Pharmacology: Chapter 40: Drugs Affecting the Female Reproductive System
A nurse has administered a prescribed dose of dinoprostone intravaginally. What outcome best indicates a therapeutic response? a.The client expresses relief from menopausal symptoms. b.The client's contractions are less than 5 minutes apart. c.The client's pregnancy is terminated. d.The client does not become pregnant within the next 6 months.
c. The client's pregnancy is terminated. Response Feedback:Dinoprostone is the prototype abortifacient; the goal of administration is to terminate the pregnancy, not to stimulate labor or prevent future pregnancy.
The nurse is preparing to administer clomiphene to the female client. What dosage would the nurse find is within usual dosage range? a.100 mg b.10 mg c.1 mg d.0.1 mg
Ans: A Feedback: The usual dosage range for clomiphene is 50 to 100 mg/d PO with length of therapy and timing dependent on the particular situation. Options B, C, and D are not correct.
The client asks the nurse, "Why shouldn't I smoke when taking estrogen? I mean, are the risks really that high?" What is the nurse's best response? a."The risk is truly that high because estrogen increases serum triglyceride, cholesterol, and glucose levels." b."The risk is high because estrogen stimulates skeletal growth, causing increased production of red blood cells (RBCs), a problem that is called polycythemia." c."The risk is pretty high because estrogen decreases blood levels of several clotting factors." d."There is a documented high risk because estrogen combined with nicotine creates a significant risk for blood clots."
Ans: D Feedback: Smoking while taking estrogens should be strongly discouraged, because the combination of therapeutic estrogen with nicotine increases the risk for development of thrombi and emboli and this risk is well documented and researched. The risk is not due to skeletal growth, decreased clotting factors, or an impact on triglycerides, cholesterol, or glucose.A decrease in clotting factors would create a risk for bleeding, not thromboembolism.
The nurse assesses the postpartum client who has been receiving ergonovine and suspects ergotism when what manifestations are found? Select all that apply. a.Weak pulse b.Dyspnea c.Numb cold extremities d.Chest pain e.Postpartum hemorrhage
Ans: A, B, C, D Feedback: Ergonovine and methylergonovine can produce ergotism, manifested by nausea, blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, and even coma. Postpartum hemorrhage can occur as an adverse effect of ergonovine but is not a manifestation of ergotism.
The nurse is providing client teaching for a woman who will begin receiving Depo-Provera injections. When should the nurse schedule the appointment for the next injection? a.1 month from last injection b.3 months from last injection c.6 months from last injection d.12 months from last injection
Ans: B Feedback: Depo-Provera is administered by deep intramuscular (IM) injection every 3 months. Options A, C, and D are not correct.
The nurse is preparing to administer an infusion of oxytocin (Pitocin) to the pregnant client. What is the priority assessment before beginning the infusion? a.Cervical dilation b.Cephalopelvic proportions c.Electrocardiogram readings d.Respiratory excursion
Ans: B Feedback: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated so this is not a priority assessment, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting cardiac condition.
The nurse is preparing to give a client an injection of carboprost. What is the nurse's priority action before administering the drug? a.Explain the ethical indications of the drug b.Assess for contraindications or cautions c.Verify that the woman thoroughly understands what will happen d.Draw up the medication and inject within 5 minutes
Ans: C Feedback: Carboprost is an abortifacient and it is important that the woman understand what will happen after the drug is taken and that she cannot change her mind. Contraindications and cautions should have been checked before the drug was prescribed. It is not the nurse's place to share ethical beliefs with the patient. After the patient's understanding is verified, the drug can be prepared.
When caring for a client on estrogen therapy, what is the nurse's priority assessment? a.Blood glucose levels b.Bowel sounds c.Weight d.Therapeutic drug effects
Ans: D Feedback: Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. Bowel sounds, weight, and blood sugar may be part of the assessment, but it is most important to assess for therapeutic and adverse effects of the medication.
The client calls the clinic and says she just started oral contraceptives the previous month and is experiencing breakthrough bleeding, fluid retention resulting in edema, changes in libido, and palpitations. What symptom would the nurse recognize as being caused by a factor other than adverse effects of the oral contraceptive? a.Breakthrough bleeding b.Fluid retention c.Changes in libido d.Palpitations
Ans: D Feedback: Palpitations are not commonly associated with contraceptives and so the patient would need to be seen and evaluated. The most common adverse effects of estrogens include breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, and changes in libido. Other adverse effects can result from the systemic effects of estrogens, including fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, and edema. GI effects also are fairly common and include nausea, vomiting, abdominal cramps and bloating, and colitis. Potentially serious GI effects, including acute pancreatitis, cholestatic jaundice, and hepatic adenoma, have been reported with the use of estrogens.
A client presents to the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the client should be the priority concern for the nurse? a.The client smokes 8 to 10 cigarettes a day. b.The client has gained 10 lb in the last 3 months. c.The client admits to a pattern of occasional binge-eating. d.The client states that she exercises "almost never."
Ans: A Feedback: All these options are poor health habits and will impact the patient's health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 pounds, a craving for sugar, and a decrease in exercise would not be as immediate a concern although the nurse should address these issues.
The nurse is caring for an infertile couple who will take chorionic gonadotropin to become pregnant. How should the nurse describe the actions of this drug? a.Affecting FSH and LH release b.Stimulating follicular development c.Stimulating maturation of ova d.Stimulating multiple follicle development
Ans: A Feedback: Chorionic gonadotropin is used to stimulate ovulation by acting like gonadotropin-releasing hormone (GnRH) and affecting FSH and LH release. It does not stimulate follicular development, maturation of the ova, or multiple follicle development.
When the nurse learns the male client takes conjugated estrogens, the nurse questions the client about what disorder? a.Prostate cancer b.Breast cancer c.Osteoporosis d.Andropause
Ans: A Feedback: Conjugated estrogen is most commonly taken by men to treat prostate cancer because the estrogen competes with testosterone for binding sites. Although men do get breast cancer and osteoporosis, they would not be treated with estrogen for these disorders. Andropause is caused by a reduction in testosterone so they would get a male hormone replacement and not estrogen.
The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The client is on a low-residue diet for colitis. What factor in the client's history may contraindicate the use of birth control pills? a.Migraine headaches b.Age c.Asthma d.Colitis
Ans: A Feedback: Progestins should be used with caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.
The nurse is developing a nursing plan of care for a client who will receive a fast-acting abortifacient. What nursing diagnosis is most likely to apply to care provided shortly after administering the medication? a.Acute pain related to uterine contractions b.Disturbed body image related to termination of pregnancy c.Risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis d.Deficient knowledge on drug therapy
Ans: A Feedback: The rapid-acting abortifacients work within 10 to 15 minutes , so shortly after administration of the drug, the patient will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur. Deficient knowledge regarding drug therapy should have been addressed before administering the medication. There is no reason to presume that the client's body image will be affected. Ineffective coping usually occurs after acute symptoms subside and the patient begins to cope with the decision.
The nurse, working in a women's health center, is reviewing the client's medical record. The presence of what health problems would contraindicate the safe use of an abortifacient? Select all that apply. a.Active pelvic inflammatory disease (PID) b.Acute bronchitis c.Recent myocardial infarction d.Orthostatic hypotension e.Type 2 diabetes
Ans: A, B, C Feedback: Abortifacients should not be used with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Caution should be used with any history of asthma, hypertension, or adrenal disease. Orthostatic hypotension or type 2 diabetes would not contraindicate the use of an abortifacient.
The nurse is caring for a client who is extremely agitated about finding out she is pregnant and wants to take an abortifacient that will have the fastest possible action. What drug will the nurse expect to be ordered? a.Mifepristone b.Carboprost c.Prostin 15 d.Bepridil
Ans: B Feedback: Carboprost is available as an intramuscular injection with an onset of 15 minutes and a 2-hour duration of effect. Mifepristone takes 5 to 7 days to produce the desired effect so would not be appropriate for this patient. Prostin 15 is only available in Europe. Bepridil is a calcium channel blocker and would not be used as an abortifacient.
The client presents to the women's health clinic to ask about emergency contraception. The client is prescribed levonorgestrel (Plan B). What should the nurse teach the client about this medication? a.Take one tablet as soon as possible after unprotected intercourse. b.Take one tablet within 72 hours of unprotected intercourse and another 12 hours later. c.Take one tablet whenever you are likely to have unprotected intercourse in the next 12 hours. d.Make sure that any effects of alcohol have fully worn off before you take the prescribed tablet.
Ans: B Feedback: Levonorgestrel (Plan B) is taken within 72 hours of unprotected intercourse with another tablet taken 12 hours after the first. Levonorgestrel (Plan B One-Step) is taken once within 72 hours after unprotected intercourse and is available OTC for patients 17 years and older. Ulipristal (Ella) is taken once within 5 days of unprotected intercourse. It is not taken before unprotected intercourse. Taking it while alcohol is still be metabolized is not contraindicated.
A client with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse's best response? a."Taking phenytoin at the same time as oral contraceptives could make the adverse effects worse." b."The effectiveness of oral contraceptives might be reduced by phenytoin." c."You're likely to have an increase in your risk for seizures, so check with your neurologist first." d."Check with the prescriber, but you will likely need to increase the dosage of your phenytoin once you start contraceptives."
Ans: B Feedback: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin, and doing so could increase the client's risk for seizures. Phenytoin would not make the adverse effects of oral contraceptives worse.
A client with a history or perimenopausal symptoms tells the nurse she is taking soy, calcium, and a multivitamin as an alternative to taking hormone replacement pills. What is the nurse's priority response? a.Increase her iron supplement b.Discontinue her calcium supplement c.Decrease the amount of carbohydrates in her diet d.Increase calcium supplementation
Ans: B Feedback: The nurse may advise the patient to stop using a calcium supplement because soy is not to be taken with calcium, iron, or zinc. However, the patient may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates is a healthy choice, especially for a menopausal woman, but would not be the priority concern.
The nurse is caring for a client with an intact uterus who requests hormone replacement for short-term use to reduce menopausal symptoms. What combination drug would be appropriate for this client? a.Estrace b.Premphase c.Premarin d.Estratab
Ans: B Feedback: The patient would be given Premphase because it is a combination of estrogen and progesterone. The combination is important to help avoid risk of endometrial hyperplasia. Estrace, Premarin, and Estratab contain only estrogen so they are not combination drugs.
A client is using a progestin vaginal gel. What possible adverse effect should the nurse tell the client about? a.Diarrhea b.Breast enlargement c.Abdominal pain d.Local skin irritation
Ans: B Feedback: The use of a progestin vaginal gel is associated with breast enlargement. Constipation, not diarrhea, is also an adverse effect. Abdominal pain with progestin therapy is associated with the use of an intrauterine device for birth control, not a vaginal gel. Local skin irritation can result from use of a dermal patch contraceptive.
The nurse is caring for a postmenopausal client taking estradiol (Estrace) to reduce signs and symptoms of menopause. The nurse should teach the client that there is also a reduction in her risk for: a.endometriosis. b.dysfunctional uterine bleeding. c.osteoporosis. d.uterine cancer.
Ans: C Feedback: Estrogen slows the bone loss seen with osteoporosis so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer and screening for cancer should be performed before prescribing this drug.
The nurse has been conducting client teaching for a 16-year-old who is starting oral contraception. What statement indicates that the client needs additional teaching? a."I will monitor my weight and have my blood pressure checked regularly." b."I will see my woman's health provider and have a Pap smear done on a yearly basis." c."If I forget to take my pill for two consecutive days, I will take three pills to catch up." d."I will take the pill every day at the same time and aim to never miss a pill."
Ans: C Feedback: If one tablet is missed, take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the patient understood the nurse's teaching.
The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? a.The client describes a positive attitude toward sexual behavior. b.The client can explain how medication cannot prevent most sexually transmitted infections. c.The client can verbalize how and when to take medication even if a pill is missed. d.The client makes the necessary appointments for follow-up care.
Ans: C Feedback: It is most important for the nurse to evaluate the patient's understanding of how to take the medication properly, including how to respond when a pill is missed. The patient need not learn how to inject the medication because the prescription is of an oral medication. Oral contraceptives will not prevent sexually transmitted infections. Although making follow-up appointments is good, it is more important that the patient know how to take the medication. The client's attitude toward sexuality is relevant to the nurse and to the client's well-being, but taking the medication so it will have its intended effect is the priority.
A couple presents to the fertility clinic for help in getting pregnant and the nurse administers menotropins to the male partner. How does this classification of drug work? a.Stimulates FSH secretion from the pituitary b.Stimulates LH release from the anterior pituitary c.Stimulates spermatogenesis d.Increases the effects of existing testosterone
Ans: C Feedback: Menotropins stimulate spermatogenesis in men with low sperm counts and otherwise normally functioning testes. Menotropins do not stimulate FSH and LH levels, though they mimic the effects of these hormones. They do not potentiate the effects of testosterone. Options A, B, and D are not correct.
The client calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the client is taking while reviewing the medical record? a.Desogestrel b.Drospirenone c.Progesterone d.Norethindrone
Ans: C Feedback: Perineal pain and breast enlargement results from vaginal gel formulas, so the nurse would suspect the patient is receiving progesterone because this is the only progestin administered by this method. The other options are all oral medications that would not cause perineal pain or breast enlargement.
The nurse is caring for a client taking raloxifene. What manifestation reported by the client would raise the highest level of concern from the nurse? a.Headache b.Weight loss c.Calf pain d.Peripheral edema
Ans: C Feedback: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes, but this is a lower priority than possible thromboembolism. Weight loss is not a priority concern, unless it is excessive. Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation. However, these are not symptoms.
The nurse would question the use of what herbal supplement by a client taking hormone replacement therapy (HRT) containing progesterone? a.Dong quai b.Devil's claw c.Wild yam d.Black cohosh
Ans: C Feedback: Wild yam contains progesterone. Do not use with hormone replacement therapy, because it may cause increased blood glucose and other toxic effects, and do not combine with disulfiram or metronidazole—severe reaction may occur. Dong quai, devil's claw, and black cohosh are not contraindicated with HRT.
An adolescent client asks the nurse, "What should I do if I forget to take my birth control pill?" What should the nurse reply? a."Abstain from intercourse for 7 days." b."It's okay to miss a day or two, as long as you don't go over 3 days." c."Just wait until your next dose, then take double the dose." d."Take the dose as soon as you discover your oversight."
Ans: D Feedback: A missed pill should be taken as soon as the error is noticed. Telling the patient to abstain from intercourse would be inappropriate but if the patient misses three tablets they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken the better contraceptive protection provided, so patients should not wait until the next dose and then double it.
The nurse is caring for a client who just had subdermal implantation of NuvaRing. What should the nurse teach the client about this intervention? a.The implant will prevent pregnancy until the client reaches menopause, barring any complications. b.The implant confers minimal protection against bacterial sexually-transmitted infections. c.The client will need to have serum levels of progesterone drawn in 1 month. d.The implant should be replaced in around 3 years.
Ans: D Feedback: Etonogestrel, in addition to being available as a vaginal ring, NuvaRing, is available as a subdermal implant that may be left in place for up to 3 years and then must be removed. Another implant could be placed at that time. Like all forms of hormonal contraception, there is no protection against STIs. Follow-up blood work is not necessary.
The nurse is talking with a menopausal woman about the use of hormone replacement therapy (HRT). What statement, if made by the nurse, would be accurate and appropriate to share with the client? a.Symptoms of menopause are short-term and minor so HRT is not necessary. b.The newer drugs used in HRT cause cardiovascular events even when taken short-term. c.The risk for osteoporosis is much higher in women who take HRT. d.There is a possible increased risk of breast and cervical cancer when taking HRT.
Ans: D Feedback: The use of HRT can decrease the discomforts associated with menopause, although various forms of HRT have been associated with increased risks of breast and cervical cancer, heart disease, and stroke. The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use, they are associated with an increased risk of cardiovascular events. The risk for osteoporosis declines with HRT because of the bone saving effects of the drugs. It would be inappropriate and judgmental for the nurse to say symptoms of menopause are minor because some women experience more severe symptoms that can negatively impact their day-to-day life.
The nurse is caring for a client in labor who is receiving an oxytocin infusion. What action should the nurse prioritize? a.Providing emotional support to the client b.Monitoring the fetal heart rate c.Monitoring the client's pain levels d.Ensuring the client changes position at least once every 15 minutes
Monitoring the fetal heart rate Response Feedback: Close monitoring of the fetal heart rate is a major priority in the care of a client receiving an oxytocin infusion. Providing support and monitoring pain are also important, but the FHR is the highest priority since it has the closest link to successful outcomes (i.e., healthy birth). Position changes are a lower priority, except as they affect the FHR.
A 33 year-old client has been prescribed clomiphene. What outcome best indicates successful therapy? a.The client becomes pregnant. b.The client's preterm labor ceases. c.The client experiences relief from menopausal symptoms. d.The client resumes regular menstrual periods.
The client becomes pregnant. Response Feedback: Clomiphene is prescribed exclusively for infertility. As a result, pregnancy is the desired outcome. It is not prescribed for relief of menopausal symptoms, disruptions in menstrual cycles or preterm labor.
The nurse is caring for a client who would like to start taking oral contraceptives. What aspect of this client's health history should the nurse prioritize for follow-up? a.The client's body mass index (BMI) is 18.0 (underweight) b.The client uses marijuana one to two times per week c.The client takes NSAIDs for the treatment of headaches and joint pain d.The client was treated for deep vein thrombosis following surgery
The client was treated for deep vein thrombosis following surgery Response Feedback: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. The client's BMI is not prohibitively low and the use of NSAIDs or marijuana are not absolutely contraindicated with oral contraceptives.
A 14-year-old client is started on oral contraceptives. When following this client in the clinic, what is the nurse's priority assessment? a.Menstrual patterns b.Closure of the epiphyses c.Nutrition d.Cognitive development
b. Closure of the epiphyses Feedback: A 14-year-old girl is still growing. Estrogens and progestins have undergone limited testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. It is important for the nurse to monitor metabolic and other effects as well. Menstrual patterns, nutrition, and cognitive development are all components of care of the adolescent, but they are not the priority consideration.