ATI - The Reproductive and Genitourinary Systems

A nurse is caring for a client who has a new prescription for transdermal conjugated estrogen and medroxyprogesterone to treat postmenopausal symptoms. The nurse should explain to the client that this drug combination includes which of the following therapeutic effects? (Select all that apply). A. Reduces the risk of ovarian cancer B. Relieves hot flashes C. Prevents osteoporosis D. Reduces the risk of breast cancer E. Reduces the risk of thromboembolism

A, B, C Drug therapy with an estrogen and progesterone combination reduces the risk of ovarian cancer. However, the use of estrogen alone without progesterone can increase the risks of endometrial and ovarian cancer. Drug therapy with an estrogen and progesterone combination or estrogen alone reduces hot flashes and the sweating and sleep disturbances they cause. Drug therapy with an estrogen and progesterone combination or estrogen alone increases bone density and prevents osteoporosis.

A nurse is providing safety education to a client who is scheduled to begin treatment with tamsulosin for benign prostatic hypertrophy (BPH). Which of the following instructions should the nurse include in the teaching? A. Change positions slowly B. Crush the medication C. Take the medication on an empty stomach D. Report increased urinary output immediately

A. Change positions slowly Alpha adrenergic blockers such as tamsulosin are also used to treat hypertension. These drugs can cause the blood pressure to drop, leading to orthostatic hypotension. Therefore, the nurse should instruct the client to change positions slowly to prevent harm.

A provider has prescribed a dinoprostone vaginal insert to promote cervical ripening in a client who is at 40 weeks of gestation. When administering dinoprostone, which of the following actions should the nurse take? (Select all that apply). A. Encourage the client to urinate prior to insertion. B. Remove the pouch when active labor begins. C. Monitor for uterine hyperstimulation. D. Encourage the client to walk after insertion. E. Monitor the client's temperature.

A, B, C, E The client should urinate prior to the insertion of the dinoprostone pouch. This action does not specifically relate to the therapeutic effects of the drug, but it promotes comfort and prevents interruption of the administration protocol. The nurse should remove the pouch when active labor begins or 12 hr after the insertion of the dinoprostone, whichever is sooner. Uterine stimulation can cause fetal distress. The nurse should monitor uterine activity and fetal heart rate and remove the insert for fetal distress or uterine hyperstimulation. Dinoprostone can cause a fever. The nurse should monitor the client's temperature and report any changes to the provider.

A nurse is providing teaching to a client who is taking bethanechol for urinary retention. Which of the following instructions should the nurse include? (Select all that apply). A. Avoid driving and activities that require alertness. B. Increase fluid intake. C. Take the drug with food. D. Stay close to a bathroom after taking the drug. E. Increase weight-bearing activities.

A, B, D Bethanechol, a muscarinic agonist, can cause dizziness and fainting. Clients who take the drug should use caution with activities that require alertness until they know how the drug will affect them. Bethanechol can cause diarrhea and increased salivary and gastric secretions. Clients who take the drug should maintain hydration by increasing their fluid intake. Bethanechol can cause rapid relief of urinary retention or diarrhea, with fecal incontinence. Clients who take the drug should stay near a bathroom or have a bedpan or urinal ready.

A nurse should question the use of ethinyl estradiol and drospirenone by a client who has renal disease due to the increased risk of which of the following? A. Hyperkalemia B. Hyponatremia C. Hypoglycemia D. Respiratory alkalosis

A. Hyperkalemia Ethinyl estradiol and drospirenone can cause potassium retention, so a client who has renal, adrenal, or liver disease should not take the drug combination. The nurse should monitor the serum potassium levels of a client taking the drug and use it with caution with other drugs that can increase serum potassium, such as potassium-sparing diuretics.

A nurse is providing teaching to a client about using leuprolide to treat endometriosis. Which of the following instructions should the nurse include? A. Perform weight-bearing activities. B. Wear sunscreen or protective clothing. C. Take the drug with food to increase absorption. D. Avoid drinking grapefruit juice.

A. Perform weight-bearing activities Leuprolide suppresses estrogen and can cause bone loss. The nurse should instruct the client to perform weight-bearing activities and increase their intake of calcium and vitamin D.

A nurse is caring for a client who is about to begin taking finasteride to treat benign prostatic hypertrophy. The nurse should explain to the client the need to monitor which of the following laboratory values? A. Prostate-specific antigen (PSA) B. BUN C. Creatinine phosphokinase (CPK) D. ALT

A. Prostate-specific antigen (PSA) The nurse should monitor PSA levels at baseline and periodically thereafter. Increases in PSA can indicate prostate cancer. PSA levels should decrease with finasteride therapy. BUN

A nurse is teaching a client about receiving leuprolide to treat endometriosis. The nurse should instruct the client to expect which of the following side effects? A. Vaginal dryness B. Hypertension C. Blurred vision D. Orthostatic hypotension

A. Vaginal dryness Leuprolide can cause vaginal dryness. The nurse should suggest that the client use water-based vaginal lubricants to help minimize this effect.

After administering terbutaline to a client to inhibit preterm labor, the nurse should assess which of the following? A. Peripheral pulses B. Temperature C. Vision D. Heart rate

D. Heart rate Terbutaline can cause tachycardia, chest pain, and palpitations. The nurse should monitor the client's ECG for tachycardia and other dysrhythmias and monitor fetal heart rate and rhythm.

A nurse is teaching a client who has a new prescription for transdermal testosterone gel to treat delayed puberty. Which of the following instructions should the nurse include? (Select all that apply). A. "Apply the gel to the scrotum." B. "Cover the area of application with clothing." C. "Wash your hands after applying the gel." D. "Do not shower for several hours after applying the gel." E. "Apply the gel to the gums above an upper incisor."

B, C, D Clothing helps to prevent exposing others to the drug. Clients should let the gel dry before covering the application site with a shirt. Clients should wash their hands after application to prevent exposing others to the drug. Clients should not shower or swim for several hours following application of transdermal testosterone gel to avoid washing off the gel.

A nurse is assessing a client who has a new prescription of oxybutynin to treat neurogenic bladder. Which of the following assessment findings should the nurse identify as an adverse effect of the drug? (Select all that apply). A. Diaphoresis B. Dilated pupils C. Dizziness D. Distended bladder E. Fever

B, C, D, E Oxybutynin can cause mydriasis or dilated pupils, dry eyes, and blurred vision. Clients who take the drug should use lubricating eye drops to help reduce dryness. Oxybutynin can cause dizziness and drowsiness. Clients who take the drug should use caution with activities that require alertness until they know how the drug will affect them. Oxybutynin can cause urinary retention and bladder distention. Oxybutynin can cause heat exhaustion and fever. Clients who take the drug should use it with caution in hot weather.

A nurse is caring for a male client who has hyperthyroidism and is not responding to treatment. The nurse should identify that hyperthyroidism is a contraindication for which of the following drugs? A. Sildenafil B. Bethanechol C. Tamsulosin D. Finasteride

B. Bethanechol Bethanechol, a cholinergic drug, can cause cardiac dysrhythmias in clients who have hyperthyroidism by triggering the release of norepinephrine. This reaction does not occur in clients who do not have hyperthyroidism.

A nurse is providing teaching to a client about sildenafil to treat erectile dysfunction. Which of the following instructions should the nurse include? A. Take the drug with a glass of grapefruit juice. B. Do not take the drug with high-fat foods. C. Increase intake of foods rich in vitamin K. D. Avoid aged cheeses and red wine.

B. Do not take the drug with high-fat foods. High-fat foods delay absorption and reduce peak effects of sildenafil. Clients who take the drug should not take it with high-fat foods.

A nurse is caring for a client who has benign prostatic hypertrophy and is taking tamsulosin. The nurse should question the use of the drug if the client also has which of the following? A. A seizure disorder for which he takes carbamazepine B. Erectile dysfunction for which he takes sildenafil C. Diabetes mellitus for which he takes glyburide D. Angle-closure glaucoma for which he takes pilocarpine

B. Erectile dysfunction for which he takes sildenafil Drugs that lower blood pressure, such as sildenafil, can exacerbate hypotension in combination with tamsulosin. Clients who take sildenafil should not take tamsulosin.

A nurse is assessing a client who has a new prescription for the combination oral contraceptive ethinyl estradiol and drospirenone. Which of the following findings should the nurse identify as a contraindication to use of this medication? A. Drinks a glass of wine each night B. Smokes half a pack of cigarettes a day C. Runs marathons regularly D. Drives a school bus

B. Smokes half a pack of cigarettes a day Smoking increases the risks of thromboembolic events, hypertension, and cardiovascular disease for clients who are taking combination oral contraceptives, especially for those clients who are older than 35 years. Clients should quit smoking before starting this drug therapy.

A nurse is caring for a client who is about to begin taking cabergoline to treat infertility. The nurse should explain to the client the need to monitor which of the following laboratory values? A. Potassium B. Glucose C. BUN and creatinine D. Prolactin level

D. Prolactin level Cabergoline inhibits the secretion of prolactin. The provider should monitor prolactin levels to determine the appropriate dosage.

A nurse is caring for a client who received human menopausal gonadotropin (hMG). Which of the following findings should the nurse expect? A. Prolactin secretion B. Estrogen release C. Follicular maturation D. Oxytocin secretion

C. Follicular maturation Before a client receives human chorionic gonadotropin (hCG) to stimulate ovulation, they must receive a drug that induces follicular maturation, such as hMG, which is a mixture of LH and FSH, clomiphene, or follitropin. Clients receive hCG 1 day after the last dose of hMG or follitropin or 7 to 9 days after the last clomiphene dose.

A nurse is teaching a client about conjugated estrogen and medroxyprogesterone. Which of the following instructions should the nurse include? A. Monitor for rectal bleeding. B. Avoid drinking alcoholic beverages. ​C. Have blood pressure checked regularly. D. Sit up for 30 min after taking the drug.

C. Have blood pressure checked regularly ​Using conjugated estrogen and medroxyprogesterone, a combination of estrogen and progestin for hormone replacement, can cause hypertension. Clients taking the drug combination should have their blood pressure checked regularly and report headache or edema.

A nurse is caring for a client who is about to begin clomiphene therapy to treat infertility. The nurse should monitor the client for which of the following adverse effects? A. Breast cancer B. Deep-vein thrombosis C. Ovarian hyperstimulation syndrome D. Restless leg syndrome

C. Ovarian hyperstimulation syndrome Pelvic pain can indicate ovarian hyperstimulation and can lead to ovarian cyst rupture. The nurse should monitor a client who is taking clomiphene for ovarian enlargement and advise them to seek medical attention immediately for sudden or severe pelvic pain.

A nurse is caring for a client who missed a dose of her oral contraceptive. Which of the following instructions should the nurse give the client? A. Take a pregnancy test B. Double up on pills for remainder of the pack C. Take the missed dose as soon as possible D. Stop the oral contraceptive and use a different contraceptive

C. Take the missed dose as soon as possible The nurse should tell the client to take the missed dose along with the next dose. Should the client miss two doses, she should take an additional dose each day for the next 2 days and add an additional method of birth control for the remainder of the cycle.

A nurse is caring for a client who has a new prescription for conjugated equine estrogen. The nurse should instruct the client to report which of the following indications of a serious adverse reaction? A. Hot flashes B. Urinary tract infection C. Vaginal bleeding D. Bone pain

C. Vaginal bleeding Estrogen hormone replacement therapy increases the risk of endometrial cancer. The nurse should instruct clients using the drugs to report recurrent or persistent vaginal bleeding and pelvic pain.

A nurse is preparing to administer finasteride to a client who has benign prostatic hypertrophy (BPH). Which of the following precautions should the nurse plan to take when administering this drug? A. Administer medication while client is sitting or reclining. B. Withhold the medication if the client doesn't eat. C. Wear gloves when handling the tablet. D. Monitor heart rate prior to administration.

C. Wear gloves when handling the tablet. The nurse should avoid touching the drug because it can be absorbed through the skin. For women, this can potentially cause harm if they are pregnant and have a male fetus. Women should also avoid exposure to semen from individuals who are taking finasteride.

A nurse is teaching a client who has a new prescription for a testosterone transdermal patch. Which of the following statements made by the client indicates an understanding of the teaching? A. "I should have pancreatic function tests obtained while taking this drug." B. "I should have my white blood cell count checked annually." C. "I should take off the patch to shower." D. "I should apply the medication to a different site each time."

D. "I should apply the medication to a different site each time." The client should rotate the application sites with each application to prevent skin irritation.

A nurse is caring for a client who is taking combination oral contraceptive ethinyl estradiol and drospirenone and is about to begin taking rifampin to treat tuberculosis. Which of the following instructions should the nurse give the client due to a possible drug interaction? A. "Increase the rifampin dose." B. "Increase the oral contraceptive dose." C. "Wait 2 hours between taking each drug." D. "Use additional birth control methods."

D. "Use additional birth control methods." Rifampin can increase the metabolism of oral contraceptives, reducing the effectiveness. Clients who are taking oral contraceptives and rifampin should use additional contraceptive methods to prevent an unwanted pregnancy. Other drugs that can reduce the effects of oral contraceptives include some antifungal agents and anticonvulsants.

A nurse should question the use of conjugated equine estrogen by a client who has a history of which of the following? A. Osteoporosis B. Peptic ulcer disease C. Rheumatoid arthritis D. Blood clots

D. Blood clots Clients who have a history of thromboembolic disease should not use estrogen replacement therapy because of the risks of thrombophlebitis, myocardial infarction, pulmonary embolism, and cerebrovascular accident.