Wk 14- Bioterrorism; Reproduction

The nurse is educating a patient regarding the Ortho Evra transdermal contraceptive patch. Which statement, if made by the patient, indicates an understanding of the information?

"I will remove the patch each month and replace it with a new patch 1 week later." The Ortho Evra transdermal contraceptive patch has the same mechanism as combination oral contraceptives (OCs). The patch, which is 1.75 inches square (about the size of a matchbook), is applied once a week for 3 weeks, followed by 1 week off (to permit normal menstruation). Patches are applied to the lower abdomen, buttocks, upper outer arm, or upper torso (front or back)—but not to the breasts or skin that is red, cut, or irritated.

Which statement should the nurse make to instruct a patient about the use of the Ortho Evra transdermal patch?

"Rotate the placement site of the patch." The nurse should instruct a patient to rotate the placement site of the Ortho Evra transdermal patch to avoid skin irritation. The patch should be changed weekly for a period of 3 weeks and then not worn for 1 week. The nurse should ask a patient to avoid placing the patch near the breasts, as the patch contains an estrogen component, which may increase the risk of breast cancer if the added supplementation of estrogen is in close proximity to the breasts. There is no need for a patient to report withdrawal bleeding, as it would be a normal finding.

The mechanism of action of combined hormone contraception (CHC) products inhibits ovulation and prevents pregnancy. Arrange the steps of this process in the order that they occur.

1. Estrogen component prevents the formation of a dominant follicle. 2. Estrogen remains at a consistent level. 3. Luteinizing hormone (LH) surge does not occur. 4. Pregnancy does not occur because of an absence of ovulation. The estrogen component of combined hormone contraception (CHC) products prevents the formation of a dominant follicle. As a result, the estrogen remains at a consistent level. If the estrogen level does not increase, a luteinizing hormone (LH) surge will not occur. This is because the estrogen level needs to reach a peak level for the LH surge to occur. At the same time, the progestin component of the CHC products also suppresses the LH surge. Because of this suppression, there is an absence of ovulation and pregnancy does not occur.

What will the nurse assess as a successful vaccination against smallpox?

A red, itchy bump appears in 4 days that blisters, fills with pus, and starts to drain. Successful vaccination is indicated when the following events take place: (1) Within 3 to 4 days, a red, itchy bump appears. (2) During the first week, the bump becomes a blister, fills with pus, and then starts to drain. (3) During the second week, the blister begins to dry and develops a scab. (4) In the third week, the scab falls off, leaving a small scar. Reactions to primary vaccination are stronger than reactions to revaccination. Induration is typically seen with tuberculosis vaccination. Wheals are typically an indication of a reaction or irritation. A bull's-eye rash is typically seen with Lyme disease.

The nurse anticipates administering a progestin medication to which woman?

A woman who is 8 weeks pregnant and diagnosed with corpus luteum deficiency syndrome Progestins are used to support an early pregnancy in women with corpus luteum deficiency syndrome and in women undergoing in vitro fertilization (IVF). Progestin therapy is also used for prematurity prevention. One progestin—hydroxyprogesterone acetate [Makena]—is approved for preventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. It is not used for nausea or for pregnancy achievement through planned intercourse.

A nurse obtains a health history from a patient who is scheduled to take a combination oral contraceptive (OC). Which factor in the patient's history would prompt the nurse to contact the physician immediately?

Breast cancer Oral contraceptives (OCs) do not have a known risk of cancer—except for promoting breast cancer growth. OCs do not increase the risk for breast cancer for most women. For women who have the BRCA1 gene mutation, OCs promote the growth of existing breast cancer and should be avoided. OCs are not contraindicated with a history of colon polyps, tuberculosis, or endometriosis.

Which antibiotic medication is most beneficial to a patient who has an anthrax infection?

Ciprofloxacin [Cipro] Ciprofloxacin [Cipro] is the drug of choice for the treatment of anthrax. Norfloxacin [Noroxin] is used for the treatment of urinary tract infections and prostatitis. Levofloxacin [Levaquin] and moxifloxacin [Avelox] are more commonly used for the treatment of respiratory tract infections.

The nurse should recognize which antibiotic regimen from a patient's medication administration record (MAR) as the treatment for inhalation anthrax?

Ciprofloxacin [Cipro] and doxycycline [Vibramycin] Bacillus anthracis usually is susceptible to intravenous (IV) ciprofloxacin and doxycycline. However, because a particular strain of B. anthracis may be resistant to these drugs, one or two other IV antibiotics should be included in the regimen such as vancomycin, in addition to ciprofloxacin or doxycycline. Metronidazole, vancomycin, and gentamicin are not used to treat inhalation anthrax.

Which hormone is responsible for initiating activity in the ovary?

Follicle-stimulating hormone (FSH) Follicle-stimulating hormone (FSH) is responsible for initiating ovarian activity in women. FSH stimulates the ovaries to produce estrogen (primarily estradiol). Prolactin (PRL), also known as luteotropic hormone or luteotropin, is a protein that allows women to produce milk. Later in the cycle, the combined surges in the levels of estrogen, FSH, and LH stimulate ovulation. In males, LH is also called interstitial cell-stimulating hormone and stimulates Leydig cell production of testosterone.

Which symptoms described by a patient are suggestive of premenstrual disorder (PMD)? Select all that apply.

Irritability Breast tenderness Irritability and breast tenderness are common symptoms of premenstrual disorder (1) (2) (PMD). Weight gain rather than loss is common, as is ankle edema. Symptoms should be absent on day 4 through 12 of the cycle. Symptoms are present in the luteal phase and minimal or absent during the follicular phase.

A patient requests information regarding the NuvaRing contraceptive method. Which response by the nurse is correct?

It is removed for 1 week each month. NuvaRing is a hormonal contraceptive device designed for vaginal insertion. Like combination oral contraceptives (OCs), the ring contains an estrogen/progestin combination that prevents pregnancy largely by suppressing ovulation. Insertion is done by the user. One ring is inserted once each month, left in place for 3 weeks, and then removed; a new ring is inserted 1 week later. During the ring-free week, withdrawal bleeding occurs.

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases?

Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease because they provide the most barrier protection. A spermicidal agent kills sperm. An intrauterine device is placed in the uterus. A cervical diaphragm is not as effective as condoms at preventing the transmission of sexually transmitted diseases.

Which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins?

Monophasic In a monophasic regimen, the daily doses of estrogen and progestin remain constant throughout the cycle of use. In the other regimens, either the estrogen, the progestin, or both change as the cycle progresses. The biphasic, triphasic, and quadriphasic schedules reflect efforts to more closely simulate ovarian production of estrogens and progestins.

Which adverse effect is associated with estrogen therapy?

Nausea The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma (patchy brown facial pigmentation), not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy.

What are characteristics of organophosphate cholinesterase inhibitor nerve agents utilized as chemical weapons? Select all that apply.

Nerve agents are irreversible. Nerve agents inhibit cholinesterase. Nerve agents attack the central nervous system. Mechanical ventilation is necessary for respiratory failure. Nerve agents are irreversible organophosphate cholinesterase inhibitors. They attack the central nervous system and produce respiratory failure that must be supported by mechanical ventilation. Treatment consists of giving atropine, pralidoxime, and diazepam along with ventilatory support.

What are the routes for administering combined hormone contraception (CHC) products? Select all that apply.

Oral transdermal transvaginal Combined hormone contraception (CHC) products are available for administration via oral, transvaginal, and transdermal routes. The oral route requires daily intake, where CHC products are absorbed by the gastrointestinal tract and metabolized by the liver. The transvaginal route involves the use of a vaginal ring, which releases ethinyl estradiol (EE) and etonogestrel internally. The transdermal route involves the use of the Ortho-Evra patch, which delivers ethinyl estradiol (EE) and norelgestromin through a transdermal system. There are no CHC products currently available to be administered via the intramuscular or subcutaneous route.

In the event of radiation fallout, which medication should be included in the nursing care plan to reduce the risk of thyroid cancer after exposure to iodine-131?

Potassium iodide The risk of thyroid cancer caused by radioactive fallout from iodine-131 can be reduced by ingestion of over-the-counter potassium iodide. It blocks the uptake of radioactive iodine by the thyroid. To be effective, potassium iodide must be taken soon after exposure. Sodium chloride, magnesium sulfate, and sodium bicarbonate are not effective in preventing thyroid cancer from iodine-131 exposure.

What will the nurse implement for a patient suspected of being exposed to radioactive iodine-131?

Potassium iodide treatment Once in the body, iodine-131 becomes concentrated in the thyroid gland and can cause thyroid cancer. The risk can be reduced by ingesting potassium iodide, which blocks the uptake of radioactive iodine by the thyroid gland.

The patient presents to the emergency department and is diagnosed with inhaled ricin exposure. Which action should the nurse take for this patient?

Provide supportive care based on the clinical manifestations. Management of ricin poisoning is purely supportive. There is no antidote for ricin, and a vaccine is still in development. Potassium iodide (KI) is used to block the uptake of radioactive iodine by the thyroid gland, thereby protecting the thyroid from exposure to high levels of radiation.

A patient takes fluoxetine [Prozac] for premenstrual disorder (PMD). Which priority assessment allows the nurse to evaluate the effectiveness of this treatment?

Reports of mood improvement Selective serotonin reuptake inhibitors (1) (2) (SSRIs), such as fluoxetine [Prozac], are considered first-line therapy for the psychologic symptoms of premenstrual disorder (PMD). They are most effective for reducing the affective symptoms (mood improvement) of PMD; however, they also can reduce physical symptoms, such as breast tenderness, bloating, and headaches.

Which factor should a nurse recognize as one that would increase the risk of thromboembolic phenomena arising from oral contraceptive use?

Smoking Oral contraceptives (OCs) are absolutely contraindicated in smokers older than age 35 because of the risk of thromboembolic phenomena. Additional risk factors include hypertension, cerebrovascular disease, coronary artery disease, myocardial infarction, and surgery in which postoperative thrombosis might be suspected. Asthma and noncompliance do not increase the risk of thromboembolic events.

The nurse is about to administer dinoprostone [Prepidil] to a patient. For what condition is this medication used?

Termination of pregnancy The use of dinoprostone [Prepidil] or other prostaglandin E2 (PGE2) drugs is indicated in specific situations requiring termination of pregnancy. It is not indicated for the treatment of premature labor, postpartum hemorrhage, or accelerated labor.

In an assessment session, a patient tells the nurse that she became pregnant after using the contraceptive pills regularly. The nurse finds that the patient uses a Sunday start method for using contraception. Which other assessment finding could be a likely cause of the patient's pregnancy?

The patient did not use a backup contraception method. A backup method of contraception is needed when a patient uses a Sunday start method, which is when a patient begins taking a contraceptive on the Sunday after the first day of menstruation, because the patient can start the contraception later than the fifth day of the menstrual cycle. A second contraception method will ensure protection until the first method reaches its peak level of contraceptive effectiveness. Excessive smoking is likely to increase the risk for cardiovascular problems in a patient, but not pregnancy. Age does not affect the effectiveness of the contraception method. A patient should take the contraception daily within a 3-hour window each day for effectiveness.

A patient who is postmenopausal is planning to start oral estrogen/progestin therapy (EPT) for the relief of symptoms related to menopause. After further assessment of the patient, the nurse obtains a prescription for a transdermal skin patch. Which assessment finding supports the change in the prescription?

The patient has a history of peptic ulcers. Oral estrogen/progestin therapy (EPT) increases the risk for gastrointestinal problems in patients; therefore, a patient who has a history of peptic ulcers is likely to experience the adverse effects of oral EPT. A transdermal patch bypasses the gastrointestinal tract and would be more effective for such patients. A deficiency in ascorbic acid (vitamin C) is not related to the intake of oral EPT. The use of antibiotics will indicate a need to increase the estrogen/progestin dose but not the drug route. The use of EPT helps deliver estrogen to the patient, which will reduce the risk of osteoporosis; however, osteoporosis is not an indication to change the administration route.

A patient who uses a vaginal ring tells the nurse, "My vaginal ring had dislodged, but I reinserted it within 6 hours. I also took a backup oral contraceptive pill for 2 days." What can the nurse conclude from this information?

The patient is at risk for pregnancy. The vaginal ring should be reinserted within 3 hours, not 6; therefore, in this case, the patient would be at risk of pregnancy and should use a backup contraception for 7 days. Vaginal infection is a side effect of the vaginal ring and does not occur if the vaginal ring is dislodged. A patient uses a vaginal ring for 3 weeks and has withdrawal menses in the fourth week. If a patient can reinsert the vaginal ring after dislodgement, it indicates that the patient is able to use the vaginal ring effectively.

The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis?

The patient smokes cigarettes. Smoking causes thrombosis in patients who undergo estrogen therapy. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. Thrombosis is not caused by a decrease in fluids. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant.

Tularemia is suspected in a patient who is allergic to streptomycin. What management will the nurse anticipate?

The patient will be started on gentamicin. Tularemia is a potential agent of terrorism. It is not transmitted person to person and no isolation is necessary. Tularemia responds well to antibiotics. The treatment of choice is IM streptomycin (15 mg/kg twice a day for 10 days). However, this patient is allergic to streptomycin; therefore, the preferred alternative is gentamicin (5 mg/kg IM or IV once a day for 10 days). If there is a mass outbreak, oral therapy with doxycycline or ciprofloxacin is recommended. Individuals who have not yet developed symptoms may benefit from prophylactic use of oral doxycycline or ciprofloxacin.

What is the primary terroristic threat from ricin?

There is currently no vaccine. Ricin is a toxin present in castor beans, which is produced by Ricinus communis, the castor bean plant. The toxin is manufactured by extraction from the "mash" left behind when castor beans are processed to make castor oil. There is currently no vaccine for this poison and treatment is purely supportive.

What primary health risk does the nurse monitor for in the survivors of a nuclear bomb attack that occurred over a decade ago?

Thyroid cancer Ionizing radiation causes acute radiation syndromes and radiation sickness characterized by nausea, vomiting, diarrhea, fatigue, dehydration, inflammation, skin burns, hair loss, and ulceration of the mouth, esophagus, and gastrointestinal tract. Symptoms develop over days to weeks. For those who survive, radiation exposure increases the risk of cancer. Radioactive fallout, mainly iodine-131, poses a delayed risk of thyroid cancer. Once in the body, iodine-131 becomes concentrated in the thyroid gland where it can cause thyroid cancer.

What information should the nurse include when teaching about cancer risks in postmenopausal women?

Unopposed estrogen increases the risk of endometrial cancer. The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer. Estrogens used alone are not associated with increased risk of breast cancer. Estrogen in combination with progestin is associated with an increased risk of breast cancer. When estrogen is combined with progestin, the risk of endometrial cancer diminishes.