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Chapter 36: Reproductive Health Drugs

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Chapter 36: Reproductive Health Drugs

12 problems · 0 figures

Case Study 36.2.1 §36.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Susan Lopez is a 34-year-old female who presents to the public health department for counseling regarding contraception. She is planning to be married, and she and her fiancé do not want children. Susan has been sexually active with three male partners including her fiancé. She has always insisted that the partners use condoms.

Social History
Tobacco use: Smokes e-cigarettes daily. Formerly smoked regular cigarettes, 1/2 pack per day. Total time smoking is 10 years.
Alcohol use: Occasional social drink, usually wine
Sexually active

Current Medications
None

The nurse completes the initial assessment for Susan. Which finding is the most important regarding counseling about contraceptive medications?
  1. a.
    Weight and BMI
  2. b.
    Sexual history
  3. c.
    Smoking
  4. d.
    Migraine headache
Table 36.8 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: S1, S2 noted

• Respiratory: Clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurological: Within normal limits; reports history of migraine headaches

• Integumentary: Skin appropriate for age

• Gynecological: Normal exam; urine pregnancy test negative; no reports of signs or symptoms of sexually transmitted infection (STI) and none noted during exam
Blood pressure: 128/78 mm Hg
Heart rate: 74 beats/min
Respiratory rate: 16 breaths/min
Height: 5'3"
Weight: 152 lb

Answer

C. Smoking
Smoking is the most important because an estrogen-containing contraceptive can increase the likelihood of developing thrombophlebitis or thromboembolism.

Case Study 36.2.2 §36.2 source ↗

Read the following clinical scenario to answer the questions that follow.

Susan Lopez is a 34-year-old female who presents to the public health department for counseling regarding contraception. She is planning to be married, and she and her fiancé do not want children. Susan has been sexually active with three male partners including her fiancé. She has always insisted that the partners use condoms.

Social History
Tobacco use: Smokes e-cigarettes daily. Formerly smoked regular cigarettes, 1/2 pack per day. Total time smoking is 10 years.
Alcohol use: Occasional social drink, usually wine
Sexually active

Current Medications
None

After discussing all the options for contraception with Susan and considering that Susan does not want children, which method do Susan and the nurse think may be the best for her?
  1. a.
    Oral, daily combination hormone pill
  2. b.
    Depo-Provera injection once every 3 months
  3. c.
    Hormonal IUD
  4. d.
    Copper IUD
Table 36.8 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: S1, S2 noted

• Respiratory: Clear bilaterally

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurological: Within normal limits; reports history of migraine headaches

• Integumentary: Skin appropriate for age

• Gynecological: Normal exam; urine pregnancy test negative; no reports of signs or symptoms of sexually transmitted infection (STI) and none noted during exam
Blood pressure: 128/78 mm Hg
Heart rate: 74 beats/min
Respiratory rate: 16 breaths/min
Height: 5'3"
Weight: 152 lb

Answer

D. Copper IUD
The copper IUD is the longest-lasting contraceptive device and does not contain hormones. Because Susan is slightly overweight, has a smoking history, and has migraine headaches, any hormonal contraceptive may cause serious side effects.

36-1 §36.RQ source ↗

A young female client is discussing the various methods of contraception with the nurse. Which factor is most important for the nurse to consider in counseling the client?
  1. a.
    Client reports a history of migraine headaches.
  2. b.
    Client has an irregular menstrual cycle.
  3. c.
    The client’s sexual history.
  4. d.
    The cost of the contraceptive method.

Answer

A. Client reports a history of migraine headaches.
Migraine headaches are a concern with contraceptive medications that contain progestins because they may exacerbate the headaches.

36-2 §36.RQ source ↗

A client in labor is receiving an oxytocin infusion. Which signs and symptoms are a priority for the nurse to assess further?
  1. a.
    Maternal heart rate of 102 beats/minute and blood pressure of 146/90 mm Hg
  2. b.
    Sudden onset of confusion and muscle cramps
  3. c.
    Client-reported headache of 4 out of 10 on the pain scale
  4. d.
    Urine output of 100 mL/hour

Answer

B. Sudden onset of confusion and muscle cramps
Oxytocin’s effect on the kidneys can cause water intoxication and dilutional hyponatremia, which are considered significant side effects. Signs and symptoms of hyponatremia are related to the central nervous system (CNS) and musculoskeletal system.

36-3 §36.RQ source ↗

A 68-year-old male client comes to the emergency department with chest pain. Before administering the ordered sublingual nitroglycerin, which question is most important for the nurse to ask the client?
  1. a.
    “How long have you had the chest pain?”
  2. b.
    “Do you have a history of cardiac problems?”
  3. c.
    “When did you last eat or drink anything?”
  4. d.
    “Do you take any medications for erectile dysfunction?”

Answer

D. “Do you take any medications for erectile dysfunction?”
Nitroglycerin is contraindicated when a client is using drugs for ED. The combination can cause significant hypotension and possible cardiac arrest.

36-4 §36.RQ source ↗

An 11-year-old client is undergoing hormone therapy with testosterone for hypogonadism. Which assessment is most important for the nurse to monitor?
  1. a.
    Results of radiographic images of the long bones every 6 months
  2. b.
    Serum hemoglobin and hematocrit monthly
  3. c.
    Serum electrolytes weekly
  4. d.
    Blood pressure and electrocardiogram weekly

Answer

A. Results of radiographic images of the long bones every 6 months
Prepubescent clients on testosterone therapy may develop early closure of epiphyseal growth plates and stunted growth. Testosterone therapy may need to be decreased or stopped.

36-5 §36.RQ source ↗

The nurse is caring for a client in labor who will be receiving an MgSO4 infusion for eclampsia. Which provider’s order is most important to implement?
  1. a.
    Continuous cardiac monitoring
  2. b.
    Hourly urine output
  3. c.
    Nothing by mouth (NPO)
  4. d.
    Oxygen saturation monitoring

Answer

A. Continuous cardiac monitoring
MgSO4 can cause serious life-threatening cardiac rhythm changes and circulatory collapse. Therefore, continuous cardiac monitoring is the most important order to implement.

36-6 §36.RQ source ↗

A male high school student who plays on the football team has been referred to the school nurse. He reports feeling anxious and irritable, and his stomach bothers him most of the time. He tells the nurse, “I never had acne problems, but now it’s terrible. And my hair is falling out.” What question by the nurse would be most appropriate?
  1. a.
    “Do you have a family history of depression or anxiety?”
  2. b.
    “Are you eating a lot of greasy or spicy foods?”
  3. c.
    “Are you taking anything to help you build up your muscle strength?”
  4. d.
    “How many hours of sleep are you getting each night?”

Answer

C. “Are you taking anything to help you build up your muscle strength?”
Given the context of a high school football player with these signs and symptoms, the nurse should recognize that the student may be misusing steroids. This question can help the nurse further assess the situation.

36-7 §36.RQ source ↗

A postmenopausal female is at high risk for developing osteoporosis. Her provider has prescribed alendronate. Which statement by the client indicates a need for further teaching by the nurse?
  1. a.
    “I need to sit or stand for 30 minutes after taking the medication.”
  2. b.
    “I should drink a full glass of water with the medication.”
  3. c.
    “Walking 30 minutes a day can help prevent my bones from becoming weak.”
  4. d.
    “I can go ahead and have a tooth that is bothering me pulled.”

Answer

D. “I can go ahead and have a tooth that is bothering me pulled.”
Invasive dental procedures should not be planned during bisphosphonate therapy because of the high risk of developing bisphosphonate-induced osteonecrosis of the jaws (BIONJ).

36-8 §36.RQ source ↗

A 45-year-old client with prostate cancer is undergoing treatment with bicalutamide. Which problem is a priority for the nurse to address?
  1. a.
    Risk for injury: impaired liver function
  2. b.
    Disturbed body image
  3. c.
    Chronic pain
  4. d.
    Risk for imbalanced nutrition

Answer

A. Risk for injury: impaired liver function
Impaired liver function is a serious side effect of antiandrogen medications. Clients on bicalutamide have developed liver failure and died. Liver function must be monitored closely.

36-9 §36.RQ source ↗

A postmenopausal client is taking a bisphosphonate medication. Which diagnostic testing for this client does the nurse expect to be a priority?
  1. a.
    Electrocardiogram and stress testing
  2. b.
    Bone density
  3. c.
    Venous ultrasound
  4. d.
    Upper endoscopy

Answer

B. Bone density
Bone density testing should be scheduled routinely to determine the effectiveness of the drug therapy.

36-10 §36.RQ source ↗

A client with a chronic illness is taking an anabolic steroid. Which condition indicates the drug is having a therapeutic effect?
  1. a.
    Increased hemoglobin
  2. b.
    Hirsutism
  3. c.
    Worsening acne
  4. d.
    Alopecia

Answer

A. Increased hemoglobin
In this case, the anabolic steroid would be used to improve health status, indicated by increased hemoglobin.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.