Pharmacology II Prep U Chapter 40: Drugs Affecting the Female Reproductive System
A monophasic oral contraceptives composition is described as having which characteristic?
fixed amounts of both estrogen and progestin components
A postmenopausal woman is administered estradiol for the purpose of preventing which condition?
osteoporosis
A nurse is preparing to administer estrogen to a client with menopause. Through which routes can estrogen be administered? Select all that apply.
• PO • IV • IM • Transdermally
A postmenopausal woman is receiving raloxifene as part of a treatment plan for osteoporosis. The nurse would instruct the patient that this drug is administered by which route?
Oral
Medroxyprogesterone is an effective form of birth control. Long-term use can cause what serious adverse effect?
Osteoporosis
A client asks the nurse about a word they heard from the health care provider. The word was "andropause". The client asks what that is. Which is the nurse's best response?
"A gradual change, related to age, that occurs in the testes."
A client prescribed terazosin asks the nurse how the medication works. Which is the nurse's best statement?
"It works by relaxing the smooth muscle of the prostate and the bladder neck."
What statement by the client prescribed a combination contraceptive several months ago indicates a need for health education?
"It's good to know that the pill protects against some sexually transmitted infections (STIs)."
A client calls the women's health clinic and tells the nurse that she went to the dentist for an abscessed tooth. The dentist put her on an antibiotic, and the client wants to know if it will cause problems with her prescribed oral contraceptives. What is the nurse's best response?
"Use alternate means of birth control until you are finished with the antibiotic."
A patient who has come to the emergency department after being raped is given a dose of emergency contraception at 12 AM. The nurse would instruct the patient to take another dose of the drug at which time?
12 PM
Estropipate is sometimes administered to postmenopausal women to prevent which condition?
Osteoporosis
A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for:
cardiovascular complications
Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the health care provider?
Pain in one leg
When reviewing the history of a patient, which would the nurse identify as a contraindication for the use of progestins?
Pelvic inflammatory disease
Pitocin is given to prevent what condition?
Postpartum bleeding
A 31-year-old pregnant woman has been prescribed administration of a tocolytic drug. During which period is a tocolytic drug usually administered?
Pre-term labor
A client is started on terbutaline therapy. What would indicate that the therapy has been successful?
Premature birth is avoided for at least 24 hours.
A client has been prescribed vardenafil. Which medication in the client's history would the nurse be most concerned about?
nitroglycerin
A client who is taking an estrogen reports swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority?
Fluid volume excess
A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication?
Nausea
A client is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route?
Oral
When considering serious adverse effects, oral contraceptive use would most likely be contraindicated in which client?
a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day
On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which response by the nurse is most appropriate?
"It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke"
A woman who is at 31 weeks' gestation comes to the clinic in labor. The health care provider decides to use terbutaline therapy before transferring the woman to the hospital. The client is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be:
"The drug provides sufficient time for other medications to be given to improve your baby's outcome."
The health care provider has ordered a variety of laboratory assessments on a client who will need estrogen replacement. The follow labs are ordered: blood urea nitrogen (BUN), creatinine, and liver function tests (LFTs). What is the nurse's best statement explaining to a client the need to draw the labs?
"The labs will identify your body's ability to filter and excrete medications."
The contractions of a client who is receiving tocolytic therapy stop at 4 pm. The nurse would expect to continue to administer the drug infusion for at least which time frame?
12 hours
Immediately before starting an IV infusion of oxytocin (Pitocin), what should the nurse assess? (Select all that apply.)
Client's blood pressure Fetal heart rate Client's respiratory rate
A 22-year-old woman is in the clinic to end an early pregnancy. She takes three tablets of mifepristone (Mifeprex). Two days after she takes the medication, she returns to the clinic to see if she is still pregnant or if the medical abortion is complete. It is determined that she is still pregnant. The nurse will administer which drug?
Misoprostol
After teaching a patient who is prescribed estradiol vaginal cream, the nurse determines that the patient has understood the instructions when she states that she will administer the medication at which frequency?
Once a day
The nurse is caring for a patient who is beginning hormone replacement therapy. Which goal is appropriate to include in the patient's plan of care?
The patient will take drugs accurately and for the length of time prescribed.
A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The woman asks the nurse why her primary care provider has not yet proposed this treatment for her. What fact should underlie the nurse's response to the woman?
The risks of stroke and breast cancer are unacceptably high in women taking HRT.
A client is prescribed methylergonovine. The nurse reviews the client's medical record for possible contraindications to the use of this drug. Which, if found, would the nurse identify as being a contraindication to the prescribed drug?
hypertension
A 63-year-old woman taking estrogen and progestin for several years has recently changed to estrogen alone. What medical event would prompt such a change in treatment?
hysterectomy
A nurse is explaining the drug oxytocin to a client. When describing this drug, the nurse notes that oxytocin is an endogenous hormone produced by which?
posterior pituitary gland
A client is prescribed an alpha-adrenergic blocker for treatment of BPH. When explaining the action of the drug to the client, which information would the nurse integrate into the explanation?
relaxation of the smooth muscles
The nurse monitors a patient receiving oxytocin for water intoxication based on the understanding that this condition is the result of:
release of antidiuretic hormone.
A client with an extensive history of using herbal remedies asks the nurse if there is an herbal supplement for the diagnosis of BPH. Which supplement does the nurse provide information on for the treatment of BPH?
saw palmetto
A client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time?
3 months
After teaching a woman using an intravaginal estrogen preparation, the nurse determines that the teaching was successful when the client states that she will remain lying for at least how long after instilling the drug?
30 minutes
A nurse administers methylergonovine (Methergine) to a client immediately after delivery of a normal, healthy baby boy. The nurse will advise her that she may experience which common adverse effect of the drug?
An increase in blood pressure
Dinoprostone can be used to terminate a pregnancy after 20 weeks.
False
After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from:
clomiphene
Oral contraceptives decrease the effects of all the following drugs EXCEPT:
corticosteroids
Which classification of medication is used to treat overactive bladder syndrome?
Antispasmodics
A nurse is caring for a client who is receiving magnesium. The nurse would be alert for which finding?
depressed reflexes
A nurse is obtaining a history from an older adult woman. During the interview, the woman states, "When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go." The nurse would most likely identify this as which condition?
overactive bladder syndrome
The nurse has identified a nursing diagnosis of impaired mucous membranes for a client who has been prescribed darifenacin for overactive bladder. Which nursing interventions should be included in the care plan?
• Maintain fluid intake. • Instruct client about high fiber diet. • Suck on hard candy, sugarless lozenges or small pieces of ice.
The nurse is caring for a woman who takes estrogen and assesses the client for what central nervous system adverse reactions related to the use of this medication? (Select all that apply.)
• Migraine headaches • Dizziness • Depression
A client with estrogen excess may report which symptoms to the nurse during ongoing assessment during treatment with Ortho-Novum 7/7/7? (Select all that apply.)
• Nausea • Cervical mucorrhea • Edema
The nurse is assessing a client who states that she has been taking a lot of black cohosh to deal with her menopausal symptoms. What assessment findings would indicate that the client is experiencing black cohosh toxicity? (Select all that apply.)
• Nausea • Impaired vision • Headache
The nurse is on the phone with a woman who is taking an antispasmodic for overactive bladder syndrome. The woman states that her mouth is very dry, but she is afraid to drink because she does not want the urge to urinate to increase. What is the nurse's best response to this client?
"You shouldn't restrict your fluid intake because it will only make your bladder problems worse."
A young woman is being seen in the gynecology clinic of the local health department. She has decided to begin hormonal contraceptives. What action is specific to hormonal contraceptives and should be taught to this woman?
The cervical mucus is made resistant to penetration by spermatozoa.
A woman experiencing menopausal symptoms asks the nurse about herbal products that might help. Which would the nurse include in the response?
black cohosh
A new client calls on the phone requesting a prescription for contraceptives, which she has been taking for 2 years. She has not been seen in more than a year and is unable to come into the clinic until next month. She insists she is doing fine on this medication and must have her prescription now. The nurse's best response would be:
Before the drugs are prescribed, a complete medical history, physical examination, pap test, urinalysis, and weight and blood pressure measurements are recommended.
When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment?
blood pressure application
The nurse is scheduled to administer an oral contraceptive to a client admitted with adult onset diabetes. What is the priority teaching that would be provided regarding this medication?
Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg.
A female client asks the nurse about the use of progestins. The nurse shares with the client that clients who take this medication are at an increased risk for what serious adverse effect?
Cardiovascular complications
A nurse should monitor a client receiving oxytocin for which adverse effects?
cardiac arrhythmias
A client is menopausal and has been given a prescription for estrogen. She asks the nurse what some of the risks are in taking this medication. The nurse's best response is:
Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.
A female client began an infusion of oxytocin 2 hours ago and the nurse has been conducting regular assessments on her as well as monitoring the fetal heart rate closely. The nurse should prioritize which potential nursing diagnosis in the organization of the client's immediate care?
Excess fluid volume
The nurse examines the history of an antepartum client with diabetes and a large fetus prescribed oxytocin for induction of labor and should report which as contraindication(s)? Select all that apply.
Fetus in breech position Total placenta previa
Which assessment findings indicate a woman having her labor induced with IV oxytocin is developing water intoxication? (Select all that apply.)
Headache Confusion Coughing
Which would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a client taking estrogen?
Headaches
The nurse is teaching a patient about etonogestrel, which the patient is receiving as a subdermal implant. The nurse informs the patient that the implant will need to be removed at which time?
In 3 years
A 26-year-old is prescribed clomiphene as part of treatment for infertility. What is the mechanism of action of clomiphene?
Increases the output of the pituitary gonadotropins
When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process?
Interviewing the patient and observing for therapeutic and adverse effects
The nurse knows that for a client who still has her ovaries intact, estrogen must be paired with what other drug when used to treat menopausal symptoms?
Progestins
A client who is taking estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse suspects the client is experiencing what adverse reaction related to estrogen therapy?
Pulmonary embolism
A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately?
Shortness of breath
When caring for a postpartum patient who is receiving oxytocin intranasally, the nurse understands what is the action of oxytocin?
Stimulates the milk ejection reflex
While monitoring a woman who is receiving IV oxytocin for induction of labor, what event would cause the nurse to contact the health care provider immediately?
The uterine contractions are occurring every 90 seconds.
When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis?
Thromboembolism
What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen?
endometrial cancer
A client with a complex medical history is considering the use of oral contraceptives. The nurse should be aware that many antibiotics and antiseizure medications cause what effect when combined with oral contraceptives?
increased risk of pregnancy
Which statements indicate that a client understands the need for a follow-up after the initial injection of medroxyprogesterone?
"I know that this injection lasts for 3 months."
The nurse is discussing estrogen therapy with a 52-year-old woman. What information will the nurse share with this client regarding estrogen's benefit to the cardiac system?
"Any dose of estrogen should not be used as a cardioprotective drug."
A client has returned to the health care provider's office for follow up after receiving estrogen for symptoms of menopause. Which question should be included in the follow up?
"Can you describe in detail the difference in how you are feeling today and the last visit?"
A client alerts the nurse she has been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective?
"Estrogen and progesterone diminish."
A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications?
"Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots."
What assessment question is most appropriate when assessing a 58-year-old woman for therapeutic effects of prescribed estrogen therapy?
"Have you been having as many hot flashes and night sweats lately?"
Which statement indicates that the client understands the follow-up needed after an injection of Depo-Provera?
"I know that this injection lasts for 3 months."
A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client?
"Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision."
The nurse is discussing proper use of oral contraceptives with a client. The nurse should instruct the client to immediately contact a health care provider if she:
misses a menstrual period.
A patient is to receive dinoprostone at 4:00 PM. The nurse would expect the patient to begin to experience uterine contractions at which time?
4:15 PM
Which client who is taking progesterone would a nurse monitor most carefully for potential adverse effects?
A 32-year-old woman with epilepsy
After teaching a group of students about abortifacients, the instructor determines that the teaching was successful when students identify which condition as a contraindication to their use?
Active pelvic inflammatory disease
A group of students are reviewing the various fertility drugs that are available. The students demonstrate understanding when they identify which drug as being administered orally?
Clomiphene
The nurse is aware that older men are more prone to urinary tract infections because of what physiologic change related to aging?
Enlargement of the prostate
A patient is to start on misoprostol (Cytotec) therapy to produce uterine contractions. Before therapy begins, the nurse should prioritize which assessment?
History of previous cesarean delivery
A 30-year-old pregnant woman has been prescribed administration of oxytocin. When assessing the patient's drug regimen, the nurse understands that the patient is taking vasopressors. Which risk is the patient most susceptible to if oxytocin is administered along with vasopressors?
Hypertension
A nurse is caring for a pregnant patient receiving oxytocin. Via which route should oxytocin be administered during the third stage of labor?
Intramuscular
A 26-year-old client who delivered a baby 24 hours prior, reports cramping pain while breast-feeding. The nurse caring for the client understands that breast-feeding causes the release of which hormone, which can cause uterine cramping?
Oxytocin
A nurse is caring for a patient who has been administered menotropins by the intramuscular route for the secretion of sex hormones. The patient reports pain after the drug is injected. Which intervention should the nurse perform for the patient?
Rotate sites and examine previous sites for redness.
A 7 months' pregnant woman is experiencing contractions. She is admitted to the hospital in preterm labor. What will be prescribed to stop the labor?
Tocolytics
The health care provider has ordered oxytocin to be administered via IV pump and titrated until a client's contractions are every 3 minutes. The nurse caring for the client is aware that oxytocin can cause dangerous effects to the CNS, musculoskeletal, and cardiovascular systems of the client. What is the cause of these adverse effects?
Water intoxication
A client is going through menopause. She informs you that her health care provider has prescribed estrogen and progesterone. She asks why she should take two medications. The nurse's best response is:
When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.
Medroxyprogesterone acetate is indicated for the treatment of women with:
uterine bleeding
The nurse would be alert for signs and symptoms of which if methylergonovine is prescribed for a client who is a heavy smoker?
vasoconstriction
A nurse teaching a 57-year-old client about the factors that must be considered around the use of hormone replacement therapy (HRT) should discuss what increased risk associated with the therapy?
venous thromboembolism
A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the client's request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the client's:
vigilant adherence to the drug regimen.
Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect?
water intoxication
After an injection of oxytocin (Pitocin), during ongoing assessment what should the nurse monitor? (Select all that apply.)
• Blood pressure • Pulse • Respiratory rate
The nurse is caring for a client who has cancer and who until recently took estrogen. The nurse knows that estrogen may have increased the risk of development of which types of cancer? (Select all that apply.)
• Breast cancer • Endometrial cancer
The nurse examines the history of a client prescribed oral contraceptive with estrogen and progestin and should report which as contraindication(s)? Select all that apply.
• Deep vein thrombosis • Estrogen dependent breast cancer • Fatty liver disease • Migraine headaches
What nursing interventions are most important if the nurse has concerns that the client is developing fluid overload while receiving oxytocin? (Select all that apply.)
• Discontinue the oxytocin infusion. • Measure the client's output hourly.
The nurse must complete which assessments prior to starting an IV infusion of oxytocin for induction of labor? (Select all that apply.)
• Fetal heart rate • Client blood pressure • Client respiratory rate
A client is to receive oxytocin by IV infusion to promote labor. What would be most important to assess before initiating the therapy? (Select all that apply.)
• Fetal position • Uterine tone • Fetal heart rate • Maternal blood pressure
A client is prescribed flavoxate. Which adverse effects should the nurse discuss with the client? Select all that apply.
• headache • dry mouth • urinary retention
