Ph. Ch 40 Drugs used in Men's and Women's Health

Question 1

pathogens commonly transmitted by sexual contact.

Answer 1

Sexually Transmitted
Infections

Question 2

an enlargement of the prostate gland

Answer 2

Benign Prostatic Hyperplasia
(BPH)

Question 3

_________ the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity

Answer 3

Erectile Dysfunction

Question 4

______ an abnormal, whitish vaginal discharge that can occur at any age

Answer 4

Leukorrhea

Question 5

_________ a common bone disease of low mineral density which results in bone fragility and risk of fractures

Answer 5

Osteoporosis

Question 6

Irregular periods, infrequent periods, and spotting between periods

Answer 6

Dysmenorrhea

Question 7

Scenario #1: A nurse working at an outpatient clinic discussed with a women who was concerned about which type of contraceptive to take. The patient informed the nurse that she had been unsuccessful in trying to quit smoking, and recently discovered she was anemic.

Objective: Describe the major adverse effects and contraindications to the use of oral contraceptive agents.

NCLEX item type: multiple choice
Cognitive skill: evaluate

The nurse educated a woman on adverse effects that need to be reported from the combination pill. What instruction does the nurse need to discuss with the woman? (654)

1. “The combination pill may cause nausea and needs to be reported.”
2. “You need to report if you have missed a dose.”
3. “The combination pill has been shown to cause weight gain and needs to be reported.”
4. “Any time you are having leg pain, chest pain, or feel shortness of breath while taking the combination pill you need to report it.”

Answer 7

“Any time you are having leg pain, chest pain, or feel shortness of breath while taking the combination pill you need to report it.”

• Answer 1 is incorrect, nausea is a common adverse effect that resolved after several months.
• Answer 2 is incorrect, when a pill is missed, take it as soon as remembered and take the next pill at the regular scheduled time
• Answer 3 is incorrect, weight gain is a common effect that does not need to be reported
• Answer 4 is correct, because of the possibility of a venous thromboembolism any leg pain, chest pain or shortness of breath need to be reported as soon as possible.

Question 8

NCLEX item type: multiple response
Cognitive skill: application

The nurse discussed the possibility of the mini-pill, which only contains progestin,#1. The nurse explains that this oral contraceptive is preferred by some women because of their history of which conditions that are aggravated by estrogens? (Select all that apply.) (652)

1. Diabetes
2. Depression
3. Migraines
4. Hypertension
5. Hypothyroidism

Answer 8

Depression
Migraines
Hypertension

• Answer 1 is incorrect, estrogen therapy does not aggravate diabetes
• Answer 2 is correct, women who have a history of depression are particularly susceptible to the adverse effects of estrogen therapy
• Answer 3 is correct, women who have a history of migraines are particularly susceptible to the adverse effects of estrogen therapy,
• Answer 4 is correct, women who have a history of hypertension are particularly susceptible to the adverse effects of estrogen therapy,
• Answer 5 is incorrect, estrogen therapy does not aggravate hypothyroidism.

Question 9

NCLEX item type: multiple choice
Cognitive skill: explain

The nurse explains to the woman in scenario #1 why smoking while on the pill is considered to be risky for women. Which statement would the nurse use that is accurate? (652)

1. “When you take oral contraceptives and smoke it increases the chance of pregnancy.’
2. “It is not recommended to smoke and take oral contraceptives since it may increase the possibility of breakthrough bleeding.
3. “The pill loses its effectiveness after just one cigarette.”
4. “It is not recommended to smoke and take oral contraceptives because of the increased likelihood of developing a serious blood clot.

Answer 9

“It is not recommended to smoke and take oral contraceptives because of the increased likelihood of developing a serious blood clot.”

• Answer 1 is incorrect, smoking and the pill does not increase the chance of pregnancy,
• Answer 2 is incorrect, smoking and the pill does not increase the possibility of breakthrough bleeding,
• Answer 3 is incorrect, the pill does not lose it effectiveness after one cigarette,
• Answer 4 is correct, smoking and the pill does increase the likelihood of developing a blood clot.

Question 10

NCLEX item type: multiple choice
Cognitive skill: knowledge

The nurse explained the different types of combination pills with the women in scenario #1. Which type was discussed as being used for patients who have heavy menses with associated anemia? (652)

1. Biphasic
2. Triphasic
3. Quadriphasic
4. Continuous cycle

Answer 10

“Continuous cycle”

• Answer 1 is incorrect, biphasic products contain a fixed dose of estrogen and progestin in two concentrations.
• Answer 2 is incorrect, triphasic combination pills provide three concentrations of estrogen and progestin.
• Answer 3 is incorrect, quadriphasic pills provide four concentrations of hormones
• Answer 4 is correct, the continuous-cycle oral contraceptives are used primarily to shorten the duration of menses for patients with anemia.

Question 11

NCLEX item type: multiple choice
Cognitive skill: relate
The nurse discussed with the women in scenario #1 the precautions that must be taken before starting on oral contraceptives.

Which premedication assessment will the nurse gather? (652-653)

1. Obtain a list of past sexual partners
2. Ensure that the patient is not pregnant
3. Determine the sperm count of the male partner
4. Determine if any sexually transmitted infections have been contracted

Answer 11

“Ensure that the patient is not pregnant”

• Answer 1 is incorrect, it is not necessary to obtain a list of the past sexual partners prior to the start of oral contraceptives
• Answer 2 is correct, it is important to determine if the woman is pregnant prior to the start of oral contraceptives due to the possibility of birth defects.
• Answer 3 is incorrect, it is not necessary to determine the sperm count of the male partners prior to the start of oral contraceptives,
• Answer 4 is incorrect, it is not necessary to determine if there is any sexually transmitted infections prior to starting on oral contraceptives

Question 12

NCLEX item type: grid/ matrix
Cognitive skill: evaluate cues

The nurse knows that the minipill produces contraception differently from the combination pill.
Indicate with a ‘X’ the actions of the minipill and the actions of the combination pill. (650-652)

Answer 12

Question 13

Objective: Identify the patient teaching necessary with the administration of the transdermal contraceptive and the intravaginal hormonal contraceptive.

NCLEX item type: multiple response
Cognitive skill: recognize cues

In teaching a patient about the use of norelgestromin ethinyl estradiol transdermal system (Xulane),
which statements does the nurse include? (Select all that apply.) (655-656)

1. “Do not place the patch on your breast.”
2. “Trim the patch to best fit the area where you wish to apply it.”
3. “Apply the patch to the buttock, abdomen, upper outer arm, or upper torso.”
4. ” Avoid lotions or creams on the areas of the skin where the patch is applied because the patch may not adhere properly.”
5. “If the patch is partially detached for less than 24 hours, try to reapply it in the same place or replace it with a new patch immediately.”

Answer 13

“Do not place the patch on your breast.”
“Apply the patch to the buttock, abdomen, upper outer arm, or upper torso.”
“ Avoid lotions or creams on the areas of the skin where the patch is applied because the patch may not adhere properly.”
“If the patch is partially detached for less than 24 hours, try to reapply it in the same place or replace it with a new patch immediately.”

• Answer 1 is correct, patches should not be placed on the breasts
• Answer 2 is incorrect, patches should not be cut
• Answer 3 is correct, patches should be applied to clean dry, intact, healthy skin on the buttock, abdomen, upper outer arm or upper torso
• Answer 4 is correct, topical products such as makeup, powder, lotions, or creams should not be applied to the skin or to the patch area because the patch may not adhere
  properly
• Answer 5 is correct, if a patch is partially or completely detached try to reapply the patch in the same place or replace with a new patch immediately

Question 14

NCLEX item type: multiple choice
Cognitive skill: explain
A patient asks the nurse about what to do when she misses her period while on the NuvaRing.
What is an appropriate response by the nurse? (657)

1. “When you are using the ring, you will need to keep track of your periods and call if you miss one.
2. “It is uncommon to miss a period while using the ring, but you will need to be seen by a healthcare provider if this happens.”
3. “Since missing one period is not uncommon, continue on the same cycle, but if two consecutive periods are missed a pregnancy test is needed.”
4. “Missing a period is not a concern, you may also experience spotting for two or more cycles which is also normal.”

Answer 14

“Since missing one period is not uncommon, continue on the same cycle, but if two consecutive periods are missed a pregnancy test is needed.”

• Answer 1 is incorrect, women should keep track of periods, but missing one period with the ring is not of concern when adhering to the program
• Answer 2 is incorrect, since it is not uncommon to miss one period it is not necessary to notify the healthcare provider
• Answer 3 is correct, when 2 consecutive periods are missed than a pregnancy test is needed
• Answer 4 is incorrect, spotting for two or more cycles requires the healthcare provider to be notified.

Question 15

NCLEX item type: multiple response
Cognitive skill: application

Which information does the nurse include when teaching a patient about the use of the norelgestro-min-ethinyl estradiol transdermal system (Ortho Evra)? (Select all that apply.) (655)

1. “A new patch should be applied on the same day of the week.”
2. “Contraceptive therapy should be discontinued if pregnancy is confirmed.”
3. “Fold the used patch on itself and flush it down the toilet.”
4. “If the patch is detached for less than 24 hours, apply a new patch to the same location.”
5. “Report serious adverse effects such as severe headache, dizziness, blurred vision, and leg pain as soon as possible.’

Answer 15

“A new patch should be applied on the same day of the week.”
“Contraceptive therapy should be discontinued if pregnancy is confirmed.”
“If the patch is detached for less than 24 hours, apply a new patch to the same location.”
“Report serious adverse effects such as severe headache, dizziness, blurred vision, and leg pain as soon as possible.’

• Answer 1 is correct, a new patch should be applied weekly for three weeks, on the same day of the week knowns as the patch change day
• Answer 2 is correct, discontinue contraceptive therapy if pregnancy is confirmed
• Answer 3 is incorrect, used patches should be folded over on itself and placed in a sturdy container not flushed down the toilet
• Answer 4 is correct, apply a new patch in the same location if a patch has been off for less than 24 hours
• Answer 5 is correct, serious adverse effects to report include severe headache, dizziness, blurred vision, leg pain, shortness of breath,chest pain and acute abdominal pain.

Question 16

Scenario #2: A 78-year-old patient admitted to the hospital after a fall sustained a fractured femur. The patient had the fracture surgically repaired and subsequently diagnoses with osteoporosis. Their history is remarkable for diabetes mellitus, hypertension, depression, arthritis
and atrial fibrillation.

Objective: Discuss osteoporosis and its risk factors as well as preventive measures and the pharmacologic treatment used.
NCLEX item type: multiple choice
Cognitive skill: interpret

A nurse educated the patient in scenario #2 about osteoporosis. The nurse knows further teaching is needed after the patient makes which statement? (659)

1. “So you are saying that with this diagnosis of osteoporosis I will have fragile bones.”
2. “As I understand it, since I am also taking an anticoagulant that it can make the osteoporosis worse.”
3. “If I take more calcium and vitamin D and do strengthening exercises, I can preserve bone strength.”
4. “If I stop smoking and watch my alcohol intake to not exceed two drink daily, I can reverse this osteoporosis.”

Answer 16

“If I stop smoking and watch my alcohol intake to not exceed two drink daily, I can reverse this osteoporosis.”

• Answer 1 is incorrect, this statement by the patient is correct, in osteoporosis the bones are fragile and at risk for fractures
• Answer 2 is incorrect, this statement by the patient is correct, long term use of anticoagulants are a risk factor for osteoporotic fractures
• Answer 3 is incorrect, this statement by the patient is correct, calcium, vitamin D and exercise are used to preserve bone strength
• Answer 4 is correct, this statement needs to be corrected, osteoporosis cannot be reversed, treatment reduces fractures.

Question 17

NCLEX item type: multiple response
Cognitive skill: compare

The nurse discussed the drugs used for treatment of osteoporosis with the patient in scenario #2. Which drugs will the nurse discuss? (Select all that apply.) (660-661)

1. Teriparatide
2. Denosumab
3. Ibandronate
4. Alfuzosin
5. Zoledronic acid

Answer 17

Teriparatide
Denosumab
Ibandronate
Zoledronic acid

• Answer 1 is correct, teriparatide is a recombinant form of parathyroid hormone that stimulates osteoblast function, increases GI calcium absorption and increases renal tubular reabsorption of calcium
• Answer 2 is correct, denosumab is a monoclonal antibody that prevents osteoclast formation, leading to decreased bone resorption and increased bone mass, an appropriate initial therapy for most patients with osteoporosis
• Answer 3 is correct, ibandronate bisphosphonate that inhibits bone resorption by acting on osteoclasts
• Answer 4 is incorrect, alfuzosin is an alpha-1d adrenergic blocking agent used in the treatment of BPH
• Answer 5 is correct, zoledronic acid is a bisphosphonate that inhibits bone resorption by acting on osteoclasts.

Question 18

NCLEX item type: multiple choice
Cognitive skill: classify

The nurse recognized that the drug class bisphos-
phonates used for osteoporosis have which mecha-
nism of action? (660)

1.They directly affect the bone reabsorption that
occurs by the osteoblasts.
2.They decrease the rate of bone resorption by
inhibiting bone resorption action of the osteo-
clasts.
3.They indirectly affect the bone formation rate
by enhancing the bone remodeling effect of the
osteoblasts.
4.They cause the calcium and vitamin D in the
diet to directly impact the amount of bone laid
down for rebuilding.

Answer 18

They decrease the rate of bone resorption by inhibiting bone resorption action of the osteoclasts.

• Answer 1 is incorrect, osteoclasts are responsible for bone resorption not osteoclasts
• Answer 2 is correct, bisphosphonates decrease the rate of bone resorption by inhibiting bone resorption action of the osteoclasts
• Answer 3 is incorrect, bisphosphonates act on the osteoclasts only
• Answer 4 is incorrect, bisphosphonates do not effect how calcium is used to create bone

Question 19

Objective: Describe pharmacologic treatments of
benign prostatic hyperplasia.
NCLEX item type: grid / matrix
Cognitive skill: recognize cues

A nurse is describing the difference between the
symptoms of obstructive and irritative benign pros-
tatic hyperplasia (BPH) to a patient. Indicate with an
“X’ the symptoms associated with obstructive and
irritative BPH(662)

Answer 19

Question 20

NCLEX item type: multiple choice
Cognitive skill: relate

When teaching a patient about dutasteride (Avo-
dart) therapy for BPH, which statement does the
nurse include? (664)
1. “Dutasteride is also used to treat male pattern
baldness.”
2. “Dutasteride will cause an increase in serum
prostate-specific antigen (PSA) levels.”
3. “If there is no improvement of symptoms after
2 weeks of treatment, the dutasteride will be
discontinued.”
4. “Men treated with dutasteride should not do-
nate blood until at least 6 months after stopping
therapy.”

Answer 20

“Men treated with dutasteride should not donate blood until at least 6 months after stopping therapy.”

• Answer 1 is incorrect, dutasteride is not approved by the FDA to treat male pattern baldnes
• Answer 2 is incorrect, dutasteride causes a decrease in serum PSA levels
• Answer 3 is incorrect, more than 6 to 12 months of treatment may be necessary to assess whether a therapeutic response has been achieved
• Answer 4 is correct, men treated with dutasteride should not donate blood until at least 6 months after stopping therapy to avoid introducing the drug to a pregnant woman.

Question 21

NCLEX item type: multiple choice
Cognitive skill: contrast

The nurse reviewed the medications used for BPH.
Which medication works by inhibiting 5-alpha
reductase type 2? (664)

1.finasteride
2.tamsulosin
3.dutasteride
4.sildenafil

Answer 21

Finasteride

• Answer 1 is correct, finasteride is an androgen hormone inhibitor that works by inhibiting the enzyme 5-alpha reductase type 2 used to treat BPH
• Answer 2 is incorrect, tamsulosin is a alpha-1 blocking agent used for BPH
• Answer 3 is incorrect, dutasteride is an androgen hormone inhibitor that works by inhibiting the enzyme 5-alpha reductase types 1 and 2 used to treat BPH
• Answer 4 is incorrect, sildenafil is a phosphodiesterase inhibitor used to treat erectile dysfunction.

Question 22

Objective: Describe the pharmacologic treatment of
erectile dysfunction.
NCLEX item type: multiple choice
Cognitive skill: analyze

The nurse is teaching a patient about tadalafil (Cia-
lis) therapy. Which statement made by the patient
indicates teaching has been successful? (666-667)

1.”This drug is an aphrodisiac.”
2.”If I develop chest pain, I will take nitroglyc-
erin.”
3.”I can expect the medication to work within 30
minutes.
4.”I will take this medication three times a day on
a regular basis.”

Answer 22

“I can expect the medication to work within 30 minutes.”

• Answer 1 is incorrect, tadalafil is not an aphrodisiac
• Answer 2 is incorrect, nitroglycerin is not to be taken with tadalafil as it may worsen the symptoms, and cause hypotension, and arrhythmias
• Answer 3 is correct, tadalafil starts to work within 30 minutes, but may last for up to 36 hours
• Answer 4 is incorrect, tadalafil has been approved as a once-daily dose.

Question 23

NCLEX item type: multiple choice
Cognitive skill: illustrate

The nurse educated a patient regarding sildenafil
and asked the patient to teach back. Which state-
ment made by the patient about sildenafil (Viagra)
therapy indicates further teaching is needed? (667-
668)

1.”I know that Viagra can cause patients to de-
velop glaucoma.
2.”I know that I should not take nitroglycerin for
any angina while I am on Viagra.”
3.”I understand that if I suddenly lose my vision,
I need to report it immediately.’
4.”If I get an erection that lasts longer than
4 hours I will seek medical attention.”

Answer 23

“I know that Viagra can cause patients to de-
velop glaucoma.”

• Answer 1 is correct, this statement is incorrect, sildenafil may cause color vision impairment not glaucoma
• Answer 2 is incorrect, this statement by the patient is correct,
• Answer 3 is incorrect, this statement by the patient is correct
• Answer 4 is incorrect, this statement by the patient is correct.

Question 24

NCLEX item type: multiple response
Cognitive skill: application

The nurse is educating the patient on the common
adverse effects to expect when taking avanafil (Sten-
dra) to treat erectile dysfunction, and includes which
statements in the teaching? (Select all that apply.)
(667-668)

1.”Seek medical attention right away if you develop a sudden loss of hearing.”
2.”You need to be careful with nitrates in your food as they will react with the avanafil.”
3.”If you get dizzy or develop low blood pressure, lie down and let the symptoms pass.”
4.”If you develop any headache or flushing in your face and neck, these symptoms tend to be self-limiting.”
5.”It has been reported that if you become colorblind to blue or green, call your prescriber to get a dosage adjustment.”

Answer 24

“Seek medical attention right away if you develop a sudden loss of hearing.”
“If you get dizzy or develop low blood pressure, lie down and let the symptoms pass.”
“If you develop any headache or flushing in your face and neck, these symptoms tend to be self-limiting.”
“It has been reported that if you become colorblind to blue or green, call your prescriber to geta dosage adjustment.”

• Answer 1 is correct, a sudden loss of hearing with avanafil is rare, but needs to be reported for medical assistance
• Answer 2 is incorrect, nitrates in the foods do not react with avanafil
• Answer 3 is correct, avanafil may cause some hypotension and dizziness, seek medical attention if symptoms do not subside after laying down for a while,
• Answer 4 is correct, the symptoms of headache and flushing of the face and neck may occur with avanafil, these effects tend to be self-limiting
• Answer 5 is correct, if color vision impairment occurs and continues to be a problem the dose of avanafil should be reduced.