Chapter 47: Menopause and Andropause Drugs PrepU

18 See full question 15s A client who was prescribed vardenafil has a sustained erection and is being seen in the emergency department. What is the priority nursing diagnosis?

Acute pain Explanation: The client is experiencing acute pain related to priapism. When a client with priapism seeks care, injection of an alpha adrenergic stimulant like phenylephrine or norepinephrine may be helpful. Impaired oral mucous membranes, Deficient knowledge or Risk for injury are not appropriate nursing diagnosis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

9 See full question 18s Which statement by a female client who is using the Estradiol transdermal system indicates a need for further instruction?

"I prefer to apply the patch to my upper thigh only." Explanation: The client should be using more sites and must allow at least a one-week interval between applications to a particular site. The client is correct in knowledge of where to place it, to hold it in place for 10 seconds, and to keep it away from clothing that could rub and loosen the system. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

1 See full question 28s A client who is taking an estrogen reports swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority?

Fluid volume excess Explanation: The client is experiencing fluid retention, which makes this nursing diagnosis appropriate. This nursing diagnosis would be appropriate if the client was experiencing a decreased intake due to nausea and vomiting. Acute pain would be appropriate if the patient was experiencing headache or abdominal cramping. This nursing diagnosis would be appropriate if the patient was experiencing signs and symptoms of a thromboembolic disorder. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

13 See full question 22s The nurse would be alert for drug interactions with antispasmodic therapy in a client who takes which other medication? Select all that apply.

Haloperidol (Haldol) Digoxin Amoxicillin Explanation: Interactions may occur when antispasmodics are administered with antibiotics or antifungals, meperidine, flurazepam, phenothiazines, tricyclic antidepressants, haloperidol, and digoxin. No interactions are known with SSRIs or morphine sulfate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 558. Chapter 47: Menopause and Andropause Drugs - Page 558 Add a Note

7 See full question 12s The nurse is assessing a client who states that she has been taking a lot of black cohosh to deal with her menopausal symptoms. What assessment findings would indicate that the client is experiencing black cohosh toxicity? (Select all that apply.)

Nausea Impaired vision Headache Explanation: Symptoms of black cohosh toxicity include dizziness, headache, nausea, impaired vision, and vomiting. Edema and diaphoresis would not indicate black cohosh toxicity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

11 See full question 10s What medication will the nurse expect the health care provider to order for a client who comes to the emergency department with priapism?

Norepinephrine Explanation: When a client with priapism seeks care, injection of an alpha adrenergic stimulant (phenylephrine or norepinephrine) may be helpful in treating it once the engorgment is drained. Tadalafil and avanafil are medications that are used in the treatment of impotence. Tamsulosin is an antiadrenergic agent that is used for the treatment of BPH. One of its side effects is ejaculatory dysfunction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

3 See full question 10s Estropipate is sometimes administered to postmenopausal women to prevent which condition?

Osteoporosis Explanation: Estropipate and other estrogens are sometimes prescribed to postmenopausal women to prevent or treat osteoporosis associated with hormone deficiency. However, given the potentially significant risks associated with hormone replacement therapy, this use is not currently considered a first-line treatment. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 564. Chapter 47: Menopause and Andropause Drugs - Page 564 Add a Note

16 See full question 12s A client is diagnosed with overactive bladder syndrome. What would the nurse anticipate the health care provider to prescribe?

tolterodine Explanation: Tolterodine is an antispasmodic used to treat overactive bladder syndrome. Estrogen is used for menopausal women. Tamoxifen is selective estrogen receptor modulator (SERM) used for vasomotor control of menopause. Doxazosin is an alpha adrenergic medication used for treatment of benign prostate hyperplasia (BPH). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 565. Chapter 47: Menopause and Andropause Drugs - Page 565 Add a Note

1 See full question 2m 14s A 68-year-old client being is treated for benign prostatic hypertrophy. Which male hormone is responsible for the growth of the prostate?

Dihydrotestosterone Explanation: The primary hormone in prostate cells that affects growth of the prostate is dihydrotestosterone (DHT). A special enzyme, 5-alpha reductase, converts testosterone to DHT. Levels of DHT (the primary hormone in the prostate) remain fairly constant. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 558. Chapter 47: Menopause and Andropause Drugs - Page 558 Add a Note

4 See full question 8s A woman experiencing menopausal symptoms asks the nurse about herbal products that might help. Which would the nurse include in the response?

black cohosh Explanation: Black cohosh is an herbal product that is reported to be beneficial in managing the symptoms of menopause. Ephedra sinica, a species of ephedra (ma huang), contains ephedrine and pseudoephedrine. Ephedra has been found to stimulate the nervous system, increase airflow into the lungs, and constrict blood vessels. Ginger is commonly used to treat gastrointestinal discomfort including motion sickness, morning sickness, colic, upset stomach, gas, diarrhea, irritable bowel syndrome (IBS), and nausea. Saw palmetto is an herbal product that may delay the need for prostate surgery in clients with benign prostatic hypertrophy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

19 See full question 29s A group of nursing students are reviewing information about hormonal therapy for cancer. The students demonstrate understanding of the information when they identify which medication as a gonadotropin-releasing hormone analog? Select all that apply.

degarelix leuprolide Explanation: Degarelix and leuprolide are examples of gonadotropin-releasing analogs. Abiraterone and bicalutamide are antiandrogens. Estramustine is an estrogen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 567. Chapter 47: Menopause and Andropause Drugs - Page 567 Add a Note

5 See full question 18s The nurse performs which assessments when a female client comes to the clinic for a follow up visit while undergoing estrogen therapy? (Select all that apply.)

Blood pressure check Client weight Peripheral pulse Explanation: When a female client returns to the clinic while on estrogen therapy, the nurse will assess the client's blood pressure, pulse, respiratory rate, and weight. The nurse will also inquire if the client is experiencing any adverse reactions to the medication. A temperature is not indicated unless the client is showing signs of infection. Also, an oxygen saturation would not be checked unless there was a specific need for that test. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

11 See full question 41s The nurse knows that which symptoms of menopause are considered vasomotor? Select all that apply.

Flushing Sweating Explanation: The vasomotor symptoms are those that cause flushing and sweating. Atrophic vaginitis is caused by loss of subcutaneous fat and loss of elasticity of the skin. Chloasma is pigmentation of the skin that can occur with hormonal changes. Loss of bone density (osteoporosis) is a hormonal change. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

17 See full question 16s It has been determined that a 33-year-old male client would likely benefit from treatment with testosterone. What aspect of the client's medical history could contraindicate this treatment?

The client has been diagnosed with hepatitis C. Explanation: Liver disease contraindicates the use of testosterone. IV drug use and unprotected sex do not necessarily contraindicate this treatment. A low BMI does not preclude the safe use of testosterone. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

17 See full question 6s A client has been diagnosed with benign prostatic hypertrophy. Which group of medications are used to treat this disorder?

alpha adrenergic blockers Explanation: The most widely used drugs to treat BPH are the alpha adrenergic blockers. Beta blockers are used for cardiac disorders. Calcium channel blockers are used in hypertension. Cholinergic agents are used in a variety of disorders but not BPH. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 558. Chapter 47: Menopause and Andropause Drugs - Page 558 Add a Note

19 See full question 12s A client is prescribed sildenafil. When teaching the client about possible adverse reactions associated with this drug, which would the nurse include? Select all that apply.

dyspepsia nasal congestion flushing Explanation: Sildenafil is associated with headache, flushing, dyspepsia, and nasal congestion. Back pain can occur with avanafil and vardenafil. Runny nose may occur with vardenafil. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 566. Chapter 47: Menopause and Andropause Drugs - Page 566 Add a Note

19 See full question 14s What is the preferred treatment for the diagnosis of atrophic vaginitis?

estrogen preparations Explanation: Estrogens are prescribed to relieve symptoms of estrogen deficiency (e.g., atrophic vaginitis and vasomotor instability, which produces "hot flashes" or "hot flushes") and to prevent or treat osteoporosis. Such use is usually called estrogen replacement therapy (ERT). Monistat is prescribed for the treatment of fungal/vaginal yeast infections, while vibramycin treats bacterial infections. Drug therapy to manage the symptoms of endometriosis includes the use of nonsteroidal anti-inflammatory agents as do hormonal contraceptives. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

3 See full question 9s A pregnant nurse should not handle crushed or broken tablets of which medications as it is classified in pregnancy category X and its absorption poses substantial risk for abnormal growth to a male fetus?

finasteride Explanation: A pregnant nurse should not handle crushed or broken tablets of finasteride or dutasteride as they are classified in pregnancy category X and their absorption poses substantial risk for abnormal growth to a male fetus. Medroxyprogesterone is used to treat endometrial or renal cancer and is a pregnancy category X drug. Nandrolone is a synthetic anabolic-androgenic steroid (AAS) derived from testosterone and is a pregnancy category X drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

15 See full question 16s A client is prescribed flavoxate. Which adverse effects should the nurse discuss with the client? Select all that apply.

headache dry mouth urinary retention Explanation: Flavoxate is an antispasmodic, which is a cholinergic blocking medication used for male urinary symptoms caused by cystitis, prostatitis, and other urinary problems. Adverse effects that should be included in the teaching plan are dry mouth, drowsiness, blurred vision, headache, and urinary retention. Fatigue and diarrhea are adverse effects of flavoxate. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 566. Chapter 47: Menopause and Andropause Drugs - Page 566 Add a Note

18 See full question 32s A client is prescribed oxybutynin in a transdermal form. The nurse would instruct the client to apply the patch to which area? Select all that apply.

hip abdomen buttocks Explanation: The transdermal form should be applied to a clean, dry area of the hip, abdomen, or buttocks. The upper arm site can be dislodged with clothing and activity, the same as with the thigh. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 563. Chapter 47: Menopause and Andropause Drugs - Page 563 Add a Note

14 See full question 23s The nurse is completing a health history on a client experieicing menopause. What assessment findings indicate menopause? Select all that apply.

hot flashes mood changes sleep problems painful intercourse Explanation: With the onset of menopause, symptoms such as hot flashes, night sweats, vaginal dryness, painful intercourse, mood changes, and sleep problems may occur. An increase in the heart rate is not associated with menopause. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

16 See full question 16s A 63-year-old woman taking estrogen and progestin for several years has recently changed to estrogen alone. What medical event would prompt such a change in treatment?

hysterectomy Explanation: Women who have an intact uterus should take both estrogen and progestin; the progestin component prevents endometrial cancer, an adverse effect of estrogen-only therapy. Posthysterectomy, women should take estrogen-only medications. None of the other options would require a treatment change. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

20 See full question 13s A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would most likely identify this as which condition?

overactive bladder syndrome Explanation: Overactive bladder syndrome involves conditions of urgency, frequency, and nocturia, with or without incontinence. Stress incontinence involves losing urine without meaning to during physical activity. Urge incontinence involves the strong, sudden need to void due to bladder spasms or contractions. Neurogenic bladder refers to impaired bladder function caused by a nervous system abnormality.

11 See full question 13s A client is unsure of a health care provider's prescription for estrogen to manage their symptoms of menopause. The client asks the nurse if there are any herbs that assist with menopause. What herbs does the nurse know aid with the symptoms of menopause? Select all that apply.

sage black cohosh primrose oil Explanation: Black cohosh, sage, dandelion, evening primrose oil, and calendula are herbs used to manage symptoms of menopause. Tea tree oil has antibiotic properties and is used for infections. Peppermint is used for taste in a variety of culinary dishes. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

16 See full question 11s A client with an extensive history of using herbal remedies asks the nurse if there is an herbal supplement for the diagnosis of BPH. Which supplement does the nurse provide information on for the treatment of BPH?

saw palmetto Explanation: Saw palmetto is used to relieve the symptoms of BPH, which include urinary frequency, decreased flow of urine, and nocturia. Tea tree is used for a variety of ailments and also has antioxidant properties. Ginger is used for nausea. St. John's wort is used for depression. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 560. Chapter 47: Menopause and Andropause Drugs - Page 560 Add a Note

17 See full question 19s A client has BPH and ED. Which phosphodiesterase type 5 (PDE5) inhibitor is approved for these two conditions?

tadalafil Explanation: Tadalafil is approved for daily use because it also relieves urinary difficulties resulting from an enlarged prostrate. Avanafil, sildenafil, and vardenafil are used for erectile function. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 560. Chapter 47: Menopause and Andropause Drugs - Page 560 Add a Note

7 See full question 37s The client is about to begin therapy for erectile dysfunction and asks the nurse about the likelihood of priapism occurring with these medications. The nurse knows that priapism is most likely to occur in clients with which condition? Select all that apply.

Multiple myeloma Leukemia Explanation: Priapism is more likely to occur in clients with sickle cell anemia (no iron deficiency), multiple myeloma, leukemia, or an anatomic deformity of the penis. A history of testicular torsion or Raynaud's disease does not increase the chance that the client will develop priapism. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 582. Chapter 47: Menopause and Andropause Drugs - Page 582 Add a Note

10 See full question 18s The nurse receives a call from a client who is taking oxybutynin (Ditropan XL) and reports observing pieces of the medication capsule in the stool. What is the nurse's best response to this client?

"That is a normal finding because the outer coating of the medication doesn't disintegrate." Explanation: Oxybutynin contains an outer coating that may not disintegrate and sometimes may be observed in the stool. This is not a cause for concern. The client will not need a stool examination, will not need the medication changed, nor any changes to the diet. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 563. Chapter 47: Menopause and Andropause Drugs - Page 563 Add a Note

3 See full question 23s The nurse is on the phone with a woman who is taking an antispasmodic for overactive bladder syndrome. The woman states that her mouth is very dry, but she is afraid to drink because she does not want the urge to urinate to increase. What is the nurse's best response to this client?

"You shouldn't restrict your fluid intake because it will only make your bladder problems worse." Explanation: Dry mouth related to antispasmodics can be treated with sugarless hard candy, pieces of ice, or sugarless lozenges. The client may also perform frequent mouth care but strong mouthwash may cause oral irritation. The client shouldn't limit the amount of fluid because it will only make the urinary symptoms worse. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

2 See full question 27s Which client is least likely to benefit from treatment with megestrol (Megace)?

A 23-year-old with endometrial cancer Explanation: Megestrol is used as palliative treatment for clients with advanced breast or endometrial cancer (tablet form) or to increase appetite in clients with AIDS (suspension form). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 568. Chapter 47: Menopause and Andropause Drugs - Page 568 Add a Note

9 See full question 26s The nurse knows that that the loss of estrogen causes physiologic changes to the vagina and perineum leading to what age-related disorder? Select all that apply.

Atrophic vaginitis Vaginal candidiasis Cervical erosion Explanation: Hormonal changes lead to the vaginal walls becoming thinner, shorter, and the loss of elasticity. There is less vaginal lubrication and lubrication occurs at a slower rate during sexual arousal. The pH environment changes, making the vagina more susceptible to yeast infection. All of these lead to atrophic vaginitis, vaginal candidiasis, and cervical erosion. Abdominal bloating or skeletal pain are not related to hormonal changes of the vagina. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

6 See full question 20s The nurse knows that certain herbal products such as black cohosh have been shown to be effective in reducing the symptoms of menopause. What other herbal products have been effective? Select all that apply.

Dandelion Sage Calendula Explanation: Along with black cohosh, other herbs used to relieve menopausal symptoms include sage, dandelion, and calendula. Neither thyme nor oregano have been shown to relieve menopause symptoms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

5 See full question 17s The nurse is caring for a 77-year-old client. The nurse anticipates this client may be dealing with which physiologic change of the urinary system? Select all that apply.

Decreased filtration in the kidney. Decreased size of the urinary bladder. Increased susceptibility to urinary tract infection. Explanation: All parts of the urinary system are affected by aging. Changes in kidney size and blood flow to the kidney reduce renal function by almost 50%. The bladder decreases in size, strength, and flexibility and the urethra shortens, which increases the susceptibility to infection. The kidneys are less able to filter and the urine becomes more dilute. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 557. Chapter 47: Menopause and Andropause Drugs - Page 557 Add a Note

18 See full question 20s A client who was prescribed doxazosin is talking with the nurse about adverse effects of the medication. What is the priority nursing diagnosis?

Deficient knowledge Explanation: Discussion with the nurse centers on the knowledge of the client. The client is asking about additional information regarding the medication. The nurse would document deficient knowledge and document how the medication works and the adverse effects. Impaired oral mucous membranes, risk for injury or acute pain are not the priority nursing diagnosis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

8 See full question 12s The nurse receives a call from a female client who is on estrogen therapy, stating that she is experiencing some discoloration of the skin. The nurse tells the client that this may occur with the use of estrogen and also states that other skin conditions may result from this therapy. Which are they? Select all that apply.

Increased pigmentation of the skin Itching of the skin Rash on the skin Explanation: Dermatologic reactions to estrogen therapy include dermatitis, pruritus, chloasma (pigmentation of the skin), or melasma (discoloration of the skin). Loss of pigmentation and hair loss are not seen with estrogen therapy. Women may actually see increased hair growth while on estrogen therapy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

4 See full question 15s The health care provider has ordered estrogen for a woman who is experiencing uterine bleeding resulting from a hormone imbalance. The nurse knows that this medication may be administered in what way? Select all that apply.

Intravenously Intramuscularly Explanation: Estrogen is given IM or IV to treat uterine bleeding caused by hormone imbalance. It is not administered transdermally, orally, or subcutaneously for this condition. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 564. Chapter 47: Menopause and Andropause Drugs - Page 564 Add a Note

6 See full question 31s A 53-year-old client is being seen by a health care provider for the treatment of the symptoms of menopause. The health care provider prescribes estrogen and progesterone. What should the nurse tell the client is the primary reason that progesterone is prescribed?

Progesterone is used to decrease the risk of endometrial cancer in women using estrogen therapy. Explanation: Some women may be anxious because of a fear of experiencing uterine cancer as the result of HRT. The nurse may explain that taking progestin, which counteracts the negative effect of estrogen, can prevent estrogen-induced cancer of the uterus. Progesterone is also added to postmenopausal HRT to decrease the risk of endometrial cancer from estrogen therapy. There is no medical evidence that shows that progesterone reduces a woman's risk of breast cancer; in actuality, it may increase the risk of breast cancer. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

12 See full question 13s The nurse is seeing a client who reports having flu-like symptoms including a runny nose. This client has been on estrogen therapy. The nurse suspects the client is experiencing which adverse effect of the medication?

Rhinitis Explanation: One of the adverse reactions to taking estrogen therapy is rhinitis, the client's reports of flu like symptoms is consistent with this finding. A pulmonary embolism would likely produce more imminent symptoms such as shortness of breath and/or chest pain. Dysmenorrhea refers to the pain associated with menstruation. Cholasma is a hyperpigmentation of skin that can occur with the use of estrogen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

8 See full question 28s The nurse is providing information to a female client who is starting estrogen therapy. What adverse effect should the client report to the health care provider immediately? Select all that apply.

Shortness of breath Sudden, severe headache Explanation: The health care provider must be notified immediately if the client experiences pain in the legs or groin area; sharp chest pain or sudden shortness of breath; lumps in the breast; sudden severe headache, dizziness or fainting; vision or speech disturbances; weakness or numbness in the arms, face, or legs; severe abdominal pain; depression; or yellowing of the skin or eyes. Many clients experience some GI disturbances (which should be reported if recurring) but these do not require immediate notification. Breast tenderness and amenorrhea also may occur (both of these do not require immediate notification). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

20 See full question 10s What is the most plausible rationale for a female client being prescribed danazol?

The client has endometriosis. Explanation: Clinicians may use danazol, a synthetic form of testosterone, in women to prevent or treat endometriosis or fibrocystic breast disease. None of the other options are accepted reasons for prescribing danazol.

14 See full question 23s A client alerts the nurse she has been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective?

"Estrogen and progesterone diminish." Explanation: During menopause, estrogen and progesterone diminish, causing the menstrual cycle to become more irregular and then stop altogether. Symptoms of the decrease in estrogen and progesterone are hot flashes, night sweats, vaginal dryness, and sleep problems. There is not an increase of gonadotropins during menopause. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

7 See full question 41s The nurse is caring for a male client who is taking estrogen and knows that this medication is used in men to treat which condition?

Advanced prostate cancer Explanation: Estrogen is given to male clients for palliative treatment of advanced prostate cancer. It does not treat andropause, urinary incontinence, or osteoporosis in men. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

2 See full question 9s The nurse is caring for a client with overactive bladder who would like to take an antispasmodic to assist with the symptoms of this disorder. What other condition in this client may cause the health care provider to use an antispasmodic with extreme caution?

The client has hyperthyroidism. Explanation: Antispasmodics are used wih caution in clients with GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic or renal disease, and hypertension. It is indicated for use in clients with neurogenic bladder. Psoriasis (a skin disease) is not affected by antispasmodics. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 558. Chapter 47: Menopause and Andropause Drugs - Page 558 Add a Note

9 See full question 23s The nurse is taking the medical history of a female client who is scheduled to begin estrogen therapy. It is most important for the nurse to determine if the client has a history of what condition? Select all that apply.

Thrombophlebitis Liver disease Hypertension Explanation: It is important to determine if the client has a history of thrombophlebitis or other vascular disorders, a smoking history, and a history of liver disease. These may contraindicate the use of estrogen. A history of osteomyelitis (bone infection) would not impact estrogen therapy. Having a maximum of one glass of wine per day for females is considered safe in conjunction with estrogen therapy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

5 See full question 18s The original HRT therapy was found to be associated with increased risks of breast and cervical cancer. Newer drugs used in HRT are associated with only a possible increased risk of breast and cervical cancer, but with long-term care are associated with an increased risk of:

cardiovascular events. Explanation: 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 are associated with an increased risk of cardiovascular events. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, pp. 561-562. Chapter 47: Menopause and Andropause Drugs - Page 561-562 Add a Note

12 See full question 12s A client is prescribed tamoxifen. Which medical condition in the client's history would lead to tamoxifen being prescribed with caution? Select all that apply.

stroke deep vein thrombosis myocardial infarction Explanation: SERMS, like tamoxifen, are used in caution with menopausal women with a history of deep vein thrombosis, stroke, and/or myocardial infarction. Arthritis and heart attack are associated with tamoxifen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 557. Chapter 47: Menopause and Andropause Drugs - Page 557 Add a Note

14 See full question 11s A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's <b>best</b> statement?

"It works by relaxing the smooth muscle of the prostate and the bladder neck." Explanation: Terazosin is an alpha adrenergic blocker and works by relaxing the smooth muscle of the prostate and the bladder neck. By blocking norepinephrine, the muscles relax, and this allows urine to flow to the bladder. Terazosin does not prevent the conversion of testosterone or stimulates the bladder to void. Terazosin does not affect the desire for sexual relations. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 558. Chapter 47: Menopause and Andropause Drugs - Page 558 Add a Note

6 See full question 26s The nurse knows that the transdermal method of estrogen therapy is safest for female clients with which disorder? Select all that apply.

Elevated triglyceride level Type 2 diabetes mellitus Explanation: Transdermal delivery systems are being explored to reduce the use of oral estradiol products and provide lower concentrations in the circulatory system.The transdermal delivery route of estrogen has been found to be safer - especially for women who have elevated triglycerides, type 2 diabetes, hypertension, migraine headache, or those who smoke. Though safer for all women, the transdermal delivery system would not be as important for clients with elevated cholesterol, alcoholism, or orthostatic hypotension. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

1 See full question 11m 44s What is the preferred treatment for the diagnosis of atrophic vaginitis?

Estrogen preparations Explanation: Estrogens are prescribed to relieve symptoms of estrogen deficiency (eg, atrophic vaginitis and vasomotor instability, which produces "hot flashes" or "hot flushes") and to prevent or treat osteoporosis. Such use is usually called estrogen replacement therapy (ERT). Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

13 See full question 54s Which are normal physiological changes in the urinary system that occur with age? Select all that apply.

Filtration changes and the urine becomes more dilute. Urethra shortens and the lining becomes thinner, resulting in increasing susceptibility to infection. Explanation: All parts of the urinary system are affected by aging. Changes in kidney size and blood flow to the kidney reduce renal function by almost 50% in older individuals. These changes decrease filtration and the urine becomes more dilute. The urinary bladder diminishes in strength, flexibility, and capacity resulting in frequent urination, especially at night (nocturia). The urethra shortens and its lining becomes thinner, increasing susceptibility to infection. In addition to the effects of childbirth and loss of muscle tone in pelvic structure, the urinary sphincter becomes less flexible and is less able to close tightly, resulting in urine leakage or stress incontinence. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 557. Chapter 47: Menopause and Andropause Drugs - Page 557 Add a Note

12 See full question 11s The nurse is aware that estrogen is used without progestin for hormone replacement therapy in what circumstance?

If the client has had her uterus removed Explanation: Estrogen may be used alone if the woman has had her uterus removed. The use of estrogen without progesterone in women who have an intact uterus can increase the risk of endometrial cancer. Estrogen therapy is contraindicated in clients who have had thrombophlebitis or breast cancer. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 554. Chapter 47: Menopause and Andropause Drugs - Page 554 Add a Note

15 See full question 19s A client is prescribed tamoxifen for vaginal atrophy and menopausal symptoms. The client asks the nurse how this drug works. What is the nurse's best response?

It blocks estrogen effects in different tissues in the body. Explanation: Tamoxifen is a selective estrogen receptor modulator drug. SERMS potentiate or block estrogen effects in different tissues and aid in hormonal treatment of postmenopausal symptoms. Tamoxifen is used to treat breast cancer, not ovarian cancer. Tamoxifen can be used for osteoporosis prevention but this is not indicated in the client's history. Tamoxifen does not activate estrogen receptors in the breasts. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 557. Chapter 47: Menopause and Andropause Drugs - Page 557 Add a Note

15 See full question 12s The nurse has identified a nursing diagnosis of impaired mucous membranes for a client who has been prescribed darifenacin for overactive bladder. Which nursing interventions should be included in the care plan?

Maintain fluid intake. Instruct client about high fiber diet. Suck on hard candy, sugarless lozenges or small pieces of ice. Explanation: A common adverse reaction to darifenacin, an antispasmodic, includes dry mouth and constipation. The nurse should teach the client to suck on hard candy, sugarless lozenges, or small pieces of ice but also perform mouth care. The client should be instructed to maintain fluid intake and encourage a high fiber diet. The client should not be instructed to stop the medication if constipation occurs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 562. Chapter 47: Menopause and Andropause Drugs - Page 562 Add a Note

13 See full question 22s The nurse knows that a male client with benign prostatic hypertrophy should not take saw palmetto if he had which other condition?

Peptic ulcer Explanation: Saw palmetto can aggravate GI disorders such as peptic ulcer disease. It does not affect skin disorders or glaucoma. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 560. Chapter 47: Menopause and Andropause Drugs - Page 560 Add a Note

10 See full question 12s The nurse receives a call from a client who complains of difficulty controlling the bladder paired with urinary urgency. The nurse knows that this client has the symptoms of what disorder related to urinary aging?

Overactive bladder syndrome Explanation: Overactive bladder syndrome is the involuntary contraction of the bladder muscle and presents with urinary urgency. Urge incontinence is the sudden and urgent need to void that may be accompanied by a loss of urine. Stress incontinence is incontinence caused by activity. Nocturia is frequent urination at night. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 557. Chapter 47: Menopause and Andropause Drugs - Page 557 Add a Note

8 See full question 16s The nurse expects the health care provider to perform which client examinations prior to the start of estrogen therapy? (Select all that apply.)

Papanicolaou (Pap) test Breast exam Rectal exam Explanation: The primary health care provider may perform breast and pelvic examinations and a Papanicolaou (Pap) test for women, or a rectal exam which examines the uterine/ovary area. A chest x-ray and an eye exam would not be required prior to the start of estrogen therapy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 561. Chapter 47: Menopause and Andropause Drugs - Page 561 Add a Note

4 See full question 28s The nurse is aware that progestins will be prescribed with extreme caution in a client with which condition? (Select all that apply.)

Renal disease Epilepsy Asthma Explanation: Progestins are used with extreme caution in clients with renal impairment, migraine headaches, epilepsy, asthma, and cardiac disease. There is no caution if clients with abdominal cramping or arthritis use progestins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 556. Chapter 47: Menopause and Andropause Drugs - Page 556 Add a Note

10 See full question 21s The client has begun using antispasmodic drugs for overactive bladder symptoms and asks what he should know before he plans his vacation. What type of vacation site should cause the client to use extreme caution?

Tropical beach Explanation: Clients who take antispasmodics should use caution if exposed to high temperatures or hot climates because heat prostration may occur. A beach vacation would likely render the client exposed to high heat for long periods. The nurse should encourage the client to avoid this destination or use caution. Snow skiing, duck hunting, and whitewater rafting all allow the client to be in a cold climate or be near water for cooling. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 563. Chapter 47: Menopause and Andropause Drugs - Page 563 Add a Note

20 See full question 34s After teaching a class of nursing students about genitourinary changes that occur with aging, the instructor determines that the teaching was successful when the students identify which finding as a change? Select all that apply.

diminished estrogen secretion shortening of the vaginal wall scar tissue formation in the prostate diminished testicular tissue Explanation: With aging, estrogen secretion diminishes, the vaginal wall shortens and thins, scar tissue replaces prostate cells, and testicular tissue diminishes. Testosterone levels remain relatively constant.

2 See full question 11s After teaching a group of students about drugs used to treat genitourinary problems in the older adult, the instructor determines that the teaching was successful when the students identify which as an example of an androgen hormone inhibitor that is used to treat clients with benign prostatic hypertrophy?

dutasteride Explanation: Dutasteride is an example of an androgen hormone inhibitor that is used to treat clients with benign prostatic hypertrophy. Anastrozole and exemestane are aromatase inhibitors used to treat breast cancer. Megestrol is a progestin used to treat breast or endometrial cancer. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 47: Menopause and Andropause Drugs, p. 566. Chapter 47: Menopause and Andropause Drugs - Page 566 Add a Note