Chapter 40 Karch Pharmcology
The nurse is preparing to administer clomiphene to the female patient. What dosage would the nurse find is within usual dosage range? A) 100 mg B) 10 mg C) 1 mg D) 0.1 mg
A) 100mg RATIONALE: The usual dosage range for clomiphene is 50 to 100 mg/d PO with length of therapy and timing dependent on the particular situation. Options B, C, and D are not correct.
17. An adolescent patient asks the nurse, What should I do if I forget to take my birth control pill? What should the nurse reply? A) Abstain from intercourse for 7 days. B) It's okay to miss a day or two, as long as you don't go over 5 days. C) Just wait until your next dose, then take double the dose. D) Take the dose as soon as you discover your oversight.
A) Abstain from intercourse for 7 days RATIONALE: A missed pill should be taken as soon as the error is noticed. Telling the patient to abstain from intercourse would be inappropriate but if the patient misses three tablets they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken the better contraceptive protection provided, so patients should not wait until the next dose and then double
The nurse, working in a women's health center, is reviewing the patient's medical record and recognizes the patient with what medical history should not receive an abortifacient? (Select all that apply.) A) Active pelvic inflammatory disease (PID) B) Pulmonary disease C) Cardiovascular disease D) Hypertension E) Adrenal disease
A) Active pelvic inflammatory disease (PID) B) Pulmonary disease C) Cardiovascular disease RATIONALE: Abortifacients should not be used with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Caution should be used with any history of asthma, hypertension, or adrenal disease.
The nurse is developing a nursing plan of care for a patient who will receive a fast-acting abortifacient. What nursing diagnosis would apply to care provided shortly after administering the medication? A) Acute pain related to uterine contractions or headache B) Ineffective coping related to abortion or fetal death C) Risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis D) Deficient knowledge regarding drug therapy.
A) Acute pain related to uterine contractions or headache RATIONALE: The rapid-acting abortifacients work within 10 to 15 minutes , so shortly after administration of the drug, the patient will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur. Deficient knowledge regarding drug therapy should have been addressed before administering the medication. Ineffective coping usually occurs after acute symptoms subside and the patient begins to cope with the decision.
The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The patient is on a low-residue diet for colitis. What factor in the patient's history may contraindicate the use of birth control pills? A) Migraine headaches B) Age C) Asthma D) Colitis
A) Migraine headaches RATIONALE: Progestins should be used with caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.
What is the priority assessment for the 23-year-old female patient who is on estrogen therapy? A) Monitor liver function periodically for the patient on long-term therapy. B) Assess for contraindications to drug therapy. C) Help plan a diet rich in calcium and vitamin D. D) Provide patient teaching for diet therapy to prevent osteomyelitis
A) Monitor liver function periodically for the patient on long-term therapy. RATIONALE: Assessing liver function is important for the patient on long-term estrogen therapy. Teaching is an intervention and not an assessment. The patient should be assessed for contraindications before administering the medication initially
When the nurse learns the male patient takes conjugated estrogens, the nurse questions the patient about what disorder? A) Prostate cancer B) Breast cancer C) Osteoporosis D) Andropause
A) Prostate cancer RATIONALE: 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.
A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse? A) Smoking a pack of cigarettes a day B) Gaining 10 pounds in the last 3 months C) Craving sugar D) Spending less time exercising
A) Smoking a pack of cigarettes a day RATIONALE: All these options are poor health habits and will impact the patient's health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 pounds, a craving for sugar, and a decrease in exercise would not be as immediate a concern although the nurse should address these issues.
The nurse is providing patient teaching for a woman who will begin receiving Depo-Provera injections. When will the nurse schedule the appointment for the next injection? A) 1 month from last injection B) 3 months from last injection C) 6 months from last injection D) 12 months from last injection
B) 3 months from last injection RATIONALE: Depo-Provera is administered by deep intramuscular (IM) injection every 3 months. Options A, C, and D are not correct.
A patient is using a progestin vaginal gel. What possible adverse effects should the nurse tell the patient about? A) Diarrhea B) Breast enlargement C) Abdominal pain D) Local skin irritation
B) Breast enlargement RATIONALE: The use of a progestin vaginal gel is associated with breast enlargement. Constipation, not diarrhea, is also an adverse effect. Abdominal pain with progestin therapy is associated with the use of an intrauterine device for birth control, not a vaginal gel. Local skin irritation can result from use of a dermal patch contraceptive.
The nurse is preparing to administer an infusion of oxytocin (Pitocin) to the pregnant patient. What is the priority assessment before beginning the infusion? A) Cervical dilation B) Cephalopelvic proportions C) Electrocardiogram readings D) Respiratory excursion
B) Cephalopelvic proportions RATIONALE: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated so this is not a priority assessment, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting condition
A patient tells the nurse she is taking soy, calcium, and a multivitamin as an alternative to taking hormone replacement pills. What is the nurse's priority response? A) Increase her iron supplement. B) Discontinue her calcium supplement. C) Decrease the amount of carbohydrates in her diet. D) Increase calcium supplementation.
B) Discontinue her calcium supplement. RATIONALE: The nurse may advise the patient to stop using a calcium supplement because soy is not to be taken with calcium, iron, or zinc. However, the patient may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates is a healthy choice, especially for a menopausal woman, but would not be the priority concern.
A 13-year-old teenage girl is started on oral contraceptives. When following this girl in the clinic, what is the nurse's priority assessment? A) Closure of the epiphyses B) Menstrual patterns C) Nutrition D) Cognitive development
B) Menstrual patterns RATIONALE: A 13-year-old girl is still growing. Estrogens and progestins have undergone limited testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. It is important for the nurse to monitor metabolic and other effects as well. Menstrual patterns, nutrition, and cognitive development are all components of care of the adolescent, but they are not the priority consideration.
When the nurse administers an endogenous estrogen, what systemic effects does the nurse expect the drug will have? A) Causes proliferation of endometrial lining B) Provides protection of heart from atherosclerosis C) Retains calcium in the bloodstream D) Inhibits ovulation
B) Provides protection of heart from atherosclerosis RATIONALE: Estrogens produce a wide variety of systemic effects, including protecting the heart from atherosclerosis, retaining calcium in the bones, not the bloodstream, and maintaining the secondary female sex characteristics. Proliferation of endometrial lining and inhibiting ovulation are effects of estrogen but are not systemic effects.
The patient comes to the women's health clinic to ask about emergency contraception. The patient is prescribed levonorgestrel (Plan B). How will the nurse instruct the patient to take this medication? A) Take one tablet within 4 days of unprotected intercourse. B) Take one tablet within 72 hours of unprotected intercourse and another 12 hours later. C) Take one tablet within 5 days of unprotected intercourse. D) Take one tablet within 72 hours of unprotected intercourse and another daily for 5 days.
B) Take one tablet within 72 hours of unprotected intercourse and another 12 hours later. RATIONALE: Levonorgestrel (Plan B) is taken within 72 hours of unprotected intercourse with another tablet taken 12 hours after the first. Levonorgestrel (Plan B One-Step) is taken once within 72 hours after unprotected intercourse and is available OTC for patients 17 years and older. Ulipristal (Ella) is taken once within 5 days of unprotected intercourse.
A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse's priority response? A) The effect of oral contraceptives containing progestin is reduced by phenytoin. B) The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin. C) The effect of oral contraceptives containing estrogen is reduced by phenytoin. D) You will need to increase the dosage of your phenytoin once you start contraceptives.
B) The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin. RATIONALE: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin.
The nurse is caring for a patient taking raloxifene. What manifestation reported by the patient would raise the highest level of concern from the nurse? A) Headache B) Weight loss C) Calf pain D) Edema
C) Calf pain RATIONALE: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes. Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation. However, these are not symptoms.
The nurse has been conducting patient teaching for a 16-year-old who is starting oral contraception. What statement indicates that she needs additional teaching? A) I will monitor my weight and have my blood pressure checked monthly. B) I will see my woman's health provider and have a Pap smear done on a yearly basis. C) If I forget to take my pill for 2 consecutive days I will take three pills to catch up. D) I will take the pill every day at the same time and never miss a pill.
C) If I forget to take my pill for 2 consecutive days I will take three pills to catch up. RATIONALE: If one tablet is missed, take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the patient understood the nurse's teaching.
The patient calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the patient is taking on reviewing the medical record? A) Desogestrel B) Drospirenone C) Progesterone D) Norethindrone
C) Progesterone RATIONALE: Perineal pain and breast enlargement results from vaginal gel formulas, so the nurse would suspect the patient is receiving progesterone because this is the only progestin administered by this method. The other options are all oral medications that would not cause perineal pain or breast enlargement.
The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication? A) Reduced risk of endometriosis B) Reduced risk of dysfunctional uterine bleeding C) Reduced risk of osteoporosis D) Reduced risk of uterine cancer
C) Reduced risk of osteoporosis RATIONALE: Estrogen slows the bone loss seen with osteoporosis so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer and screening for cancer should be performed before prescribing this drug.
The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? A) The patient can demonstrate how to inject the medication. B) The patient can explain how medication will prevent sexually transmitted infections. C) The patient can verbalize how and when to take medication even if a pill is missed. D) The patient makes the necessary appointments for follow-up care.
C) The patient can verbalize how and when to take medication even if a pill is missed. RATIONALE: It is most important for the nurse to evaluate the patient's understanding of how to take the medication properly, including how to respond when a pill is missed. The patient need not learn how to inject the medication because the prescription is of an oral medication. Oral contraceptives will not prevent sexually transmitted infections. Although making follow-up appointments is good, it is more important that the patient know how to take the medication.
. A nurse is taking care of a woman receiving an abortifacient. The nurse is aware that the most serious adverse effect is what? A) Vomiting B) Nausea C) Uterine rupture D) Diarrhea
C) Uterine Rupture RATIONALE: All these options are adverse effects of abortifacients. However, the most serious adverse effect would be uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken.
The nurse would question the use of what herbal supplement by a patient taking hormone replacement therapy (HRT) containing progesterone? A) Dong quai B) Devil's claw C) Wild yam D) Black cohosh
C) Wild yam RATIONALE: Wild yam contains progesterone. Do not use with hormone replacement therapy, because it may cause increased blood glucose and other toxic effects, and do not combine with disulfiram or metronidazolesevere reaction may occur. Dong quai, devil's claw, and black cohosh are not contraindicated with HRT.
The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs? A) Decreased appetite B) Dehydration C) Occasional headaches D) History of deep vein thrombosis
D) History of deep vein thrombosis RATIONALE: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. A loss of appetite would not contraindicate oral contraceptives but would require further assessment to determine the cause. Dehydration would require fluid administration to correct but is not a contraindication to oral contraceptives. Occasional headaches are not uncommon and would not contraindicate contraceptive use.
The patient calls the clinic and says she just started oral contraceptives last month and is experiencing breakthrough bleeding, fluid retention resulting in edema, changes in libido, and palpitations. What symptom would the nurse recognize is not an adverse effect of the oral contraceptive and requires an appointment as soon as possible so the patient can be evaluated? A) Breakthrough bleeding B) Fluid retention C) Changes in libido D) Palpitations
D) Palpitations RATIONALE: Palpitations are not commonly associated with contraceptives and so the patient would need to be seen and evaluated. The most common adverse effects of estrogens include breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, and changes in libido. Other adverse effects can result from the systemic effects of estrogens, including fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, and edema. GI effects also are fairly common and include nausea, vomiting, abdominal cramps and bloating, and colitis. Potentially serious GI effects, including acute pancreatitis, cholestatic jaundice, and hepatic adenoma, have been reported with the use of estrogens.
When caring for a patient on estrogen therapy, what is the nurse's priority assessment? A) Blood sugar levels B) Bowel sounds C) Weight D) Therapeutic and adverse drug effects
D) Therapeutic and adverse drug effects RATIONALE: 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.
The nurse is talking with a menopausal woman about the use of hormone replacement therapy (HRT). What statement, if made by the nurse, would be accurate and appropriate to share with the patient? A) Symptoms of menopause are short-term and minor so HRT is not necessary. B) The newer drugs used in HRT cause cardiovascular events even when taken short-term. C) The risk for osteoporosis is much higher in women who take HRT. D) There is a possible increased risk of breast and cervical cancer when taking HRT.
D) There is a possible increased risk of breast and cervical cancer when taking HRT. RATIONALE: The use of HRT can decrease the discomforts associated with menopause, although various forms of HRT have been associated with increased risks of breast and cervical cancer, heart disease, and stroke. The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use, they are associated with an increased risk of cardiovascular events. The risk for osteoporosis declines with HRT because of the bone saving effects of the drugs. It would be inappropriate and judgmental for the nurse to say symptoms of menopause are minor because some women experience more severe symptoms that can negatively impact their day-to- day life.
The patient asks the nurse, Why can't I smoke when taking estrogen. Is the risk for blood clots really that high? What is the nurse's best response? A) The risk is truly that high because estrogen increases serum triglyceride, cholesterol, and glucose levels. B) The risk is high because estrogen stimulates skeletal growth, causing increased production of red blood cells (RBCs). C) The risk is pretty high because estrogen decreases blood levels of several clotting factors. D) There is documented high risk because estrogen combined with nicotine creates a significant drugdrug interaction.
D) There is documented high risk because estrogen combined with nicotine creates a significant drugdrug interaction. RATIONALE: Smoking while taking estrogens should be strongly discouraged, because the combination of therapeutic estrogen with nicotine increases the risk for development of thrombi and emboli and this risk is well documented and researched. The risk is not due to skeletal growth, decreased clotting factors, or an impact on triglycerides, cholesterol, or glucose.