NURS 317 Unit 4 Chapter 40 Pharm Point Questions

Question 1

A 14-year-old client is receiving oral contraceptives. What problem should the nurse assess for that is particular to a client of this age?

A) Closure of epiphyses

B) Thromboembolic disorders

C) Breakthrough bleeding

D) Edema due to fluid retention

Answer 1

A) Closure of epiphyses

Rationale:The estrogens and progestins have undergone little testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. Thromboembolic disorders, edema due to fluid retention, and breakthrough bleeding are concerns with all clients and not specifically for younger girl

Question 2

Dinoprostone can be used to terminate a pregnancy after 20 weeks.

A) FALSE

B) TRUE

Answer 2

A) FALSE

Rationale:Dinoprostone is used to terminate pregnancies ranging from 12 to 20 weeks’ gestation.

Question 3

A client who is taking an estrogen reports swelling and weight gain. Which nursing diagnosis would the nurse most likely identify?

A) Fluid volume excess

B) Acute pain

C) Imbalanced nutrition, more than body requirements

D) Ineffective peripheral tissue perfusion

Answer 3

A) Fluid volume excess

Rationale:The client is experiencing fluid retention, which makes this nursing diagnosis appropriate. This nursing diagnosis would be appropriate if the client was experiencing decreased intake due to nausea and vomiting. Acute pain would be appropriate if the client was experiencing headache or abdominal cramping. This nursing diagnosis would be appropriate if the client was experiencing signs and symptoms of a thromboembolic disorder.

Question 4

The nurse is caring for a client who will receive an abortifacient. What condition would the nurse recognize is a contraindication to these drugs?

A) Asthma

B) Adrenal disease

C) Hypertension

D) Active pelvic inflammatory disease

Answer 4

D) Active pelvic inflammatory disease

Rationale:Active PID is a contraindication to the use of abortifacients because the infection could be exacerbated by the drug. Abortifacients are used cautiously in clients with asthma. Abortifacients are used cautiously in clients with hypertension. Abortifacients are used cautiously in clients with adrenal disease.

Question 5

A client is to receive oxytocin by IV infusion to promote labor. What are necessary nursing assessments before initiating the therapy? Select all that apply.
A) Maternal blood pressure

B) Uterine tone

C) Fetal reflexes

D) Fetal heart rate

E) Fetal position

Answer 5

A) Maternal blood pressure
B) Uterine tone
D) Fetal heart rate
E) Fetal position

Rationale:Assessing fetal position is important to ensure that there is no cephalopelvic disproportion to complicate labor. Assessing uterine tone is important because oxytocin can overstimulate the uterus. Assessing fetal heart rate is important to establish fetal well-being. Assessing maternal blood pressure would be important because the drug is discontinued if the blood pressure rises dramatically. Assessment of fetal reflexes is not necessary; rather, the maternal reflexes would be evaluated as part of the neurological assessment.

Question 6

A client is receiving a progestin in a vaginal gel formulation. The nurse should instruct the client about what possible adverse effects? Select all that apply.

A) Perineal pain

B) Headache

C) Abdominal pain

D) Constipation

E) Breakthrough bleeding

Answer 6

A) Perineal pain
B) Headache
D) Constipation

Rationale:Headache is associated with vaginal gel formulations. Constipation is associated with vaginal gel formulations. Perineal pain is associated with vaginal gel formulations. Abdominal pain is associated with intrauterine systems. Breakthrough bleeding is associated with estrogen use.

Question 7

When caring for the couple receiving fertility treatment, what is a teaching priority for the nurse?

A) Multiple births

B) Low chance of success

C) Breakthrough bleeding

D) Risk for breast cancer

Answer 7

A) Multiple births

Rationale:The risk of multiple births should be explained, as should the need for frequent monitoring. It would be important to know the drug prescribed before knowing if there was a chance for breakthrough bleeding. Risks for success and breast cancer depend on the individual circumstances, so this would not be appropriate teaching.

Question 8

A client is receiving menotropins. The nurse would anticipate administering this drug by which route?

A) Subcutaneous

B) Intradermal

C) Oral

D) Intramuscular

Answer 8

D) Intramuscular

Rationale:Menotropins are administered intramuscularly.

Question 9

A client is receiving treatment for infertility and is receiving a drug that stimulates LH and FSH production. Which drug would this most likely be?

A) Chorionic gonadotropin

B) Cetrorelix

C) Follitropin beta

D) Follitropin alfa

Answer 9

A) Chorionic gonadotropin

Rationale:Chorionic gonadotropin is used to stimulate LH and FSH production. Cetrorelix inhibits premature LH surges in women undergoing controlled ovarian stimulation. Follitropin alfa and beta are injected to stimulate follicular development.

Question 10

The client is experiencing varied symptoms of menopause and has sought care to explore the possibility of hormone replacement therapy. The client asks the nurse, “I’ve read a lot of conflicting reports lately. Is HRT safe and effective?” How should the nurse reply?

A) “Despite what you might have read, HRT has been shown to be safe. There are some serious risks, but they are all treatable.”

B) “The benefits of HRT were often overstated in the past, and for most women the risks outweigh the benefits.”

C) “Current guidelines state that HRT should be avoided unless menopausal symptoms interfere greatly with quality of life.”

D) “The current consensus is that women should feel comfortable taking HRT for less than 5 years.”

Answer 10

D) “The current consensus is that women should feel comfortable taking HRT for less than 5 years.”

Rationale:The current recommendation of the U.S. Preventative Services Task Force is that women should feel comfortable taking HRT to reduce the symptoms of menopause for short-term therapy (fewer than 5 years). The harms of long-term use outweigh the benefits for most women. The benefits of short-term use, however, must be considered if a woman is having a difficult time getting through menopause. Serious adverse effects are comparatively rare but are not always treatable. HRT has been proven effective

Question 11

Clomiphene is administered subcutaneously as well as orally.

A) FALSE

B) TRUE

Answer 11

A) FALSE

Rationale:Clomiphene is administered orally only.

Question 12

The client arrives at the clinic and requests emergency birth control. After an examination, the client receives a prescription for levonorgestrel. What instructions should the nurse give the client about taking this medication?

A) Take the first tablet within 24 hours of unprotected intercourse and then one tablet every day for 5 days.

B) Take one tablet within 72 hours of unprotected intercourse and take a second tablet 12 hours later.

C) Take one tablet within 72 hours of unprotected intercourse.

D) Take one tablet within 5 days of unprotected intercourse

Answer 12

C) Take one tablet within 72 hours of unprotected intercourse.

Rationale:Levonorgestrel is taken within 72 hours after unprotected intercourse, and there is no need to take any further medication. Levonorgestrel is taken within 72 hours and another tablet is taken 12 hours later. Ella can be taken within 5 days of unprotected intercourse.

Question 13

What would a client most likely be using if the nurse assesses the client for signs and symptoms of hyperkalemia?

A) Norgestrel

B) Norethindrone

C) Medroxyprogesterone

D) Drospirenone

Answer 13

D) Drospirenone

Rationale:Only drospirenone has antimineralocorticoid activity and can block aldosterone, leading to increased potassium levels

Question 14

After teaching a client who is prescribed estradiol vaginal cream, the nurse determines that the client has understood the instructions when she states that she will administer the medication at which frequency?

A) Once a month

B) Once a week

C) Once every other day

D) Once a day

Answer 14

D) Once a day

Rationale:Intravaginal estradiol is administered every day.

Question 15

What would a nurse expect to administer to a client with premenstrual dysphoric disorder?

A) Desogestrel

B) Drospirenone

C) Levonorgestrel

D) Estropipate

Answer 15

B) Drospirenone

Rationale:Drospirenone is used for the treatment of premenstrual dysphoric disorder. Desogestrel is used only as an oral contraceptive. Estropipate is used to alleviate the signs and symptoms of menopause and for the treatment of female hypogonadism. Levonorgestrel is used for contraception and as the “morning after” pill.

Question 16

The nurse is reviewing the medical history of the client requesting hormone replacement therapy. What finding would indicate the need for caution with the use of estrogen in this client?

A) Idiopathic vaginal bleeding

B) Thromboembolic disorders

C) Hepatitis C

D) Breast cancer

Answer 16

C) Hepatitis C

Rationale:Estrogens should be used cautiously in clients with hepatitis C because of the risk for altered hepatic metabolism. Thromboembolic disorders, idiopathic vaginal bleeding, and breast cancer contraindicate the use of estrogen.

Question 17

The nurse is teaching a client about etonogestrel, which the client is receiving as a subdermal implant. What should the nurse teach the client about this form of contraception?

A) The client should supplement with a barrier form of birth control for the first 4 weeks

B) African-American clients are more susceptible to adverse effects

C) The implant will be effective for up to 3 years

D) The client will need to be closely monitored for the first 48 hours after implantation

Answer 17

C) The implant will be effective for up to 3 years

Rationale:An etonogestrel subdermal implant may be left in place for up to 3 years, but then it must be removed. African-American clients do not have an increased risk for adverse effects, and there is no need for close monitoring after implantation. There is no recommendation for using a barrier form of contraception.

Question 18

The use of nicotine with estrogens increases the woman’s risk for thromboembolic disorders.

A) TRUE

B) FALSE

Answer 18

A) TRUE

Rationale:Estrogens are contraindicated with heavy smokers because of the increased risk of thrombus and embolus development.

Question 19

Estrogens are associated with serious GI effects such as acute pancreatitis and cholestatic jaundice.

A) FALSE

B) TRUE

Answer 19

B) TRUE

Rationale:Potentially serious GI effects—including acute pancreatitis, cholestatic jaundice, and hepatic adenoma—have been reported with the use of estrogens.

Question 20

A male client is receiving therapy to stimulate spermatogenesis. Which agent would the nurse most likely administer?

A) Chorionic gonadotropin

B) Follitropin beta

C) Menotropins

D) Ganirelix

Answer 20

C) Menotropins

Rationale:Menotropins are used to stimulate spermatogenesis in men. Chorionic gonadotropin is used to stimulate ovulation in women. Ganirelix is used to inhibit premature LH surges in women receiving ovarian hyperstimulation for infertility. Follitropin beta is used to stimulate follicular development.

Question 21

The nurse is caring for a client who received an abortifacient and is preparing the client for discharge from the clinic following the procedure. What assessment should the nurse perform before providing discharge education?

A) Assessment of the client’s anxiety

B) Assessment of the circumstances surrounding the client’s pregnancy

C) Assessment of the client’s level of social support

D) Assessment of the client’s overall health status

Answer 21

A) Assessment of the client’s anxiety

Rationale:When abortifacients are used, clients need a great deal of psychological support. The client’s level of stress and anxiety will have a major effect on the content, timing, and quantity of discharge teaching. Each of the other listed factors should have been thoroughly assessed prior to drug administration.

Question 22

After teaching the client about raloxifene, the nurse evaluates that further teaching is required when the client identifies what as an adverse effect?

A) Edema

B) GI upset

C) Hot flashes

D) Amenorrhea

Answer 22

D) Amenorrhea

Rationale:Vaginal bleeding, not amenorrhea, is associated with raloxifene. The other answer choices are correctly associated with raloxifene.

Question 23

The nurse has just initiated a laboring client’s prescribed oxytocin infusion. What action by the nurse is most appropriate while this medication is infusing?

B) Monitor the client’s contraction pattern closely.

C) Ensure that the infusion does not last for more than 30 minutes.

D) Expect to see an effect on the client’s labor within 10 minutes.

Answer 23

B) Monitor the client’s contraction pattern closely.

Rationale:Oxytocin carries a risk for uterine hypertonicity, so the nurse must monitor the client’s contractions closely. Oxytocin IV has an immediate onset of action, and there is no direct need for frequent repositioning. The infusion must not be excessive but is likely to last more than 30 minutes.

Question 24

Tocolytics can be used to halt the contractions associated with preterm labor.

A) FALSE

B) TRUE

Answer 24

B) TRUE

Rationale:Tocolytics are agents used to relax the gravid uterus to prolong pregnancy.