Female Reproductive Drug

Question 1

Hormone Replacement Therapy

ESTROGENS

Answer 1

many symptoms of menopause attributed to decreased estrogen

1. osteoporosis
   2.hot flushes
   3.atrophic vaginitis

Question 2

Contraceptive Drugs

Combination of estrogen and progesterone

ORAL: = LOESTRIN (norethindone /ethyl estradiol

TRANSVAGINAL= NORELGESTROMINE / ETHYL ESTRADIOL

INTRAVAGINAL= NUVARING (etonogestrel-ethyl estradiol)

**PROGESTIN ONLY= medroxy (depo provera) every 3 months
BBW: loss of bone mineral density

Answer 2

it can prevent pregnancy but it cant prevent STD

Question 3

CONTRAINDICATIONS/WARNINGS

1. pregnancy lactation (category x)
2. hx of cv disease (DVT, MI,CVA)

3.***SMOKING rf Thrombus formation

ANTIBIOTICS: contraceptive becomes less effective

Question 4

BBW

Answer 4

RF increase CV events
DVT , PE , MI , ISCHEMIC CVA

RF increase endometrial or breast cancer

Question 5

ADVERSE EFFECT

BEGELS w CREAM CHEESE

Breakthrough bleeding
Edema
GI effects
Embolism
Lost libido
Stop smoking

Contraceptives less effective with antibiotics
Cardiovascular events increase risk

Answer 5

1. breakthrough bleeding /menstrual irregularities
2. change libido
3. fluid retention *edema * headache * dizziness
4. GI effects ( NV, Abd cramps,bloating)
5. Thromboembolism ( DVT , PE , CVA )

Question 6

NURSES**

1. Assess age , lifestyle, mens cycle , child bearing status , wellness exam , cancer screenings
2. RF cv disease , esp thromboembolism

INTERVENTIONS

1. counsel tobacco
   2.oral contraceptive , take at the same time each day missed dose follow package direction use alteration form of contraception for 7 days
   3.less effective when taking antibiotics
   4.may take with food if gi stress occurs

Question 7

OSTEOPOROSIS Biphosphonates

ALENDRONATE (fosamax)

MOA:
INDIC:
ROUTE/DOSE:
CONTRAINDIC:
AE:
NURSING:

Answer 7

MOA: slow bone resorption
INDIC: osteoporosis
ROUTE/DOSE: oral daily /weekly
CONTRAINDIC:
1. esophageal or gastric ulcer
2.esophagitis
AE:
1.NA/DI
2.Esophageal erosion (GI Problem)

NURSING:

1. take in the am with full glass of water (no food just water) 30 minutes prior to food or drink
2. sit upright for at least 30 minutes after administration to minimize reflux)
3. limit use to 5 years

Question 8

OSTEOPOROSIS Estrogen Receptor Modulators

RALOXIFENE (Evista)

MOA
INDIC
CONTRAINDIC
AE

Answer 8

MOA
1.increases bone mineral density without stimulating the endometrium

2. modulates effects endogenous estrogen at specific receptor sites

INDIC prevention and treatment of osteoporosis in post menopausal receptor sites

CONTRAINDIC pregnancy /lactation , hx, dvt , or smoking

AE
1.venous thromboembolism
2. vaginal bleeding

Question 9

The nurse is providing teaching for a patient who is to receive progestin (medroxy) therapy. Which statement is correct to include in the teaching session?

a. “If you miss a dose, double-up on the next dose.”

b. “There’s no need to be concerned about breast lumps or bumps that occur.”

c. “Be sure to report any weight gain of 5 pounds or more per week.”

d. “Take the medication on an empty stomach to enhance absorption.”

Answer 9

c. “Be sure to report any weight gain of 5 pounds or more per week.”

Question 10

he nurse recognizes that use of estrogen drugs is contraindicated in which patient?

a. A patient who has atrophic vaginitis

b. A patient who has inoperable prostate cancer

c. A woman who has just given birth and wants to prevent postpartum lactation

d. A woman with a history of thrombophlebitis

Answer 10

d. A woman with a history of thrombophlebitis

Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease.

Atrophic vaginitis and inoperable prostate cancer are potential INDICATION for estrogen therapy

Question 11

A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem?

a. Methylergonovine (Methergine)

b. Estradiol transdermal (Estraderm)

c. Raloxifene (Evista)

d. Medroxyprogesterone (Provera)

Answer 11

d. Medroxyprogesterone (Provera)

Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea

Question 12

A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition?

a. Hypocalcemia

b. Breast cancer

c. Stress fractures

d. Venous thromboembolism

Answer 12

d. Venous thromboembolism

SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders.

Question 13

A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition?

a. Hypocalcemia

b. Breast cancer

c. Stress fractures

d. Venous thromboembolism

Answer 13

d. Venous thromboembolism

SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders.

Question 14

During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased:

a. incidence of nausea.
b. risk for thrombosis.
c. levels of triglycerides.
d. tendency to bleed during menstruation.

Answer 14

b. risk for thrombosis.

Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation.

Question 15

During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased:

a. incidence of nausea.
b. risk for thrombosis.
c. levels of triglycerides.
d. tendency to bleed during menstruation.

Answer 15

b. risk for thrombosis.

Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation.

Question 16

A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy?
a. Complete blood count
b. Serum potassium level
c. Vaginal cultures
d. Pregnancy test

Answer 16

d. Pregnancy test

Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X.

Question 17

The nurse is providing patient teaching about the oral bisphosphonate alendronate (Fosamax). Which statement by the patient indicates a good understanding of when this drug should be taken?

a. “I will take it in the evening just before bedtime.”

b. “I will take it in the morning with an 8-ounce glass of water.”

c. “I will take it with the first bite of the morning meal.”

Answer 17

b. “I will take it in the morning with an 8-ounce glass of water.”

*Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion.

• In addition, the patient must sit upright for 30 minutes after taking them.

Question 18

A woman is preparing for a 10 hour trans-Atlantic flight. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient?

a. She needs to stop taking the drug at least 72 hours before the trip.

b. She must remember to take this drug with a full glass of water each morning.

c. She will not take the drug while traveling on the plane.

d. No change in how the drug is taken will be needed.

Answer 18

a. She needs to stop taking the drug at least 72 hours before the trip.

A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.

Question 19

A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time?

a. She will continue to take the alendronate with water.

b. She cannot take the alendronate until she can sit up for 30 minutes.

c. She can take the medication with breakfast.

Answer 19

b. She cannot take the alendronate until she can sit up for 30 minutes.

The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time.

Question 20

A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time?

a. She will continue to take the alendronate with water.

b. She cannot take the alendronate until she can sit up for 30 minutes.

c. She can take the medication with breakfast.

Answer 20

b. She cannot take the alendronate until she can sit up for 30 minutes.

The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time.

Question 21

The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate?

a. Subcutaneous
b. Intramuscular
c. Vaginal

Answer 21

b. Intramuscular

Question 22

The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate?

a. Subcutaneous
b. Intramuscular
c. Vaginal

Answer 22

b. Intramuscular

Question 23

he nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.)

a. Cephalexin (Keflex)
b. Guaifenesin (Robitussin)
c. Warfarin (Coumadin)
d. Ibuprofen (Motrin)
e. Theophylline (Uniphyl)

Answer 23

a. Cephalexin (Keflex)
c. Warfarin (Coumadin)
e. Theophylline (Uniphyl)

Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.

Question 24

he nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.)

a. Cephalexin (Keflex)
b. Guaifenesin (Robitussin)
c. Warfarin (Coumadin)
d. Ibuprofen (Motrin)
e. Theophylline (Uniphyl)

Answer 24

a. Cephalexin (Keflex)
c. Warfarin (Coumadin)
e. Theophylline (Uniphyl)

Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.

Question 25

A patient is to receive medroxyprogesterone (Depo-Provera) 700 mg weekly, intramuscularly, as part of palliative therapy for endometrial cancer. The medication is available in vials of 400 mg/mL. Identify how many milliliters will the nurse draw up and administer with each injection. (record answer using one decimal place) _______

Answer 25

ANS: 1.8 mL

400 mg:1 mL :: 700 mg:x mL.
(400 × x) = (1 × 700); 400x = 700; x = 1.75, rounded to 1.8 mL.

Question 26

The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs?

A) Decreased appetite
B) Dehydration
C) Occasional headaches
D) History of deep vein thrombosis

Answer 26

D) History of deep vein thrombosis

Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development.

Question 27

The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs?

A) Decreased appetite
B) Dehydration
C) Occasional headaches
D) History of deep vein thrombosis

Answer 27

D) History of deep vein thrombosis

Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development.

Question 28

The nurse is caring for a patient who just had subdermal implantation ofNuvaRing. As part of drug teaching, the nurse will tell the patient this implant needs to be removed when?

A) 3 months
B) 6 months
C) 1 year
D) 3 years

Answer 28

D) 3 years

Question 29

A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurse’s priority response?

A) ​The effect of oral
contraceptives containing progestin is reduced by phenytoin.​

B) ​The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin.

C) ​The effect of oral contraceptives containing estrogen is reduced by phenytoin.​

D) ​You will need to increase the dosage of your phenytoin once you start contraceptives.​

Answer 29

B) ​The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin.

The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy.

Question 30

A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse?

A) Smoking a pack of cigarettes a day

B) Gaining 10 pounds in the last 3 months

C) Craving sugar

Answer 30

A) Smoking a pack of cigarettes a day

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.

Question 30

A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse?

A) Smoking a pack of cigarettes a day

B) Gaining 10 pounds in the last 3 months

C) Craving sugar

Answer 30

A) Smoking a pack of cigarettes a day

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.

Question 31

The patient asks the nurse, ​Why can’t I smoke when taking estrogen. Is the risk for blood clots 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).​

C) ​The risk is pretty high because estrogen decreases blood levels of several clotting factors.​

D) ​There is documented high risk because estrogen combined with nicotine creates a significant drug​drug interaction.​

Answer 31

D) ​There is documented high risk because estrogen combined with nicotine creates a significant drug​drug interaction.​

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.

Question 32

he nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The patient is on a low-residue diet for colitis. What factor in the patient’s history may contraindicate the use of birth control pills?
A) Migraine headaches
B) Age
C) Asthma
D) Colitis

Answer 32

A) Migraine headaches

Progestins should be used with caution in patients with epilepsy, migraine headaches,

Question 33

The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication?

A) Reduced risk of endometriosis

B) Reduced risk of dysfunctional uterine bleeding

C) Reduced risk of osteoporosis

D) Reduced risk of uterine cancer

Answer 33

C) Reduced risk of osteoporosis

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.

Question 33

The patient comes to the women’s health clinic to ask about emergency contraception. The patient is prescribed levonorgestrel (Plan B). How will the nurse instruct the patient to take this medication?

a. Take one tablet within 4 days of unprotected intercourse.

b.Take one tablet within 72 hours of unprotected intercourse and another 12 hours later.

c.Take one tablet within 5 days of unprotected intercourse.

d.Take one tablet within 72 hours of unprotected intercourse and another daily for 5 days.

Answer 33

b.Take one tablet within 72 hours of unprotected intercourse and another 12 hours later.

Question 34

The nurse is caring for a patient taking raloxifene. What manifestation reported by the patient would raise the highest level of concern from the nurse?

a.Headache
b.Weight loss
c.Calf pain

Answer 34

c.Calf pain

The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has

Question 35

When caring for a patient on estrogen therapy, what is the nurse’s priority assessment?

A) Blood sugar levels
B) Bowel sounds
C) Weight
D) Therapeutic and adverse drug effects

Answer 35

D) Therapeutic and adverse drug effects

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 assess

Question 36

What is the priority assessment for the 23-year-old female patient who is on estrogen therapy?

A) Monitor liver function periodically for the patient on long-term therapy.

B) Assess for contraindications to drug therapy.

C) Help plan a diet rich in calcium and vitamin D.

D) Provide patient teaching for diet therapy to prevent osteomyelitis.

Answer 36

A) Monitor liver function periodically for the patient on long-term therapy.

Assessing liver function is important for the patient on long-term estrogen therapy. Teaching is an intervention and not an assessment. The patient should be assessed for contraindications before administering the medication initially.

Question 37

When the nurse administers an endogenous estrogen, what systemic effects does the nurse expect the drug will have?

a.Causes proliferation of endometrial lining

b.Provides protection of heart from atherosclerosis

c, Retains calcium in the bloodstream

d.Inhibits ovulation

Answer 37

b.Provides protection of heart from atherosclerosis

Question 38

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 patient?
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.

Answer 38

D) There is a possible increased risk of breast and cervical cancer when taking HRT.

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 wom

Question 39

The nurse is caring for an infertile couple who will take chorionic gonadotropin to become pregnant. How would the nurse describe the actions of this drug?
A) Affecting follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release
B) Stimulating follicular development
C) Stimulating maturation of ova
D) Stimulating multiple follicle development

Answer 39

A) Affecting follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release

Question 40

The patient calls the clinic and says she just started oral contraceptives last month and is experiencing breakthrough bleeding, fluid retention resulting in edema, changes in libido, and palpitations. What symptom would the nurse recognize is not an adverse effect of the oral contraceptive and requires an appointment as soon as possible so the patient can be evaluated?
A) Breakthrough bleeding
B) Fluid retention
C) Changes in libido
D) Palpitations

Answer 40

D) Palpitations

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

Question 41

The patient calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the patient is taking on reviewing the medical record?

a.Desogestrel b.Drospirenone c.Progesterone d.Norethindrone

Answer 41

C progesterone