Contraceptive Therapy

Question 4 of 9 Which time frame represents the anticipated elimination half-life of most testosterone products? 1 to 5 minutes 10 to 100 minutes 120 to 150 minutes 180 to 240 minutes

10 to 100 minutes Most testosterone products have an anticipated elimination half-life of 10 to 100 minutes. One exception to this is intramuscular testosterone cypionate, which has an elimination half-life of 8 days.

Question 6 of 12 Which patients does a nurse determine cannot safely receive treatment with the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®)? Select all that apply. A 33 year old with epilepsy A 36 year old with hepatitis A A 35 year old with hyperthyroidism A 37 year old with complicated mitral valve prolapse A 36 year old who smokes one pack of cigarettes per day A 26 year old with attention-deficit/hyperactivity disorder

A 36 year old with hepatitis A A 37 year old with complicated mitral valve prolapse A 36 year old who smokes one pack of cigarettes per day

Question 3 of 5 Which patients would a nurse determine cannot safely receive therapy with testosterone as part of fertility therapy? Select all that apply. A 52-year-old with osteoporosis A 55-year-old with prostate cancer A 48-year-old with a hematocrit of 56% A 46-year-old with type 1 diabetes mellitus A 49-year-old with gastroesophageal reflux disease

A 55-year-old with prostate cancer A 48-year-old with a hematocrit of 56%

Question 3 of 4 Which statements regarding the absorption of the various formulations of testosterone are accurate? Select all that apply. Absorption is slow when the drug is given intramuscularly. Oral absorption of testosterone may be reduced when taken with food. Absorption is continuous over 24 hours when testosterone is administered with a patch. The buccal formulation of testosterone allows for quick release of the drug over the course of the day. Administration of testosterone as a gel results in quick drug release across the skin.

Absorption is slow when the drug is given intramuscularly. Oral absorption of testosterone may be reduced when taken with food. Absorption is continuous over 24 hours when testosterone is administered with a patch.

Question 11 of 12 Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus norelgestromin patch (Ortho Evra®) who is switching from an oral combined hormonal contraception (CHC)? Select all that apply. The patch should be applied to the breast for 3 weeks, followed by 1 week of no patch. Before applying, the patient should ensure the skin is dry and free from lotions, creams, or oils. Apply the patch on the first day of the menstrual cycle when bleeding occurs. No backup contraception is needed. If the patch comes off and has not been off for more than 24 hours, it should be reattached. Backup contraception is not needed. If the patch comes off and remains off for more than 24 hours, a new cycle should be started with backup contraception needed for 7 days.

Before applying, the patient should ensure the skin is dry and free from lotions, creams, or oils. Apply the patch on the first day of the menstrual cycle when bleeding occurs. No backup contraception is needed. If the patch comes off and has not been off for more than 24 hours, it should be reattached. Backup contraception is not needed. If the patch comes off and remains off for more than 24 hours, a new cycle should be started with backup contraception needed for 7 days.

Question 1 of 3 Which statement accurately describes the pharmacokinetic parameters of the ethinyl estradiol plus norelgestromin patch (Ortho Evra®)? Application is fastest through the skin of the abdomen. Both hormones are minimally protein bound. The hormones undergo hepatic first-pass metabolism through transdermal administration. Both hormones are excreted in the urine and feces.

Both hormones are excreted in the urine and feces. This statement is accurate because both hormones are excreted in the urine and the feces.

Question 2 of 5 Which teaching points will the nurse share with Mrs. Shell about clomiphene citrate therapy? Select all that apply. Clomiphene citrate therapy may result in multiple births. Significant fatigue may occur with clomiphene citrate therapy. If pregnancy is suspected, a health care provider should be contacted. A reduction in muscle strength may occur with clomiphene citrate. The drug should be taken at the same time each day to allow for sustained blood levels.

Clomiphene citrate therapy may result in multiple births. Significant fatigue may occur with clomiphene citrate therapy. If pregnancy is suspected, a health care provider should be contacted. The drug should be taken at the same time each day to allow for sustained blood levels.

Question 3 of 4 A patient who takes carbamazepine for epilepsy has purchased levonorgestrel to use as emergency contraception. Which outcome does a nurse anticipate may occur in a patient taking levonorgestrel with carbamazepine? Increased carbamazepine levels Decreased carbamazepine levels Decreased efficacy of levonorgestrel Increased risk for venous thromboembolism

Decreased efficacy of levonorgestrel Carbamazepine is a CYP450 inducer and may reduce the efficacy of levonorgestrel, rendering it ineffective in the setting of emergency contraception.

Question 1 of 4 Which indications can testosterone undecanoate be used to treat? Select all that apply. Catabolism Hypogonadism Ovulatory dysfunction Delayed male puberty Testicular failure for hormone replacement

Hypogonadism Delayed male puberty

Question 8 of 12 Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®) who has never received hormonal contraception before? Select all that apply. Upon initiation, the patient does not need to use backup contraception. If it is expelled during treatment weeks, it may be washed off with warm water and reinserted. She should vaginally insert the ring between day 1 and day 5 of the menstrual cycle, even if she is bleeding. The ring should be replaced every 3 weeks, removing for 1 week at the end of this time frame before inserting a new one. If the ring is expelled for more than 3 hours during week 1 or 2 of use, she should reinsert the ring and use backup contraception for 7 days.

If it is expelled during treatment weeks, it may be washed off with warm water and reinserted. She should vaginally insert the ring between day 1 and day 5 of the menstrual cycle, even if she is bleeding. The ring should be replaced every 3 weeks, removing for 1 week at the end of this time frame before inserting a new one. If the ring is expelled for more than 3 hours during week 1 or 2 of use, she should reinsert the ring and use backup contraception for 7 days.

Question 10 of 12 Which statement by the nursing student about the administration of norethindrone tablets (Micronor®) requires correction and further education? If the patient vomits the tablet, backup contraception must be used for 48 hours. If the postpartum patient is fully breastfeeding, she may begin using norethindrone tablets within 3 weeks of delivery. The patient should begin taking the tablets on the first day of menses. If initiated on any other day, backup contraception is needed for the next 48 hours. The tablet should be taken at the same time each day. If the patient is more than 3 hours late, she should take it as soon as she remembers with backup contraception needed for 48 hours.

If the postpartum patient is fully breastfeeding, she may begin using norethindrone tablets within 3 weeks of delivery. This statement is incorrect, so the nursing student requires further education. Postpartum women who are fully breastfeeding can begin using norethindrone tablets within 6 weeks, not 3 weeks, of delivery. Patients who are partially breastfeeding can begin treatment within 3 weeks postpartum.

Question 7 of 9 A nurse is caring for a patient who has been prescribed clomiphene citrate for infertility. The patient also takes methyldopa for hypertension. Which outcome would a nurse anticipate may come from the drug interaction between methyldopa and clomiphene citrate? Impaired fertility due to an increase in prolactin Increased drug level of methyldopa causing hypotension Decreased drug level of methyldopa causing blood pressure to increase Increase in clotting factors leading to increased risk for deep vein thrombosis

Impaired fertility due to an increase in prolactin Patients who are taking methyldopa and clomiphene citrate are at risk for an increase in prolactin, which can impair fertility.

Question 4 of 5 A nurse is caring for a patient who is receiving lamotrigine, an antiepileptic, and testosterone cypionate. Which drug interaction and suggested intervention would the nurse recommend to the health care provider? Increased water retention, so the patient should monitor for edema Lowering of the seizure threshold, so the patient should be monitored for seizures Increased sex hormone-binding globulin, so an increase in testosterone therapy may be warranted Decreased sex hormone-binding globulin, so a decrease in testosterone therapy may be warranted

Increased sex hormone-binding globulin, so an increase in testosterone therapy may be warranted Antiepileptic drugs such as lamotrigine increase sex hormone-binding globulin leading to decreased testosterone levels. Therefore an increase in the dosage of testosterone dosage might be warranted. This would be determined by monitoring of the testosterone levels.

Question 1 of 9 Which description of clomiphene citrate's mechanism of action is accurate? Inhibits estrogen receptors in the hypothalamus and pituitary gland to secrete less follicle stimulating hormone (FSH) and luteinizing hormone (LH) to stimulate ovulation Stimulates estrogen receptors in the hypothalamus and pituitary gland to secrete less FSH and LH to stimulate ovulation Inhibits estrogen receptors in the hypothalamus and pituitary gland to secrete more FSH and LH to stimulate ovulation Stimulates estrogen receptors in the hypothalamus and pituitary gland to secrete more FSH and LH to stimulate ovulation

Inhibits estrogen receptors in the hypothalamus and pituitary gland to secrete more FSH and LH to stimulate ovulation Clomiphene citrate works to inhibit estrogen receptors in the hypothalamus and pituitary gland. As a result, the body falsely believes estrogen levels are low, causing the pituitary gland to secrete more FSH and LH. As a result of the elevated LH levels, the ovaries produce more egg follicles, which will be released during ovulation.

Question 3 of 3 Which statement about the pharmacodynamic parameters of medroxyprogesterone acetate is accurate? The drug begins working in about 2 hours. Medroxyprogesterone acetate's elimination half-life is 25 hours. The effects of one dose of medroxyprogesterone acetate last for up to 3 years. Intramuscular injection provides higher peak levels due to reabsorption of crystalline deposits.

Intramuscular injection provides higher peak levels due to reabsorption of crystalline deposits. Medroxyprogesterone acetate is administered as an intramuscular injection. It is a crystalline suspension and is not lipid or water soluble. The crystalline deposits in body tissues and then is reabsorbed. This drug provides higher peak levels of progestin compared to other progestin-only contraception products (POPs).

Question 1 of 12 Which statement accurately describes the pharmacokinetic parameters for levonorgestrel used as emergency contraception? The drug is slowly absorbed with oral administration. Levonorgestrel is minimally protein bound (<25%). The drug is subject to first-pass metabolism. Levonorgestrel is excreted in both urine and feces.

Levonorgestrel is excreted in both urine and feces. The drug is excreted in both the urine and the feces.

Question 1 of 5 Which medical conditions would the nurse ensure Mrs. Shell does not have as part of her pre-administration assessment? Select all that apply. Liver disease Autoimmune disorders Gastrointestinal disorders Abnormal uterine bleeding Uncontrolled thyroid/adrenal dysfunction

Liver disease Abnormal uterine bleeding Uncontrolled thyroid/adrenal dysfunction

Question 2 of 12 Which hormonal contraceptive has the longest elimination half-life? Norethindrone tablet (Micronor®) Etonogestrel implant (Nexplanon®) Medroxyprogesterone acetate injection (Depo Provera®) Ethinyl estradiol + etonogestrel vaginal ring (NuvaRing®)

Medroxyprogesterone acetate injection (Depo Provera®) Medroxyprogesterone acetate injection (Depo Provera®) has the longest elimination half-life of 50 days.

Question 5 of 9 A nurse is caring for a patient who has been prescribed oral methyltestosterone therapy for infertility. This patient also takes warfarin and lisinopril. Which outcome and intervention are recommended to manage a potential drug interaction with methyltestosterone? Methyltestosterone may increase the effects of warfarin; decrease the dosage of warfarin. Methyltestosterone may decrease the effects of warfarin; increase the dosage of warfarin. Methyltestosterone may increase the effects of lisinopril; decrease the dosage of lisinopril. Methyltestosterone may decrease the effects of lisinopril; increase the dosage of lisinopril.

Methyltestosterone may increase the effects of warfarin; decrease the dosage of warfarin. The effects of warfarin may be increased with methyltestosterone, and as a result, the dosage of warfarin would need to be decreased.

Question 1 of 4 Which potential side effects and adverse effects would a nurse share with Ms. Wilson regarding treatment with intramuscular medroxyprogesterone acetate (Depo Provera®)? Select all that apply. Weight loss Osteoporosis Injection-site reactions Delay of conception upon discontinuation of therapy Menstrual irregularities, particularly heavier menstrual bleeding

Osteoporosis Injection-site reactions Delay of conception upon discontinuation of therapy

Question 2 of 3 Which mechanisms of action describe how levonorgestrel works as emergency contraception? Select all that apply. Prevention of ovulation Prevention of fertilization Reduction in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peaks Inhibition of implantation through alteration of the endometrium Delay of the egg's travel through the fallopian tubes

Prevention of ovulation Prevention of fertilization Inhibition of implantation through alteration of the endometrium

Question 3 of 12 Which effects are advantages to the use of nonoral combined hormonal contraceptives (CHCs) over oral CHC? Select all that apply. Reduced risk for breast cancer Reduced drug interaction potential Rapidly achieved serum hormone levels Reduced risk for venous thromboembolism Decreased fluctuations of hormone levels in blood

Reduced drug interaction potential Rapidly achieved serum hormone levels Decreased fluctuations of hormone levels in blood

Question 4 of 12 Which advantages are associated with the use of progestin-only products (POPs) compared with combined hormonal contraceptives (CHCs)? Select all that apply. Relative safety of contraception Less irregular menstrual bleeding Increased efficacy of the contraceptive Protection against sexually transmitted infections Reversibility of contraception, except the depot POP

Relative safety of contraception Reversibility of contraception, except the depot POP

Question 12 of 12 Which teaching points would a nurse share with a patient who is taking levonorgestrel 0.75 mg PO BID for two doses for emergency contraception? Select all that apply. Remember to take the second dose within 12 hours of the first dose. Once implantation occurs, emergency contraception is not effective. Emergency contraception does not protect against sexually transmitted infections. Nausea, vomiting, and heavier menstruation may occur with emergency contraception. Increase calcium and vitamin D intake for the next 7 days because emergency contraception reduces bone mineral density.

Remember to take the second dose within 12 hours of the first dose. Once implantation occurs, emergency contraception is not effective. Emergency contraception does not protect against sexually transmitted infections. Nausea, vomiting, and heavier menstruation may occur with emergency contraception.

Question 9 of 12 Which potential symptoms resulting from treatment with a combined hormonal contraception (CHC) would a nurse teach a patient to report immediately to the health care provider? Select all that apply. Severe abdominal pain Dry mouth and metallic taste Chest pain or shortness of breath Severe leg pain or swelling in the calf or thigh Severe headaches, dizziness, speech difficulties Eye disorders such as blurry vision or loss of vision

Severe abdominal pain Chest pain or shortness of breath Severe leg pain or swelling in the calf or thigh Severe headaches, dizziness, speech difficulties Eye disorders such as blurry vision or loss of vision

Question 5 of 12 A 29-year-old woman with hypertension had unprotected sexual intercourse about 36 hours ago. Which statement accurately explains whether this patient is a candidate for emergency contraception? She is a candidate because she is less than 30 years old. She is not a candidate for emergency contraception because she has hypertension. She is a candidate for emergency contraception because it may be taken within 72 hours of unprotected sexual intercourse. She is not a candidate for emergency contraception because it is not effective when taken more than 24 hours after unprotected sexual intercourse.

She is a candidate for emergency contraception because it may be taken within 72 hours of unprotected sexual intercourse. This patient is a candidate for emergency contraception. It should ideally be taken within 72 hours of unprotected intercourse, which this patient's situation fits. The American College of Obstetricians and Gynecologists suggest that it should be offered to women within 5 days of unprotected sexual activities because there is modest efficacy through this time frame.

Question 2 of 4 Which patient parameters will a nurse ensure are assessed before the initiation of ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®)? Select all that apply. Alcohol intake Smoking status Reproductive history Current pregnancy status Bone mineral density value Complete medical, gynecologic, and obstetric history

Smoking status Reproductive history Current pregnancy status Complete medical, gynecologic, and obstetric history

Question 7 of 12 A female patient has been taking ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®) for contraception. She was recently prescribed rifampin for the prevention of tuberculosis because her husband was recently diagnosed with the infection. Which nursing interventions would be appropriate to address the reduction in contraception efficacy? Select all that apply. Switch to another form of contraception. Increase the estrogen dosage in the combined hormonal contraception (CHC). Reduce the dose of the progestin in the CHC. Advise her to monitor for breakthrough bleeding, which might indicate lack of CHC effect. Advise the patient to use a second form of contraception like a condom while receiving rifampin.

Switch to another form of contraception. Increase the estrogen dosage in the combined hormonal contraception (CHC). Advise her to monitor for breakthrough bleeding, which might indicate lack of CHC effect. Advise the patient to use a second form of contraception like a condom while receiving rifampin.

Question 4 of 4 A patient who has been taking ethinyl estradiol and norgestimate (Ortho Tri-Cyclen®) tablets calls a nurse to determine what she needs to do because she has missed two doses of her daily regimen. She is in week 2 of the contraceptive cycle and is a "Sunday starter." Which instructions would the nurse give the patient? Take 1 tablet as soon as she remembers. Continue taking 1 tablet daily and no backup contraception needed. Take the 2 missed tablets as soon as she remembers and then 1 tablet daily. No backup contraception is needed. Take the 2 missed tablets as soon as she remembers and the next 2 active tablets the next day. Continue taking daily until package is finished. Backup contraception should be used for 7 days. Continue taking 1 tablet daily until Sunday. Throw out pack and start a new pack. Backup contraception should be used for 7 days

Take the 2 missed tablets as soon as she remembers and the next 2 active tablets the next day. Continue taking daily until package is finished. Backup contraception should be used for 7 days. Because this patient has missed 2 active doses during week 2, she will take the 2 tablets as soon as she remembers and then 2 active tablets the next day. She will continue taking 1 tablet daily until the package in finished and will need backup contraception for the next 7 days.

Question 2 of 9 Which statement about the pharmacokinetic parameters of testosterone is accurate?Testosterone is highly protein bound.The drug is predominantly excreted in the feces.Testosterone undergoes hepatic metabolism and beta-oxidation.Oral administration of testosterone requires smaller doses because the drug does not undergo first-pass metabolism. NOT SURE

Testosterone undergoes hepatic metabolism and beta-oxidation. This statement is accurate because testosterone undergoes metabolism in the liver and beta-oxidation. The drug is metabolized to dihydrotestosterone and estradiol.

Question 8 of 9 Which administration considerations would be given to a nurse who is caring for a patient initiated on clomiphene citrate? Select all that apply. The dose may be taken with or without food. The maximum number of sequential cycles of clomiphene citrate is three. Clomiphene citrate should be given on days 1 through 5 of the menstrual cycle. Each new regimen may not begin sooner than 15 days after the previous regimen. The initial dose of 50 mg once daily and may be increased by 50 mg/day for a second course if ovulation does not occur. Ovulation typically occurs within 5 to 10 days after the last dose, and intercourse should take place at least every other day.

The dose may be taken with or without food. The maximum number of sequential cycles of clomiphene citrate is three. The initial dose of 50 mg once daily and may be increased by 50 mg/day for a second course if ovulation does not occur. Ovulation typically occurs within 5 to 10 days after the last dose, and intercourse should take place at least every other day.

Question 6 of 9 Which teaching points would a nurse share with a patient who has diabetes and is initiated on a gel formulation of testosterone? Select all that apply. The drug can be transferred to others if is not completely dry. The patient should not abruptly discontinue therapy with testosterone. The patient should monitor his weight and report any weight gain of more than 5 lbs in a week. The patient should have his testosterone levels monitored within 2 to 4 weeks after starting the drug. The patient should monitor his glucose more carefully because testosterone may cause hyperglycemia.

The drug can be transferred to others if is not completely dry. The patient should not abruptly discontinue therapy with testosterone. The patient should monitor his weight and report any weight gain of more than 5 lbs in a week. The patient should have his testosterone levels monitored within 2 to 4 weeks after starting the drug.

Question 2 of 4 Which statement accurately describes the pharmacokinetic parameters of clomiphene citrate?The drug is readily absorbed following oral administration.Clomiphene citrate's volume of distribution is very small.The drug does not undergo metabolism.Clomiphene citrate is predominantly excreted in the urine.

The drug is readily absorbed following oral administration. This statement is accurate because clomiphene citrate is readily absorbed when administered orally.

Question 3 of 9 Which statements about the therapeutic use and pharmacodynamic parameters of clomiphene citrate are accurate? Select all that apply. The drug's elimination half-life is 5 to 7 days. Clomiphene citrate's duration of action is 30 days. Clomiphene citrate's onset of action is 6 to 12 hours. The drug is indicated for use in women with persistent ovulatory dysfunction to stimulate ovulation. When administered to women with polycystic ovary syndrome (PCOS) who are on metformin, the success rate of ovulation is increased.

The drug's elimination half-life is 5 to 7 days. Clomiphene citrate's duration of action is 30 days. The drug is indicated for use in women with persistent ovulatory dysfunction to stimulate ovulation. When administered to women with polycystic ovary syndrome (PCOS) who are on metformin, the success rate of ovulation is increased.

Question 9 of 9 Which patient parameters would a nurse inquire about when a patient returns to have his testosterone levels monitored? Select all that apply. Thyroid function Weight changes Mood alterations Blood glucose readings Blood pressure changes

Weight changes Mood alterations Blood glucose readings Blood pressure changes

Question 4 of 4 Which molecules that serve as templates for protein production undergo enhanced synthesis by testosterone? DNA mRNA tRNA rRNA

mRNA Once testosterone is bound to androgen receptors, the testosterone-receptor complex moves from the cytoplasm to the cell nucleus where it acts on DNA to enhance synthesis of mRNA molecules. These molecules serve as templates for protein production to mediate the effects of testosterone.