contraceptive and use a different contraceptive.Missing one oral contraceptive pill is unlikely to increase the risk of pregnancy. It is not necessary to stop the oral contraceptive and use a different birth control.

A nurse is providing teaching to a client about sildenafil to treat erectile dysfunction. Which of the following instructions should the nurse include?

Take the drug with a glass of grapefruit juice.Grapefruit juice and other CYP3A4 inhibitors reduce the metabolism of sildenafil, increasing plasma levels and the risk of adverse effects. Clients who take the drug should avoid grapefruit juice. Do not take the drug with high-fat foods.MY ANSWERHigh-fat foods delay absorption and reduce peak effects of sildenafil. Clients who take the drug should not take it with high-fat foods. Increase intake of foods rich in vitamin K.It is not necessary to increase vitamin K-enriched foods while taking sildenafil. Clients who take warfarin should keep their intake of vitamin K consistent. Avoid aged cheeses and red wine.It is not necessary to avoid tyramine-containing foods while taking sildenafil. Clients who take MAOIs, such as phenelzine, should avoid tyramine-containing foods.

A nurse is teaching a client about receiving leuprolide to treat endometriosis. The nurse should instruct the client to expect which of the following side effects?

Vaginal drynessMY ANSWERLeuprolide can cause vaginal dryness. The nurse should suggest that the client use water-based vaginal lubricants to help minimize this effect. HypertensionLeuprolide is unlikely to cause hypertension. Methylergonovine is a reproductive-system drug that can cause this effect. Blurred visionLeuprolide is unlikely to cause blurred vision. Clomiphene is a reproductive-system drug that can cause this effect. Orthostatic hypotensionLeuprolide is unlikely to cause orthostatic hypotension. Cabergoline is a reproductive-system drug that can cause this effect.

A nurse is caring for a client who is about to begin taking finasteride to treat benign prostatic hypertrophy. The nurse should explain to the client the need to monitor which of the following laboratory values? ​-Prostate-specific antigen (PSA) -BUN -Creatine phosphokinase (CPK) -ALT

​-Prostate-specific antigen (PSA) The nurse should monitor PSA levels at baseline and periodically thereafter. Increases in PSA can indicate prostate cancer. PSA levels should decrease with finasteride therapy. -BUN Finasteride should not alter serum BUN. Celecoxib is a drug that can cause elevations in BUN. -Creatine phosphokinase (CPK) Finasteride should not alter CPK levels. Pramipexole is a drug that can alter CPK levels. -ALT Finasteride should not alter ALT levels. Pioglitazone is a drug that can alter LDL levels.