Ch 45

A client's anemia has not responded to conservative treatments, so the client has been prescribed oxymetholone 2.5 mg/kg PO per day. The client weighs 154 lbs. How many 50 mg tablets should the client take each day?

3.5 Explanation: The client's weight should first be converted to kilograms: 154 lbs ÷ 2.2 = 70 kg. The daily dose is 2.5 mg/kg/day, and 2.5 x 70 = 175 mg. The drug is available in 50 mg tablets, and 175 mg ÷ 50 mg/tablet = 3.5 tablets.

Which statement made by an adult man prescribed sildenafil suggests that the nurse's teaching has been ineffective?

"I know that sildenafil can cause hypertension if I use my angina medicine." Explanation: Sildenafil-nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. The onset of action is 20 to 60 minutes, and the drug does not protect against infections. It should not be taken more than once in any 24-hour period.

The nurse is educating a young adult client diagnosed with androgen deficiency about the prescribed testosterone transdermal system, apply two systems (dose of 5 mg) nightly. Which statement made by the client establishes the need for further clarification?

"One transdermal patch is applied to my back, upper arm, or abdomen to dry, clean skin, and the other to my groin." Explanation: The nurse needs to clarify the statement that the client made regarding applying the transdermal patch to the groin. The client should not apply the patch to the groin. The client needs to rotate sites, so there is 7 days before another patch is paced on the area of skin. The thigh was not mentioned, which may be used as a site. The other statements are correct. Common adverse effects of the drug include acne, headache, bitter taste or mouth irritation, hair loss, and increase in libido. The client may weigh self once or twice a week, and should report if there is an increase in weight, which reflects fluid retention. Keeping appointments for follow-up is essential because hypercalcemia can occur leading to renal calculi, polyuria, nausea and vomiting, and abdominal pain.

A nurse caring for a client receiving fluoxymesterone for the treatment of inoperable breast carcinoma should weigh the client daily or as ordered by the health care provider and report a change in weight of how many pounds (kilograms) in either direction to the health care provider?

5 lb (2.3 kg) Explanation: A nurse caring for a client receiving fluoxymesterone for the treatment of inoperable breast carcinoma should weigh the client daily or as ordered and report a change in weight of 5 lb (2.3 kg) more or less to the health care provider. Fluctuations of less than 5 lb (2.3 kg) do not need to be reported.

A male client is receiving an androgen. The nurse would assess the clent for which possible adverse effects? Select all that apply.

Acne Hirsutism Explanation: Acne is an adverse effect of androgen therapy. Hirsutism is an adverse effect of androgen therapy. Weight gain is an adverse effect of androgen therapy. Flushing is an anti-estrogen effect of androgen therapy in women. Emotional lability is an anti-estrogen effect of androgen therapy in females.

A client is taking androgens and warfarin (Coumadin). What effect will these two medications have on the client's coagulation

Coagulation will be decreased.

Which of the following medications, when administered concomitantly with oral contraceptives, can decrease the effect of the contraceptives?

Anticonvulsants Explanation: Anticonvulsants may decrease the effects of oral contraceptives by inducing enzymes that accelerate metabolism of estrogens and progestins.

A female client has been prescribed estrogen therapy. Which will the nurse advise the client is a common adverse effect of estrogen therapy?

Breakthrough bleeding Explanation: The nurse will advise the client that common adverse effects include breakthrough bleeding, changes in menstrual flow, dysmenorrhea, premenstrual-like syndrome, headache, nausea and vomiting, bloating, abdominal cramps, chloasma, and photosensitivity. Migraine headaches, dizziness, and changes in libido are less common adverse effects.

The nurse is caring for a client who is extremely agitated about finding out she is pregnant and wants to take an abortifacient that will have the fastest possible action. What drug will the nurse expect to be ordered?

Carboprost Explanation: Carboprost is available as an intramuscular injection with an onset of 15 minutes and a 2-hour duration of effect. Mifepristone takes 5 to 7 days to produce the desired effect so would not be appropriate for this client. Prostin 15 is only available in Europe. Bepridil is a calcium channel blocker and would not be used as an abortifacient.

16s The nurse determines that teaching about testosterone therapy via a transdermal patch is effective when the male client states that he will change the patch in which time frame

Daily

Which results with the administration of testosterone?

Decreased protein catabolism Protein catabolism decreases. Red blood cell production increases. Retention of nitrogen increases. Retention of sodium increases.

Which of the following mood disorders can result from estrogen therapy?

Depression Explanation: Mental depression is a potential adverse effect of estrogens.

When fluoxymesterone is administered to a 14-year-old male, what is the expected result?

Development of sexual organs

A male client with cancer has developed cachexia and been prescribed anabolic steroids. The client's most recent laboratory results indicate a hemoglobin levels of 15.8 g/dL (158 g/L). What is the nurse's best action?

Document the therapeutic effects of treatment Explanation: Increased hemoglobin levels are a desired effect of anabolic steroids. For a male, this client's hemoglobin in the high-normal range. Assistance with ADL's is unrelated to this finding, and the client may need less help than before, owing to increased oxygen-carrying capacity. There is no obvious indication for iron supplements.

A client on long term testosterone therapy is at risk for the development of hepatocellular cancer. The nurse explains to the client that a hepatic function test should be done and evaluated on what schedule during the therapy?

Every 6 months Explanation: A potentially life-threatening effect associated with this therapy is hepatocellular cancer. This may occur because of the effect of testosterone on hepatic cells. Patients on long-term therapy should have hepatic function tests monitored regularly— before beginning therapy and every 6 months during therapy.

Adult males who use androgens might experience what effects? Enlargement of the prostate

In adult men, adverse effects include prostate enlargement. They do not generally include increased breast size, increased output, or hoarseness.

A female client is taking hormonal contraceptives to prevent pregnancy. She visits the gynecology clinic and is noted with a blood pressure of 176/102 mm Hg. The client is started on enalapril mesylate 10 mg. In collaboration with the primary care provider, what other client teaching should be provided based on her current medical regimen?

Instruct to discontinue the contraceptives. Explanation: Because of widespread effects on the body tissues and reported adverse reactions, the client should be instructed to discontinue hormonal contraceptives that contribute to hypertension. The client should restrict salt but not eliminate salt. The implementation of relaxation techniques is important but not crucial to the current medical regimen.

In evaluating a plan of care for a client on estrogen therapy, what would be an appropriate part of the evaluation?

Interview and assess for therapeutic and adverse drug effects. Explanation: The nurse should monitor client response to the drug (palliation of signs and symptoms of menopause, prevention of pregnancy, decreased risk factors for coronary artery disease, palliation of certain cancers); adverse effects (liver changes, GI upset, edema, changes in secondary sex characteristics, headaches, thromboembolic episodes, breakthrough bleeding). The other options are client teaching guidelines for those on estrogen or progestin therapy. They are not part of the evaluation process of the care plan.

A male taking anabolic steroids may experience which side effects?

Jaundice Explanation: Patients taking anabolic steroids can experience jaundice. Elevated blood urea nitrogen, bradycardia, and decreased weight will not be related to the administration of anabolic steroids.

The school nurse is teaching a group of adolescent men about the dangers of anabolic steroids and includes what issues? Select all that apply.

Liver tumors, Aggressive reactions, Increased risk for suicide

After teaching a group of students about the use of estrogens, the instructor determines that additional teaching is needed when the students identify which as a contraindication?

Metabolic bone disease Explanation: Estrogens should be used cautiously in patients with metabolic bone disease because of the bone conserving effects of estrogen, which could exacerbate the disease. Thromboembolic disorders contraindicate the use of estrogen. Idiopathic vaginal bleeding is a contraindication for the use of estrogens. Breast cancer is a contraindication for the use of estrogens.

The nurse is caring for a 23-year-old female client who is on estrogen therapy. What intervention would be appropriate in a care plan for this client?

Monitor liver function periodically. Explanation: Appropriate interventions for clients taking estrogen therapy include to monitor liver function periodically for the client on long-term therapy, to evaluate liver function and ensure discontinuation of drug at any sign of hepatic dysfunction. The nurse should help post-menopausal women plan for adequate calcium and vitamin D in the diet and adequate weight-bearing exercise to maintain bone strength and prevent osteoporosis; assist clients in obtaining follow-up health care when indicated; and provide client teaching for drug therapy. The client should not combine medications unless ordered. The client in the scenario is not old enough to be concerned about calcium and vitamin D in the diet connected with osteoporosis. The nurse would provide client teaching for anything to prevent osteomyelitis because nothing in the scenario says the client has osteomyelitis.

The nurse is discussing the addition of testosterone gel (Androgel) to a male client who has a decreased libido related to a low testosterone level. The client currently takes imipramine (Tofranil) for treatment of depression. Which behavior does the nurse advise the client might occur because of this drug interaction?

Paranoid behavior Explanation: The interaction of imipramine and androgen can cause an increased risk of paranoid behavior, so it is important that a family member be given the information as well as the client. This interaction does not cause hallucinations, manic, or dissociative behaviors.

When the nurse learns the male client takes conjugated estrogens, the nurse questions the client about what disorder?

Prostate cancer Explanation: Conjugated estrogen is most commonly taken by men to treat prostate cancer because the estrogen competes with testosterone for binding sites. Although men do get breast cancer and osteoporosis, they would not be treated with estrogen for these disorders. Andropause is caused by a reduction in testosterone so they would get a male hormone replacement and not estrogen.

An adolescent client asks the nurse, "What should I do if I forget to take my birth control pill?" What should the nurse reply?

Take the dose as soon as you discover your oversight

An older male client will soon begin taking an androgen. The client has difficulty swallowing tablets and pills. Because of the available drug route, a good choice for this client would be:

Testosterone (Testoderm)

An older male client will soon begin taking an androgen. The client has difficulty swallowing tablets and pills. Because of the available drug route, a good choice for this client would be:

Testosterone (Testoderm). Explanation: A good choice for this client would be testosterone because the drug can be administered by long-acting depository forms and by dermatological patch. These forms would eliminate the need for the client to swallow a pill or tablet.

What is the primary goal of care for a client in his 50s who has recently been diagnosed with an androgen deficiency?

The client will reestablish masculine characteristics. Explanation: In postpubertal men who become androgen deficient, the goal of testosterone therapy is to reestablish and maintain masculine characteristics and functions. Testicular size and urinary function are not usually focuses of treatment. A particular sperm count may be important for some men, but maintenance of masculine traits is more commonly a priority.

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

When caring for a client on estrogen therapy, what is the nurse's priority assessment?

Therapeutic drug effects Explanation: Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. Bowel sounds, weight, and blood sugar may be part of the assessment, but it is most important to assess for therapeutic and adverse effects of the medication.

Which statement should the nurse share with a client to best describe the rationale for using a 28-day oral contraceptive pack?

This will assist clients to comply with their medication regimen, making it less likely to forget taking their pill every day. Explanation: Dispensers with 28 tablets contain 7 inactive or placebo tablets of a third color. Several combination products and alternative dosage forms are available to help individualize treatment and promote adherence. None of the other options present accurate statements regarding oral contraception packs.

The nurse is preparing to give a client an injection of carboprost. What is the nurse's priority action before administering the drug?

Verify that the woman thoroughly understands what will happen. Explanation: Carboprost is an abortifacient and it is important that the woman understand what will happen after the drug is taken and that she cannot change her mind. Contraindications and cautions should have been checked before the drug was prescribed. It is not the nurse's place to share ethical beliefs with the client. After the client's understanding is verified, the drug can be prepared.

The nurse is discussing the androgenic effects a pre-pubescent client can expect. What areas of development should be focused upon? Select all that apply.

Vocal pitch Hair distribution Skin condition Genital development Androgenic effects are associated with development of male sexual characteristics and secondary characteristics (e.g., deepening of voice, hair distribution, genital development, acne). Cognitive development is not identified with either primary or secondary sexual characteristics.

A menopausal client, prescribed estrogen and progesterone, asks why she should take two different medications. Which explanation best addresses the client's question?

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer. Explanation: During menopause, estrogens are prescribed to relieve symptoms of estrogen deficiency and to prevent or treat osteoporosis. When estrogen is prescribed for women with an intact uterus, a progestin is also given to prevent unwanted thickening of the lining of the uterus and to decrease the risk of cancer of the uterus, a possible result of using estrogen alone. Both drug therapies are commonly referred to as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT). None of the other options accurately describe the reason for the prescription of both medications.

The nurse is closely following a client who began treatment with testosterone several months earlier. When assessing the client for potential adverse effects of treatment, the nurse should prioritize which assessment?

assessment of serum calcium levels Explanation: In the client taking testosterone, the nurse should monitor serum calcium levels and observe for signs of hypercalcemia (e.g., kidney stones, polyuria, abdominal pain, nausea, vomiting, and depression). ABGs, respiratory function, and skin integrity are not typically affected by testosterone.

A 52-year-old male with type 2 diabetes is using an anabolic steroid for treatment of hormonal deficiency. He is taking the sulfonylurea glyburide (DiaBeta) to treat his diabetes. The nurse caring for this client would closely monitor his:

blood glucose level.

When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment?

blood pressure application Explanation: Oral contraceptives can result in increased blood pressure. Regular monitoring is consequently indicated. It is not normally necessary to assess skin integrity or respiration. These drugs have adverse effects influencing the cardiovascular system, but such effects are unlikely to result in alterations in rate and rhythm.

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 Explanation: 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.

Which is an example of an androgen that can be used to treat hypogonadism?

fluoxymesterone Explanation: Fluoxymesterone is an androgen that can be used to treat hypogonadism. Nandrolone is an anabolic steroid used to treat anemia of renal insufficiency, and human immunodeficiency virus (HIV) wasting syndrome. Dutasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is the androgen primarily responsible for the initial development and subsequent enlargement of the prostate gland. Oxymetholone is an anabolic steroid used to treat anemia associated with renal insufficiency.

A client is prescribed androgen therapy to be given by IM injection. The nurse would select which site for administration?

gluteal muscle Explanation: When androgens are administered IM, the injection is administered by deep IM injection into the gluteal muscle. The other muscles are not as large.

A client is prescribed oxymetholone (Anadrol-50) for treatment of angioedema. The nurse knows the client has type 2 diabetes and will instruct the client that the combination of oxymetholone with antidiabetic agents may lead to:

hypoglycemia. Explanation: Because of its effects on the liver, stanozolol (Winstrol) may interact with antidiabetic agents to decrease their metabolism and increase their effectiveness, leading to hypoglycemia. The dosage of the antidiabetic agents should be reduced and the client monitored closely.

After teaching a group of nursing students about testosterone, the nurse determines that additional teaching is needed when they identify that testosterone can be given by which route?

intravenous Explanation: Testosterone is not given intravenously. Testosterone does come in the forms of oral buccal, topical gel, injectable, pellet for subcutaneous administration, transdermal, and spray.

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. Explanation: 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 37-year-old woman has a 10 pack/year smoking history and has been using oral contraceptives for the past 2 years. The nurse should plan health education interventions in the knowledge that this client faces a priority increased risk of:

myocardial infarction. Explanation: For women 35 years of age and older who smoke, there is an increased risk of myocardial infarction and other cardiovascular disorders, even with low-dose oral contraceptives. The increase in this risk supersedes that of osteoporosis, dementia, or DVT.

A nurse is preparing to administer an anabolic steroid. Which would the nurse most likely be administering?

nandrolone Explanation: Nandrolone is an example of an anabolic steroid. Fluoxymesterone is an androgen that can be used to treat hypogonadism. Dutasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is the androgen primarily responsible for the initial development and subsequent enlargement of the prostate gland. Testosterone is a potent androgen that produces signs of puberty in young male adolescents such as hair growth and organ growth.

The etiology of secondary hypogonadism may involve which condition?

pituitary dysfunction Explanation: Secondary hypogonadism results from a problem in the hypothalamus or the pituitary gland, areas of the brain that signal the testicles to produce testosterone. Unlike primary hypogonadism, this disorder does not involve direct insult to the testicles themselves. Addisonian crisis does not cause hypogonadism.

An 8-year-old boy has been diagnosed with a sex hormone deficiency and has begun a course of treatment with testosterone. What change in the boy's health status would necessitate a stop to the course of treatment?

signs of puberty

A middle-aged client with erectile dysfunction has sought care and is receiving health education from the nurses. The client has expressed a desire to understand the physiology of the sex hormone production and the sexual response. The nurse should describe the fact that testosterone is normally secreted in response to:

stimulation by luteinizing hormone. Explanation: Certain cells in the testes, called Leydig cells, secrete testosterone in response to stimulation by luteinizing hormone (LH) from the anterior pituitary gland. Testosterone secretion is not the result of sexual arousal, ACTH, or low cortisol.

A nurse is caring for clients receiving androgen therapy. For which conditions may androgen therapy be given as replacement therapy? Select all that apply.

testosterone deficiency delayed puberty testicular development failure Explanation: Androgen therapy may be prescribed for treating testosterone deficiency, delayed puberty, and failure of development of the testes. Male-pattern baldness and symptoms of benign prostatic hypertrophy can be treated with the use of androgen hormone inhibitors and not androgen therapy.

A nurse is educating a group of young sports persons about the adverse effects associated with the use of anabolic steroids. Which of the following would the nurse include as occurring typically only in females?

virilization