Pharm CBA 4 complete

Which application instruction is the priority for a nurse to provide to a patient starting to use AndroGel testosterone gel? "Apply the gel to clean, dry skin of the shoulders or upper arms." "Squeeze the entire packet into your palms and then rub the gel into your skin." "Wait about 5 or 6 hours before showering or swimming." "Wash your hands after applying the gel to prevent transfer to others."

"Wash your hands after applying the gel to prevent transfer to others."

A nurse identifies therapeutic goals for androgen therapy for which patients? (Select all that apply.) A male patient with prostate cancer A female patient with breast cancer A male patient with hypogonadism A female patient with breast engorgement A female patient with acquired immunodeficiency syndrome (AIDS)

A male patient with hypogonadism A female patient with breast engorgement A female patient with acquired immunodeficiency syndrome (AIDS)

1. A patient is to receive medroxyprogesterone (Depo-Provera) 700 mg weekly, intramuscularly, as part of palliative therapy for endometrial cancer. The medication is available in vials of 400 mg/mL. Identify how many milliliters will the nurse draw up and administer with each injection. (record answer using one decimal place) _______

ANS: 1.8 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

1. A patient will be receiving testosterone cypionate (Depo-Testosterone) 400 mg intramuscularly every 4 weeks. The medication is available in a 200-mg/mL strength. Identify how many milliliters will the nurse draw up for each injection. _______

ANS: 2 ml DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation

12. A woman who lives in Seattle is preparing to take a plane trip to London. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient? a. She needs to stop taking the drug at least 72 hours before the trip. b. She must remember to take this drug with a full glass of water each morning. c. She will not take the drug while traveling on the plane. d. No change in how the drug is taken will be needed.

ANS: A A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 549 TOP: NURSING PROCESS: Implementation

8. The nurse is reviewing the medication list of a patient who will be starting androgen therapy. Which drug classes, if taken with androgens, may have an interaction with them? a. Oral anticoagulants b. Nitrates c. Beta blockers d. Proton pump inhibitors

ANS: A Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 558 TOP: NURSING PROCESS: Planning

1. A patient is being treated for infertility. An examination reveals cervical mucus that is scant, thick, and sticky. The nurse suspects that the patient has been taking which medication? a. Clomiphene [Clomid] b. Estrogen c. Follicle-stimulating hormone (FSH) d. Progesterone

ANS: A Because clomiphene has antiestrogenic actions, it can force the production of scant and viscous cervical mucus, which interferes with conception. Estrogen is given to create a favorable cervical mucous environment that is more hospitable to sperm. FSH and progesterone do not alter cervical mucus in this way. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771

2. When a male patient is receiving androgen therapy, the nurse will monitor for signs of excessive androgens such as: a. fluid retention. b. dehydration. c. restlessness. d. visual changes.

ANS: A Fluid retention is an undesirable effect of androgens. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 557 TOP: NURSING PROCESS: Assessment

4. The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? a. Headache b. Drowsiness c. Dysmenorrhea d. Hypertension

ANS: A Headache is one of the possible adverse effects of the fertility drugs. They may also cause vomiting, restlessness, and urticaria. Drowsiness, dysmenorrhea, and hypertension are not potential adverse effects. See Table 34-5 for other adverse effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 544 TOP: NURSING PROCESS: Assessment

A patient calls a family planning clinic and tells the nurse that her vaginal ring, which has been in place for 2 weeks, came out sometime during the night while she was sleeping. The nurse will instruct her to: a. clean the ring with warm water, reinsert it, and use condoms for 7 days. b. discard the ring and insert a new ring after 1 week has passed. c. discard the ring and insert a new one to begin a new cycle. d. wash the ring in hot, soapy water and reinsert it.

ANS: A If a ring is expelled before 3 weeks have passed, it can be reinserted after being washed in warm water. If the ring has been out longer than 3 hours, backup contraception should be used for 7 days. Because this ring was expelled while the patient was sleeping, using backup contraception is prudent. Discarding the ring is not indicated if it can be cleaned. The ring should not be washed in hot water.

A patient has just purchased a 1-year supply of 28-day-cycle oral contraceptives. She tells the nurse she wishes she had planned things better, because she has calculated that her period will begin during her upcoming honeymoon. What will the nurse suggest? a. She should discard the inert pills and start a new pack during the honeymoon. b. She should discontinue the oral contraceptives and use an alternative form of birth control. c. She should discuss a prescription for an extended-cycle product with her provider. d. She should discuss DMPA (Depo-Provera) injections in addition to the OC with her provider.

ANS: A OC users can achieve an extended-cycle schedule by discarding the inert pills and beginning a new pack for up to four cycles. It is not necessary to discontinue OCs. Because this woman has already purchased a 1-year supply, using the 28-day-cycle product as described is appropriate. If this woman opts for a long-term product, she should discontinue the OC.

5. A patient has received two doses of dinoprostone [Prepidil] to initiate labor. It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe and dilated to 4 cm, but contractions are diminishing in intensity and frequency. What will the nurse expect to do? a. Administer oxytocin. b. Monitor urine output. c. Prepare for a cesarean section. d. Watch closely for fetal distress.

ANS: A Once the cervix is ripe and labor has occurred, labor should progress, with contractions increasing in duration and frequency. This woman is showing signs of stalled labor and, because the cervix is ripe, can be induced with oxytocin. Large doses of oxytocin can cause water intoxication, which is not a risk at this point in this patient. There is no indication for a cesarean section at this point. The risk of fetal distress is not increased at this point. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

16. A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for which potential drug interaction? a. Thyroid replacement therapy b. Oral anticoagulant therapy c. Nonsteroidal anti-inflammatory drugs d. Beta blockers

ANS: A Orally administered soy may interfere with thyroid hormone absorption, so concurrent use must be avoided. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 536 TOP: NURSING PROCESS: Assessment

5. A 21-year-old male athlete admits to using androgenic steroids. The nurse tells him that which of these is a possible adverse effect of these drugs? a. Liver damage b. Renal failure c. Heart failure d. Stevens-Johnson syndrome

ANS: A Peliosis of the liver, the formation of blood-filled cavities, is a potential effect of androgenic anabolic steroid therapy and may be life threatening. Other serious hepatic effects are hepatic neoplasms (liver cancer), cholestatic hepatitis, jaundice, and abnormal liver function. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 557 TOP: NURSING PROCESS: Implementation

13. The nurse recognizes that the risk of osteoporosis is higher in an individual with which risk factor? a. White or Asian race b. African-American race c. History of participation in active sports d. Obesity

ANS: A Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 541 TOP: NURSING PROCESS: Assessment

4. An infertile couple begins treatment with menotropins. To enhance the therapeutic effects of the medication, the nurse will advise the patients to have intercourse: a. before hCG injection and the following 2 to 3 days. b. the morning of the hCG injection and later that evening. c. the evening of the injection and the following day. d. the evening of the injection and the following morning.

ANS: A The nurse should advise the patients to have intercourse the evening before the injection and on the following 2 to 3 days (during the probable period of ovulation). Having intercourse the morning of the hCG injection and later that evening will not enhance the effects of menotropins. Avoiding intercourse the evening of the injection and on the following day will not enhance the effects of menotropins. Having intercourse the evening of the injection and on the following morning will not enhance the effects of menotropins. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772

7. A postpartum patient is receiving methylergonovine to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do? a. Continue to monitor and tell the patient to report increased cramping. b. Notify the provider of possible uterine hypertonicity. c. Notify the provider of the patient's blood pressure. d. Request an order to administer the methylergonovine intravenously.

ANS: A This patient is showing signs of a desired response to the drug, so the nurse should continue to monitor. Increased cramping may be a sign of overdose, so the patient should know to notify the nurse if this occurs. A firm uterus with minimal bleeding is the desired effect. The blood pressure is within normal limits. There is no indication for giving this drug intravenously, because that method poses significant risks and is indicated only with severe hemorrhage. PTS: 1 DIF: Cognitive Level: Application REF: p. 784

9. A nurse is caring for a woman during the perinatal and postnatal period. To stop postpartum hemorrhage, how will the nurse administer oxytocin [Pitocin] to this patient? a. 20 units in 1000 mL of IV solution after delivery of the placenta b. 20 units intramuscularly prior to delivery of the placenta c. 40 units intramuscularly after delivery of the placenta d. 60 units per rectum prior to delivery of the placenta

ANS: A To stop postpartum hemorrhage, oxytocin is administered either IV or IM following delivery of the placenta. If given IV, the dose is 10 to 40 units in 1000 mL of IV fluid. The IM dose is 10 units given as a single injection, also after delivery of the placenta. Misoprostol [Cytotec] is given rectally. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

A patient at increased risk for thromboembolic disorders will begin taking a progestin-only oral contraceptive. Which statement by the patient indicates understanding of how this oral contraceptive works? a. "I will need to use backup contraception if I miss a pill." b. "Irregular bleeding is an indication that I should stop using this drug." c. "The mini-pill is safer than combination OCs and is just as effective." d. "The progestin-only mini-pill will prevent me from ovulating."

ANS: A When a patient taking a progestin-only OC misses one or more pills, backup contraception should always be used for at least 2 days. Irregular bleeding occurs but is not an indication to stop using the drug, although many women do because of the inconvenience. The mini-pill is slightly safer than combination OCs but not as effective. The mini-pill is a weak inhibitor of ovulation.

A woman has been taking a progestin-only oral contraceptive and will begin using a vaginal ring. The nurse will teach the patient to insert the ring: a. the day the last pill is taken and use backup contraception for 7 days. b. 1 week before taking the last pill. c. 1 to 5 days after taking the last pill and use backup contraception for 2 days. d. within 7 days after taking the last pill.

ANS: A When patients who have been using a progestin-only OC begin using a vaginal ring, they should be instructed to insert the ring on the last day of the pill and use backup contraception for 7 days.

2. An infertile patient has received two 5-day courses of clomiphene [Clomid] to help her conceive. An ultrasound 1 week after the last dose reveals that follicular maturation has occurred without ovulation. The nurse expects the next step for this patient to be: a. administration of human chorionic gonadotropin (hCG). b. an order for cabergoline to be given twice weekly. c. evaluation of ovarian and pituitary function. d. repeating clomiphene once daily for 5 days.

ANS: A When treatment with clomiphene has failed to produce ovulation after two courses, hCG is used to promote ovulation after follicular maturation has occurred. Cabergoline is used to treat hyperprolactinemia when excessive prolactin secretion occurs. Ovarian and pituitary function should be evaluated before a patient begins treatment with clomiphene. If ovulation had occurred, another cycle of clomiphene would be indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771 | pp. 772-773

3. Which drugs are useful for preventing preterm labor? (Select all that apply.) a. Antibiotics b. Hydroxyprogesterone c. Indomethacin d. Magnesium sulfate e. Terbutaline

ANS: A, B Two drug interventions may help to prevent preterm labor: antibiotics and hydroxyprogesterone. Indomethacin, magnesium sulfate, and terbutaline are all used to stop preterm labor after it starts. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 780

1. A pregnant patient is 1 week post-term and will receive intravenous oxytocin. Which will the nurse evaluate before starting the infusion? (Select all that apply.) a. Cervical ripening b. Fetal monitoring c. Renal function d. Respiratory function e. Uterine activity

ANS: A, B, E Before labor can be safely induced, cervical ripening must occur. Baseline data must include full maternal and fetal status. Maternal renal function and respiratory function are not part of the baseline assessment. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 783 | p. 786

2. Which are indications for early induction of labor? (Select all that apply.) a. Abruptio placentae b. Active genital herpes infection c. Gestational hypertension d. Premature rupture of the membranes e. Umbilical cord prolapse

ANS: A, C, D Indications for early induction of labor include abruptio placentae, gestational hypertension, and premature rupture of the membranes. Active genital herpes infection and umbilical cord prolapse are contraindications to induction, even at term, because they can involve significant harm to the fetus. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 781

A patient asks about the effectiveness of various birth control methods. The nurse should inform her that the most effective methods are what? (Select all that apply.) a. Intrauterine devices (IUDs) b. Spermicides c. Intramuscular medroxyprogesterone acetate d. Etonogestrel subdermal implants e. Male or female sterilization

ANS: A, C, D, E The most effective methods of birth control are IUDs, intramuscular medroxyprogesterone acetate [Depo-Provera], implants, and sterilization. Spermicides are not one of the most effective methods of birth control.

1. The nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.) a. Cephalexin (Keflex) b. Guaifenesin (Robitussin) c. Warfarin (Coumadin) d. Ibuprofen (Motrin) e. Theophylline (Uniphyl)

ANS: A, C, E Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 540 TOP: NURSING PROCESS: Planning

2. The nurse is instructing a male patient about application of transdermal testosterone gel (AndroGel). Which body location is preferred for this medication? (Select all that apply.) a. Back b. Chest c. Thigh d. Scrotum e. Abdomen f. Upper arms

ANS: A, C, E, F AndroGel is applied to the skin of the back, abdomen, upper arms, or thighs. Testoderm patches are applied to the scrotal skin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Implementation

1. The nurse notes in a patient's medication history that the patient is taking the synthetic androgen danazol (Danocrine). Indications for danazol include which conditions? (Select all that apply.) a. Endometriosis b. Decreased sexual libido c. Postpartum breast engorgement d. Fibrocystic breast disease in women e. Hereditary angioedema f. Metastatic breast cancer

ANS: A, D, E Danazol is used to treat hereditary angioedema and to treat women who have endometriosis or fibrocystic breast disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 555 TOP: NURSING PROCESS: Planning

11. The nurse is providing patient teaching about the oral bisphosphonate alendronate (Fosamax). Which statement by the patient indicates a good understanding of when this drug should be taken? a. "I will take it in the evening just before bedtime." b. "I will take it in the morning with an 8-ounce glass of water." c. "I will take it with the first bite of the morning meal." d. "I will take it between meals on an empty stomach."

ANS: B Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 549 TOP: NURSING PROCESS: Implementation

A patient who is taking a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient tells the nurse she has begun experiencing spotting during her cycle. What will the nurse tell her to do? a. Change to condoms instead of oral contraceptives. b. Discuss an oral contraceptive with increased estrogen. c. Request a decreased dose of carbamazepine. d. Stop taking the oral contraceptive immediately.

ANS: B Carbamazepine induces hepatic cytochrome P450 and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced OC blood levels; patients experiencing this symptom may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing the dose of carbamazepine is not correct. Discontinuing the OC immediately is not correct.

6. A nurse is explaining to a nursing student how clomiphene [Clomid] works to improve fertility. Which statement by the student indicates a need for further teaching? a. "Clomiphene blocks estrogen receptors to cause increased secretion of gonadotropins." b. "Clomiphene directly stimulates the ovary, causing follicular maturation and ovulation." c. "If follicular maturation is the only result of clomiphene therapy, human chorionic gonadotropin may be given." d. "If the pituitary gland cannot produce LH and FSH, clomiphene will not be effective."

ANS: B Clomiphene blocks receptors for estrogen; it does not directly stimulate the ovary. When estrogen receptors are blocked, the pituitary increases production of the gonadotropins LH and FSH. Clomiphene may produce follicular maturation without ovulation, and hCG will be given to produce ovulation. Without a pituitary capable of producing LH and FSH, clomiphene will not be effective. PTS: 1 DIF: Cognitive Level: Application REF: pp. 770-771

15. The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate? a. Subcutaneous b. Intramuscular c. Vaginal d. Transdermal

ANS: B Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 549 TOP: NURSING PROCESS: Planning

3. A patient is receiving finasteride (Proscar) for treatment of benign prostatic hyperplasia. The nurse will tell him that a possible effect of this medication is: a. alopecia. b. increased hair growth. c. urinary retention. d. increased prostate size.

ANS: B Finasteride is given to reduce prostate size in men with benign prostatic hyperplasia. It has been noted that men taking this medication experience increased hair growth. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 557 TOP: NURSING PROCESS: Planning

6. During the administration of finasteride (Proscar), the nurse must remember which important precaution? a. It must be taken on an empty stomach. b. It must not be handled by pregnant women. c. It is given by deep intramuscular injection to avoid tissue irritation. d. The patient needs to be warned that alopecia is a common adverse effect.

ANS: B Finasteride must not be handled by pregnant women because of its teratogenic effects. It is taken orally and without regard to meals. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Implementation

9. A patient receives an injection of human chorionic gonadotropin after follicular maturation has been induced with another agent. The patient comes to the clinic 2 days later complaining of headache, irritability, and fatigue. What will the nurse do? a. Perform a urine pregnancy test. b. Reassure the patient that these are known adverse effects. c. Request an order for a serum estrogen level. d. Review the patient's abdominal ultrasound.

ANS: B Headache, irritability, and fatigue are known adverse effects of hCG. A urine pregnancy test is not indicated, because it is too soon for the patient to be pregnant. A serum estrogen level and an abdominal ultrasound are not indicated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 772-773

4. A patient who has experienced preterm births with her previous two pregnancies will begin receiving hydroxyprogesterone caproate [Makena] to prevent preterm delivery with her current pregnancy. Which statement by the patient indicates a need for further teaching about this drug? a. "I should report any calf pain immediately." b. "I will eventually learn to administer the injections of this drug myself." c. "This drug may cause fluid retention and glucose intolerance." d. "This medication must be given once a week until 37 weeks' gestation."

ANS: B Hydroxyprogesterone caproate is given IM and must be given by a healthcare provider and not by the patient. Although serious side effects are rare, thrombosis and thromboembolism may occur, so the patient should report signs of thrombosis immediately. Fluid retention and glucose intolerance may occur. The medication is given weekly from 16 to 21 weeks' gestation up to 37 weeks or delivery of the baby. PTS: 1 DIF: Cognitive Level: Application REF: pp. 780-781

7. A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil

ANS: B In patients with pre-existing cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 558 TOP: NURSING PROCESS: Assessment

3. A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin [Pitocin]. The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs? a. Contractions occur every 2 to 3 minutes. b. Individual contractions last 2 minutes. c. Mild to moderate pain occurs with uterine contractions. d. Resting intrauterine pressure is greater than 10 to 15 mm Hg.

ANS: B Induction of labor in patients of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin infusions should be interrupted for contractions that last longer than 1 minute. Contractions that occur more often than every 2 to 3 minutes are a concern. Mild to moderate pain is normal with contractions. A resting intrauterine pressure greater than 15 to 20 mm Hg is a concern. PTS: 1 DIF: Cognitive Level: Application REF: p. 783

8. A patient receiving menotropins [Repronex] for infertility comes to the clinic for evaluation on the ninth day of treatment. Her serum estrogen level is 200 pg/mL per maturing follicle. An ultrasound reveals that follicles have enlarged to 22 mm. The patient complains of left lower abdominal pain. What will the nurse do? a. Administer human chorionic gonadotropin, because the ovary has ripened. b. Assess for abdominal fullness and distension and auscultate lung sounds. c. Inform the patient that the pain is associated with ovulation. d. Recommend ibuprofen for pain and administer the next dose of menotropins.

ANS: B Menotropins can cause ovarian hyperstimulation syndrome, which can cause sudden enlargement of the ovaries. When it occurs rapidly and is accompanied by ascites, pleural effusion, and pain, the patient should be hospitalized and the menotropins should be withdrawn. Although the follicular size and estrogen level indicate a ripened ovary, the first priority is to assess for ovarian hyperstimulation syndrome, because this patient reports pain. Ovulation will not occur until hCG is given, so this pain is not associated with ovulation. Until ovarian hyperstimulation syndrome has been ruled out, it is not appropriate to administer the next dose of menotropins. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772

17. The nurse is administering oxytocin (Pitocin). Which situation is an indication for the use of oxytocin? a. Decreased fetal heart rate and movements b. Stimulation of contractions during labor c. Cervical ripening near term in pregnant patients d. To reverse premature onset of labor

ANS: B Oxytocin is used to induce labor at or near full-term gestation and to enhance labor when uterine contractions are weak and ineffective. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 545 TOP: NURSING PROCESS: Implementation

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient? a. The patient should ask her provider about an OC with less progestin. b. The patient should discuss an alternate method of birth control prior to surgery. c. The patient should request an OC containing less estrogen after surgery. d. The patient should take the OC at bedtime after her surgery to reduce side effects.

ANS: B Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

A patient has been taking a progestin-only, or "minipill," OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will: a. question the patient about any possible missed doses of the pill. b. reassure the patient that this is normal with this form of contraception. c. recommend that she take a pregnancy test to rule out pregnancy. d. suggest that she use a backup form of contraception until these symptoms resolve.

ANS: B Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated. It is not necessary to use a backup form of contraception.

8. During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased: a. incidence of nausea. b. risk for thrombosis. c. levels of triglycerides. d. tendency to bleed during menstruation.

ANS: B Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 537 TOP: NURSING PROCESS: Planning

14. A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time? a. She will continue to take the alendronate with water. b. She cannot take the alendronate until she can sit up for 30 minutes. c. She can take the medication with breakfast. d. She will stop taking the medication 72 hours before her surgery.

ANS: B The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 549 TOP: NURSING PROCESS: Implementation

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse will recommend discussing which contraception with the provider? a. An intrauterine device with a spermicide b. DMPA (Depo-Provera) and condoms c. Tubal ligation and condoms d. Progestin-only oral contraceptives

ANS: B This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her; patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and should not be used by young women, because it is irreversible. Progestin-only oral contraceptives must be taken every day.

6. A pregnant patient is being induced with oxytocin, which has been infusing for 1 hour. The initial rate was 6 milliunits/min, and the rate now is 18 milliunits/min. The nurse notes regular contractions occurring every 3 minutes, each lasting 35 seconds. The nurse will: a. increase the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes. b. increase the rate of infusion by 3 to 6 milliunits/min every 15 to 40 minutes. c. interrupt the infusion and continue to monitor the patient before restarting. d. interrupt the infusion and notify the provider of potential oxytocin toxicity.

ANS: B This patient is being induced with a high-dose regimen of oxytocin, which starts at 6 milliunits/min and is increased by 3 to 6 milliunits/min every 15 to 40 minutes. The frequency and rate of her contractions are within normal limits, so the nurse can continue to increase the rate by 3 to 6 milliunits/min every 15 to 40 minutes until contractions last longer than 1 minute or occur more frequently than every 2 to 3 minutes. Increasing the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes is part of the low-dose regimen. Because the frequency and duration of contractions have not reached optimum level, there is no need to interrupt the infusion. There are no signs of oxytocin toxicity. PTS: 1 DIF: Cognitive Level: Application REF: p. 783 | p. 786

6. The nurse is reviewing the use of uterine tocolytics, such as indomethacin (Indocin). Which statement best describes the indication for these drugs? a. Prevention of preterm labor in the 15th week of pregnancy b. Prevention of preterm labor in the 22nd week of pregnancy c. Stimulation of contractions in prolonged labor d. Stimulation of ovulation as part of infertility treatments

ANS: B Tocolytics relax uterine smooth muscles and stop the uterus from contracting and are used along with nonpharmacologic measures to prevent preterm labor between 20 and 37 weeks of pregnancy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 546 TOP: NURSING PROCESS: Planning

A patient has been experiencing side effects with a combination oral contraceptive, and her provider has ordered a different combination product. The nurse will instruct the patient to do what? a. Begin taking the new product immediately. b. Change products at the beginning of her next cycle. c. Stop taking the old OC 1 week before starting the new OC. d. Use an alternate method of contraception for 1 month before starting the new OC.

ANS: B When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately; to stop the old product 1 week before starting the new product; or to use an alternate method of birth control between regimens.

10. A patient with endometriosis is being treated with the gonadotropin-releasing hormone (GnRH) agonist leuprolide [Lupron Depot]. A nurse is teaching the patient about the drug. Which statement by the patient indicates understanding of the teaching? a. "I can continue to take the medication if I get pregnant." b. "I can expect the medication to cure my symptoms." c. "I may have menopausal-like symptoms when taking this medication." d. "I will need to take the medication for several years."

ANS: C Because the GnRH agonists deprive the ovary of the stimulation to produce estrogen, women may experience symptoms associated with menopause, including hot flashes, vaginal dryness, decreased libido, mood changes, and headache. GnRH agonists are teratogenic and should not be used during pregnancy. The medication does not produce a cure; symptoms return in up to 50% of women after discontinuation of the drug. GnRH agonists should be discontinued after 6 months of treatment because of the risk of osteoporosis. PTS: 1 DIF: Cognitive Level: Application REF: p. 774

A patient is taking a combination oral contraceptive (OC) and reports breast tenderness, edema, and occasional nausea. What will the nurse recommend? a. The patient should ask her provider about an OC with less progestin. b. The patient should discuss an alternate method of birth control. c. The patient should request an OC containing less estrogen. d. The patient should take the OC at bedtime to reduce side effects.

ANS: C Breast tenderness, edema, and nausea are associated with estrogen; women experiencing these side effects may benefit from an OC with a lower estrogen dose. Lowering the progestin will not decrease these symptoms. It is not necessary to change birth control methods if side effects can be managed by altering the estrogen dose. Taking the OC at bedtime will not affect the symptoms.

11. The nurse counseling a couple who cannot conceive learns that female infertility problems have been ruled out. What will the nurse expect to tell this couple? a. "If medication is necessary for male infertility, treatment will last a few months." b. "Male infertility is usually treatable with a combination of medications." c. "Most male infertility is not linked to known endocrine disorders." d. "Treatment with sildenafil [Viagra] will be necessary to improve fertility."

ANS: C In most cases, infertility in males in not associated with an identifiable endocrine disorder, and with the exception of infertility associated with erectile dysfunction, male infertility is generally unresponsive to drugs. In rare cases, failure to produce sperm is related to insufficient gonadotropin secretion and hCG may be used, but therapy is prolonged and may be required for up to 3 to 4 years. Treatment with sildenafil is necessary only when ED has been identified. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 769

18. An older adult female patient is receiving the progestin drug megestrol (Megace). Which is the most likely reason megestrol is ordered for this patient? a. Migraine headaches b. Osteoporosis c. Appetite stimulant d. Reduction of hot flashes

ANS: C Megestrol can cause appetite stimulation and weight gain, and therefore is used in the management of anorexia, cachexia, or unexplained substantial weight loss in patients with acquired immunodeficiency syndrome (AIDS) and in patients with cancer. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 539 TOP: NURSING PROCESS: Planning

A nurse is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) [Mifeprex]? "This drug is most effective if I use it: a. before the first missed menstrual period." b. the day after unprotected intercourse." c. within 7 weeks of conception." d. immediately after ovulation."

ANS: C Mifepristone is most effective if it is used within 7 weeks of conception. The timing specified in the other responses is incorrect.

5. A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? a. Giving magnesium sulfate along with the oxytocin b. Administering the medication in an intravenous (IV) bolus c. Administering the medication with an IV infusion pump d. Monitoring fetal heart rate and maternal vital signs every 6 hours

ANS: C Oxytocin is infused via an infusion pump, not via an IV bolus. Magnesium sulfate is not administered with oxytocin. Fetal heart rate and maternal vital signs should be monitored continuously. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 549 TOP: NURSING PROCESS: Implementation

1. The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? a. "If you miss a dose, double-up on the next dose." b. "There's no need to be concerned about breast lumps or bumps that occur." c. "Be sure to report any weight gain of 5 pounds or more per week." d. "Take the medication on an empty stomach to enhance absorption."

ANS: C Patients taking oral estrogen therapy should report weight gain of 5 pounds or more per week to a physician. The other statements are not true for estrogen replacement therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 550 TOP: NURSING PROCESS: Implementation

8. A nurse provides teaching to a woman who is taking tranexamic acid [Lysteda] for menorrhagia. Which statement by the patient indicates a need for further teaching? a. "I may experience back pain or muscle cramps while taking this drug." b. "I may take two tablets 3 times daily for up to 5 days with each period." c. "I should take an oral contraceptive to prevent pregnancy while taking this drug." d. "I should take this medication with food to improve absorption of the drug."

ANS: C The greatest concern with tranexamic acid (TA) is venous or arterial thrombosis. Women taking TA should not take oral contraceptives, which would increase the risk of thrombosis. Back pain and muscle cramps are known adverse effects. Women may take up to two tablets 3 times a day for up to 5 days with each period. The medication can be taken with or without food, but bioavailability increases in the presence of food. PTS: 1 DIF: Cognitive Level: Application REF: p. 785

1. A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, "Why am I getting a patch? Can't I just take a pill?" Which response by the nurse is correct? a. "The patch reduces the incidence of side effects." b. "If you don't take the patch, you will have to have injections instead." c. "The patch allows for better absorption of the medication." d. "You will only have to change the patch weekly."

ANS: C The transdermal form allows for better absorption of testosterone because of its high first-pass effect. Oral forms are poorly absorbed, and the transdermal form is preferable to an injection and is preferred for hormonal replacement therapy. The patch is changed daily. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 555 TOP: NURSING PROCESS: Implementation

9. When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? a. Monophasic b. Biphasic c. Triphasic d. Short acting

ANS: C The triphasic drugs most closely duplicate the normal hormonal levels of the female menstrual cycle. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 540 TOP: NURSING PROCESS: Assessment

4. The nurse notes in a female patient's history that she has an order for the androgen methyltestosterone (Android). Based on this finding, the nurse interprets that the patient has which disorder? a. Fibrocystic breast disease b. Hereditary angioedema c. Hypertension d. Inoperable breast cancer

ANS: D Methyltestosterone can be used in cases of inoperable breast cancer in women. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 557 TOP: NURSING PROCESS: Assessment

1. A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics: a. are given until term to reduce fetal mortality. b. are used to help the fetal lungs mature. c. help delay delivery while glucocorticoids are given. d. help treat the infections that cause preterm labor.

ANS: C Tocolytic agents are used to postpone premature labor and, on average, for only 48 hours. During this time, glucocorticoids are given to help the fetal lungs mature. Tocolytic agents do not suppress labor long term. They do not directly help the fetal lungs to mature; they help by allowing time for glucocorticoids to be given. They do not treat infection. PTS: 1 DIF: Cognitive Level: Application REF: pp. 777-778

A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient? a. "If breakthrough spotting occurs, you should begin taking a new pack of pills." b. "Protection from pregnancy will begin immediately." c. "Use another form of contraception for the next month." d. "You may take the pills at different times of day."

ANS: C When beginning oral contraceptives, it is important that the patient use another form of contraception for the first month, because protection is not immediate. Breakthrough spotting is common and is not an indication for starting a new cycle. Protection from pregnancy is not immediate. It is important to take the pills at the same time each day.

A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception? a. A 45-year-old married woman with four children b. A 30-year-old monogamous married woman c. An 18-year-old woman with multiple sexual partners d. A 35-year-old woman with a history of rosacea

ANS: C Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD.

9. A 63-year-old male patient is scheduled for a physical examination, and he tells the nurse that he wants to start taking a vitamin formula that includes saw palmetto for prostate health. Which is the nurse's best response? a. "I've heard many good things about saw palmetto." b. "It's not a good idea to start herbal therapy at your age." c. "There are very few adverse effects with saw palmetto therapy." d. "The doctor will need to draw some blood and do a digital rectal exam first."

ANS: D A prostatic-specific antigen test and digital rectal examination needs to be performed before initiation of treatment with saw palmetto for benign prostatic hyperplasia. Adverse effects may include gastrointestinal upset, headache, back pain, and dysuria. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 560 TOP: NURSING PROCESS: Planning

2. The nurse recognizes that use of estrogen drugs is contraindicated in which patient? a. A patient who has atrophic vaginitis b. A patient who has inoperable prostate cancer c. A woman who has just given birth and wants to prevent postpartum lactation d. A woman with a history of thrombophlebitis

ANS: D Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 537 TOP: NURSING PROCESS: Assessment

2. A patient is in preterm labor, and the prescriber orders magnesium sulfate for its neuroprotective effect on the fetus. The order calls for 4 gm given as an intravenous bolus over 20 minutes, followed by a maintenance infusion of 2 gm/hr. What will the nurse do? a. Administer the drug as ordered. b. Question the bolus amount. c. Question the bolus rate. d. Question the maintenance amount.

ANS: D For fetal neuroprotective uses, magnesium sulfate should be given using a low-dose protocol, which is a 4-gm IV loading bolus over 20 minutes, followed by a maintenance infusion of 1 gm/hr. A high-dose protocol would have a maintenance infusion of 2 to 3 gm/hr. The nurse should question the maintenance amount. The bolus amount and rate are correct. PTS: 1 DIF: Cognitive Level: Application REF: p. 780

A patient calls the nurse to report that she forgot to take a combination OC pill during the third week of her cycle. She tells the nurse that she missed another pill earlier that week. The nurse will tell her to: a. continue the pack, skip the inert pills, and use an additional form of contraception for 7 days. b. not to worry, because up to 7 days can be missed without an increased risk of pregnancy. c. take a pill immediately, continue the pack, and use an additional form of contraception for 1 month. d. take a pill now, continue the pack, skip the placebo pills, and start a new pack on week 4.

ANS: D If one or two pills are missed during the second or third week of a 28-day cycle, the patient should be instructed to take one pill as soon as possible, continue the pack, skip the placebo pills, and go straight to a new pack. It is not necessary to use an alternative form of contraception. If three or more pills are missed, the risk of pregnancy increases.

3. A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem? a. Methylergonovine (Methergine) b. Estradiol transdermal (Estraderm) c. Raloxifene (Evista) d. Medroxyprogesterone (Provera)

ANS: D Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea. Secondary amenorrhea is not an indication for the other drugs listed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 538 TOP: NURSING PROCESS: Planning

7. A patient with infertility will begin taking menotropins [Repronex]. The nurse will evaluate this patient's history to determine whether the: a. patient has a history of hyperinsulinemia. b. patient has excessive prolactin secretion. c. patient's pituitary can produce LH and FSH. d. patient's ovaries are capable of responding to gonadotropins.

ANS: D Menotropins are used when gonadotropin secretion by the pituitary is insufficient to provide adequate ovarian stimulation. Candidates must have ovaries capable of responding to FSH and LH. Metformin is used for hyperinsulinemia. Women with excessive prolactin secretion are treated with cabergoline. Menotropins contain equal amounts of LH and FSH and act directly on the ovaries, so the pituitary's inability to produce these hormones is not a factor for beginning treatment with this drug. PTS: 1 DIF: Cognitive Level: Application REF: pp. 771-772 | p. 773

10. A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? a. Complete blood count b. Serum potassium level c. Vaginal cultures d. Pregnancy test

ANS: D Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 541 TOP: NURSING PROCESS: Assessment

7. A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition? a. Hypocalcemia b. Breast cancer c. Stress fractures d. Venous thromboembolism

ANS: D SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 542 TOP: NURSING PROCESS: Implementation

A nurse is teaching a community education class on contraceptives. The nurse tells the class that if spermicides containing nonoxynol-9 are used, the patient should take special precautions, because these spermicides have been linked to: a. human papillomavirus (HPV) infections. b. spontaneous abortions. c. endometrial cancer. d. increased transmission of the human immunodeficiency virus (HIV).

ANS: D Spermicides that contain nonoxynol-9 have been linked to the increased transmission of HIV. Spermicides containing nonoxynol-9 have not been linked to HPV infections, spontaneous abortions, or endometrial cancer.

5. A patient with polycystic ovary syndrome (PCOS) asks the nurse what she can do to improve her chances of getting pregnant. Which statement by the patient indicates a need for further teaching? a. "Clomiphene will help induce ovulation but will not treat the other symptoms of polycystic ovarian disease." b. "If I lose weight, my infertility and irregular periods could resolve without medications." c. "Metformin improves insulin sensitivity and reduces male hormone levels." d. "Spironolactone, which reduces androgens and facial hair, is helpful if I'm trying to conceive."

ANS: D Spironolactone is antiandrogenic; it can reduce hirsutism and acne, but it also can harm the fetus and should not be used in patients trying to conceive. Clomiphene helps induce ovulation but does not treat symptoms of PCOS. Patients who lose weight might experience a reversal of symptoms without medications, although weight loss may be difficult to achieve. Metformin reduces serum insulin levels by increasing insulin sensitivity and indirectly lowers androgen levels. PTS: 1 DIF: Cognitive Level: Application REF: p. 770

3. A patient who has endometriosis has been unable to conceive. She asks the nurse about medications to treat the condition. What will the nurse tell the patient? a. Combination oral contraceptives are effective for improving fertility. b. Gonadotropin-releasing hormone agonists are used for long-term treatment. c. Nonsteroidal anti-inflammatory drugs are second-line agents for treating pain. d. Pharmacologic agents used to treat endometriosis do not enhance fertility.

ANS: D Surgery reduces symptoms of endometriosis and improves fertility; drugs used to treat endometriosis only reduce discomfort. Combination oral contraceptives only treat symptoms; they do not improve fertility. Gonadotropin-releasing hormone agonists cannot be used long term because of side effects of osteoporosis and hot flashes. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line agents for endometriosis pain. PTS: 1 DIF: Cognitive Level: Application REF: p. 770

A nurse working in a family planning clinic is preparing to administer a first dose of intramuscular DMPA [Depo-Provera] to a young adult patient. The woman tells the nurse she has just finished her period. What will the nurse do? a. Administer the injection today and counsel backup contraception for 7 days. b. Administer the injection today and tell her that protection is immediate. c. Obtain a pregnancy test to rule out pregnancy before administering the drug. d. Schedule an appointment for her to receive the injection in 3 weeks.

ANS: D To ensure that patients are not pregnant when they receive DMPA, the first injection should be given during the first 5 days of a normal menstrual period.

A nurse teaches a health education class to male adolescents. Which of these topics should be a priority for the nurse to include? Adoption of healthy lifetime hygienic practices Effects of performance-enhancing androgens Pituitary gland regulation of sexual development Self-esteem issues related to delayed onset of puberty

Effects of performance-enhancing androgens

A nurse monitors for which adverse cardiovascular effects in a male patient taking testosterone [Androderm]? (Select all that apply.) Postural hypotension Atrial fibrillation Pedal edema and weight gain Prolonged QT interval Decrease in high-density lipoprotein (HDL) levels

Pedal edema and weight gain Decrease in high-density lipoprotein (HDL) levels

Which measurements should a nurse obtain to evaluate the effects of androgen therapy on the epiphyses of a patient with hypogonadism? Monthly height and weight Periodic hand and wrist x-rays Body mass/fat ratio indices Blood testosterone levels

Periodic hand and wrist x-rays

Androgens are prescribed for a patient with anemia. The nurse is aware that the action of the androgen in this patient is what? Iron replacement Promoting synthesis of erythropoietin Prevention of blood loss Increase in bone formation

Promoting synthesis of erythropoietin

A 14-year-old male patient has not begun puberty. His parents tell the nurse that their son does not want to go to school, because he gets teased. The nurse learns that the boy's father did not begin puberty until age 16 years. Laboratory tests on this child do not reveal true hypogonadism. What will the nurse tell these parents when they ask what can be done for their son? a. "A limited course of androgen therapy may be prescribed, but it is not necessary." b. "He will eventually begin puberty, so this is nothing to worry about." c. "He will probably have to receive injections of androgens for 3 to 4 years." d. "The risk of accelerated growth plate closure is too great to warrant androgen therapy."

a. "A limited course of androgen therapy may be prescribed, but it is not necessary."

A nurse is teaching a group of parents about the role of testosterone in puberty for boys. To evaluate the group's understanding, the nurse asks, "What physiologic effects related to testosterone can you expect to see in your sons?" Which responses indicate an understanding of the role of testosterone in male puberty? (Select all that apply.) a. "It promotes skeletal muscle growth." b. "It increases height and weight." c. "It delays epiphyseal closure." d. "It causes a high-pitched voice." e. "It causes acne."

a. "It promotes skeletal muscle growth." b. "It increases height and weight." e. "It causes acne."

A clinic nurse is assessing an adolescent male patient who has been receiving androgen therapy for hypogonadism via a transdermal patch. The patient's last clinic visit was 4 weeks earlier. Which part of the interval history is of most concern to the nurse? a. Five-pound weight gain b. Increased growth of pubic hair c. Rash at the site of the patch d. Presence of acne

a. Five-pound weight gain

A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can't take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to: a. decrease her risk of endometrial cancer. b. increase bone resorption to prevent fractures. c. lower her risk of myocardial infarction (MI). d. prevent deep vein thrombosis (DVT).

a. decrease her risk of endometrial cancer. In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT.

An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen? a. "I will need to have x-rays of my hands and feet every 6 months." b. "My libido may improve while I am taking this medication." c. "Taking this drug may lead to the development of prostate cancer." d. "This will restore fertility, so I can have a child."

b. "My libido may improve while I am taking this medication."

According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.) a. Cardiovascular protection in older patients b. Decreased osteoporosis risk c. Glycemic control d. Improved wound healing e. Prevention of colorectal cancer

b. Decreased osteoporosis risk c. Glycemic control d. Improved wound healing EPT can lower osteoporosis risk, improve glycemic control, and aid in wound healing. Preparations with estrogen alone can provide cardiovascular protection or help prevent colorectal cancer, but not preparations containing progestin.

The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.) a. Increased colon cancer b. Stroke c. Deep vein thrombosis d. Ovarian cancer e. Decreased bone density

b. Stroke c. Deep vein thrombosis d. Ovarian cancer Risk factors for EPT include stroke, deep vein thrombosis, and ovarian cancer. A decreased risk of colon cancer is associated with EPT. EPT preserves bone mineral density.

A nurse is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching? a. "I should apply this to my forearms and neck after showering." b. "I should keep treated areas exposed to the air so that they can dry." c. "I should not let my child touch the gel to prevent behavioral problems." d. "I should not swim or bathe for 3 to 4 hours after applying the gel."

c. "I should not let my child touch the gel to prevent behavioral problems."

A 12-year-old male patient diagnosed with hypogonadism will begin testosterone injections. What will the nurse include when teaching the family about this therapy? a. Annual x-rays of the hands and wrists are necessary to monitor epiphyseal closure. b. Gynecomastia may occur and is a common side effect. c. Injections are given every 2 to 4 weeks for 3 to 4 years. d. Use of this drug may lead to prostate cancer later in life.

c. Injections are given every 2 to 4 weeks for 3 to 4 years.

A 14-year-old male patient who plays football is admitted to the hospital. The nurse notes that the patient has short stature for his age according to a standard growth chart. The patient is muscular, has a deep voice, and needs to shave. The nurse notifies the provider of these findings. Which test will the nurse expect the provider to order? a. Coagulation studies b. Complete blood count (CBC) with differential c. Liver function tests and serum cholesterol d. Serum glucose and hemoglobin A1c

c. Liver function tests and serum cholesterol

A female patient who swims competitively admits to using anabolic steroids to increase her muscle mass and improve her performance. What will the nurse tell this patient? a. Anabolic steroids may actually regulate her periods. b. Breast size may increase as a result of this drug use. c. The risk of liver disease will increase. d. Voice changes and facial hair will reverse when she stops the drug.

c. The risk of liver disease will increase.

A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching? a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely." b. "I can take estrogen to reduce my risk of cardiovascular disease." c. "I should take the lowest effective dose for the shortest time needed." d. "I will need a progestin/estrogen combination since I have had a hysterectomy."

c. "I should take the lowest effective dose for the shortest time needed." For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens.

A nurse is providing education to a patient who is beginning therapy with AndroGel testosterone gel. What statement made by the patient demonstrates a need for further teaching? a. "I should not shower or swim for at least 5 to 6 hours after application." b. "I should avoid direct skin-to-skin contact with my spouse where the medication was applied." c. "I should have my blood drawn for laboratory tests in 14 days." d. "I should apply the medication to my genitals for best results."

d. "I should apply the medication to my genitals for best results."

A nurse provides teaching for a female patient with anemia who has had cancer chemotherapy and who will begin treatment with testosterone. Which statement by the patient indicates understanding of the teaching? a. "Facial hair may develop with this drug but will go away over time." b. "I may experience an increase in breast size while taking this drug." c. "Testosterone may increase my high-density lipoprotein (HDL) cholesterol and reduce my low-density lipoprotein (LDL) cholesterol." d. "Testosterone treats anemia by stimulating the synthesis of a renal hormone."

d. "Testosterone treats anemia by stimulating the synthesis of a renal hormone."

A nurse is obtaining a history and reviewing the chart of an adult male patient who has been taking oral androgens. Which assessment would warrant notifying the provider? a. Acne and increased facial hair b. Breast enlargement c. Increased libido d. Nausea, anorexia, and fatigue

d. Nausea, anorexia, and fatigue

An adolescent male patient is beginning androgen therapy for delayed puberty. His parents ask the nurse when this treatment may be stopped. The nurse will offer which response? a. After 3 to 4 years of therapy b. If acne and facial hair develop c. When complete sexual maturation has occurred d. When testicular enlargement occurs

d. When testicular enlargement occurs

A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching? a. "ET can provide protection against coronary heart disease and reverse osteoporosis." b. "EPT is generally safer than ET, especially in women who have undergone hysterectomies." c. "In women with established coronary heart disease, EPT can protect against myocardial infarction." d. "Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss."

d. "Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss." ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease.

A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? a. "Estrogen can help reverse bone loss." b. "Hormone therapy increases bone resorption." c. "Hormone therapy does not decrease fracture risk." d. "When hormone therapy is discontinued, bone mass is quickly lost."

d. "When hormone therapy is discontinued, bone mass is quickly lost." Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount.

5. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn't want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: a. Depo Provera. b. Estraderm. c. low-dose estrogens. d. Premarin vaginal.

d. Premarin vaginal. Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects. Depo Provera is a progesterone and is not indicated. Transdermal estrogen is used to treat hot flushes. Low-dose estrogens still have systemic effects.

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication? a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug.

d. Vasomotor symptoms are a common side effect of this drug. Raloxifene can induce hot flashes in patients taking the drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.

The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? "I should apply this medication to my: a. waistline and shoulders." b. abdomen and arms." c. breasts and abdomen." d. thighs and calves."

d. thighs and calves." The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen.

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that: a. an estrogen-progesterone product will reduce side effects. b. an intravaginal preparation may be best for her. c. side effects of ET are uncommon among women her age. d. transdermal preparations have fewer side effects.

d. transdermal preparations have fewer side effects Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET.