A postmenopausal patient with an intact uterus is starting estrogen therapy. A progestin is added to lower the risk of which cancer?
Endometrial cancer
✓
Breast cancer
Ovarian cancer
Cervical cancer
Correct Answer
Endometrial cancer
Estrogen given alone stimulates growth of the uterine lining and raises the risk of endometrial hyperplasia and cancer, and adding a progestin protects the endometrium. Breast cancer risk is not lowered by the progestin, and combined therapy has been linked to a higher risk of invasive breast cancer. Ovarian cancer is not the reason a progestin is added. Cervical cancer is driven mainly by human papillomavirus and is unrelated to this choice.
Category: Estrogen and Progestin Therapy
Question 2
Labeling warns that estrogen therapy, with or without a progestin, should not be used to prevent which condition?
Vaginal atrophy
Dementia
✓
Hot flashes
Postmenopausal osteoporosis
Correct Answer
Dementia
The boxed warning states that estrogen therapy should not be used to prevent cardiovascular disease or dementia, because a large trial found a higher risk of probable dementia in older postmenopausal women taking it. Vaginal atrophy is an approved use of estrogen. Hot flashes are the most familiar approved use. Postmenopausal osteoporosis prevention is also an approved use for some estrogen products.
Category: Estrogen and Progestin Therapy
Question 3
A patient taking a drospirenone-containing oral contraceptive also takes lisinopril. Which laboratory value should the nurse monitor?
Serum sodium
Serum calcium
Serum potassium
✓
Blood glucose
Correct Answer
Serum potassium
Drospirenone has antimineralocorticoid activity and can raise potassium, so labeling advises checking potassium in patients who also take drugs that raise it, such as ACE inhibitors. Serum sodium is not the main concern with this pair. Serum calcium is not affected by the combination. Blood glucose is not the value this interaction calls for.
Category: Hormonal Contraceptives
Question 4
Which symptom reported by a patient taking a combined oral contraceptive needs prompt evaluation?
Mild breast tenderness
Light spotting between periods
Mild nausea in the first weeks
Pain and swelling in one calf
✓
Correct Answer
Pain and swelling in one calf
Estrogen-containing contraceptives raise the risk of blood clots, and pain and swelling in one calf can signal deep vein thrombosis that needs prompt evaluation. Mild breast tenderness is a common, usually minor effect. Light spotting between periods is common early in use and is reported but is not an emergency. Mild nausea in the first weeks often eases as the body adjusts.
Category: Hormonal Contraceptives
Question 5
A patient who uses depot medroxyprogesterone injections plans to try to become pregnant soon. What should the nurse explain?
Return of fertility may be delayed after stopping
✓
Fertility returns the day after a missed injection
The injections cause permanent infertility
Pregnancy can be attempted while injections continue
Correct Answer
Return of fertility may be delayed after stopping
After depot medroxyprogesterone is stopped, ovulation and fertility may take a long time to return, so patients planning pregnancy soon are counseled about this delay. Fertility returning the day after a missed injection is wrong because the drug's effect persists well beyond the dosing interval. Permanent infertility is not caused by the drug. Attempting pregnancy while injections continue makes no sense because the drug prevents ovulation.
Category: Hormonal Contraceptives
Question 6
Levonorgestrel emergency contraception works mainly by which action?
Ending an established pregnancy
Delaying or preventing ovulation
✓
Killing sperm in the vagina
Blocking estrogen receptors in the breast
Correct Answer
Delaying or preventing ovulation
Levonorgestrel taken after unprotected intercourse acts mainly by delaying or preventing ovulation, so it does not work once ovulation has occurred. Ending an established pregnancy is not its action, and it does not harm an existing pregnancy. Killing sperm in the vagina describes a spermicide. Blocking estrogen receptors in the breast describes drugs such as tamoxifen.
Category: Hormonal Contraceptives
Question 7
Before estrogen therapy is started, which finding must be evaluated first?
Controlled hypothyroidism
Mild osteoarthritis of the knees
Undiagnosed abnormal vaginal bleeding
✓
Occasional constipation
Correct Answer
Undiagnosed abnormal vaginal bleeding
Undiagnosed abnormal genital bleeding is a contraindication to estrogen because it may come from endometrial cancer, which estrogen can stimulate, so its cause must be found first. Controlled hypothyroidism does not prevent estrogen therapy, though thyroid dosing may need review. Mild osteoarthritis of the knees is not a contraindication. Occasional constipation is not a contraindication either.
Category: Estrogen and Progestin Therapy
Question 8
After a contraceptive implant is placed in the inner upper arm, what should the nurse and patient do?
Massage the site firmly every day
Soak the arm in warm water that evening
Avoid using the arm until the implant dissolves
Confirm the implant can be felt under the skin
✓
Correct Answer
Confirm the implant can be felt under the skin
Labeling directs both the clinician and the patient to palpate the implant after insertion to confirm it is in place, because an implant that cannot be felt may not have been inserted and pregnancy protection cannot be assumed. Massaging the site firmly every day is not recommended and could disturb the implant. Soaking the arm in warm water that evening is not part of site care. Avoiding use of the arm until the implant dissolves is wrong because the rod does not dissolve and must be removed by a clinician.
Category: Hormonal Contraceptives
Question 9
A patient taking clomiphene for infertility reports blurred vision and seeing spots. What should the nurse do?
Report it, since the drug is usually stopped
✓
Reassure her that this is an expected effect
Advise taking the dose with a fatty meal
Suggest moving the dose to bedtime
Correct Answer
Report it, since the drug is usually stopped
Visual symptoms such as blurring, spots or flashes during clomiphene therapy call for stopping the drug and an eye evaluation, so the nurse reports them to the provider. Reassuring her that this is an expected effect would delay needed evaluation. Advising a dose with a fatty meal does not address the problem. Suggesting a bedtime dose does not make the symptom safe to ignore.
Category: Fertility Drugs
Question 10
A patient receiving gonadotropin injections for infertility reports abdominal bloating, rapid weight gain and shortness of breath. Which complication should the nurse suspect?
Polycystic ovary syndrome
Ovarian hyperstimulation syndrome
✓
Premature ovarian failure
Acute appendicitis
Correct Answer
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome causes enlarged ovaries and fluid shifts that produce abdominal distention, rapid weight gain, ascites and sometimes pleural effusion with dyspnea, and it needs prompt evaluation. Polycystic ovary syndrome is a chronic condition that often leads to fertility treatment rather than resulting from it. Premature ovarian failure is loss of ovarian function, the opposite of overstimulation. Acute appendicitis causes localized pain and fever, not rapid weight gain and breathlessness.
Category: Fertility Drugs
Question 11
During controlled ovarian stimulation, cetrorelix is given for which purpose?
To trigger final follicle maturation
To support the uterine lining after transfer
To prevent a premature LH surge
✓
To stimulate growth of many follicles
Correct Answer
To prevent a premature LH surge
Cetrorelix is a GnRH antagonist that blocks pituitary release of luteinizing hormone, preventing an early LH surge that would release eggs before retrieval. Triggering final follicle maturation is the role of human chorionic gonadotropin. Supporting the uterine lining after transfer is the role of progesterone. Stimulating growth of many follicles is the role of FSH products such as follitropin.
Category: Fertility Drugs
Question 12
During an oxytocin infusion, contractions become excessively frequent and the fetal heart rate tracing shows signs of distress. What is the nurse's first action?
Increase the oxytocin rate
Give IV methylergonovine
Position the patient flat on her back
Stop the oxytocin infusion
✓
Correct Answer
Stop the oxytocin infusion
Uterine hyperactivity with fetal distress calls for stopping the oxytocin infusion right away, followed by measures such as a side-lying position and notifying the provider. Increasing the oxytocin rate would worsen the hyperactivity. Giving IV methylergonovine would cause sustained uterine contraction and is contraindicated before delivery. Positioning the patient flat on her back can compress major vessels and further reduce placental blood flow.
Category: Uterine Motility Drugs
Question 13
Methylergonovine combined with which drug can cause severe vasoconstriction and limb ischemia?
Clarithromycin
✓
Amoxicillin
Cephalexin
Acetaminophen
Correct Answer
Clarithromycin
Clarithromycin is a strong CYP3A4 inhibitor, and labeling warns that strong CYP3A4 inhibitors such as macrolides and protease inhibitors can raise methylergonovine levels and cause serious peripheral ischemia. Amoxicillin does not inhibit CYP3A4 in a meaningful way. Cephalexin does not cause this interaction. Acetaminophen does not cause this interaction either.
Category: Uterine Motility Drugs
Question 14
Pretreatment with antiemetic and antidiarrheal drugs is often given with carboprost because the drug commonly causes which effects?
Hypertension and headache
Vomiting and diarrhea
✓
Bradycardia and hypotension
Urinary retention and constipation
Correct Answer
Vomiting and diarrhea
Carboprost is a prostaglandin that stimulates gastrointestinal smooth muscle as well as the uterus, so vomiting and diarrhea are very common and premedication reduces them. Hypertension and headache are classic concerns with methylergonovine. Bradycardia and hypotension are not the effects this premedication targets. Urinary retention and constipation are anticholinergic effects, the opposite of what carboprost does to the gut.
Category: Uterine Motility Drugs
Question 15
Why does the nurse monitor urine output closely during magnesium sulfate therapy?
Magnesium is a potent loop diuretic
Low output shows the drug is working
Magnesium is excreted by the kidneys
✓
Magnesium damages the bladder lining
Correct Answer
Magnesium is excreted by the kidneys
Magnesium is eliminated almost entirely by the kidneys, so falling urine output lets serum magnesium rise toward toxic levels. Magnesium is not a potent loop diuretic. Low output showing the drug is working is false, since low output is a warning sign. Magnesium damaging the bladder lining is not an effect of the drug.
Category: Uterine Motility Drugs
Question 16
Before mifepristone is given for medical termination of an intrauterine pregnancy, which condition must be ruled out because the drug does not treat it?
Gestational diabetes
Mild anemia
Hyperemesis gravidarum
Ectopic pregnancy
✓
Correct Answer
Ectopic pregnancy
Mifepristone with misoprostol does not end a pregnancy implanted outside the uterus, and a missed ectopic pregnancy can rupture, so labeling lists confirmed or suspected ectopic pregnancy as a contraindication. Gestational diabetes is not the condition that must be excluded. Mild anemia is assessed but is not the key contraindication here. Hyperemesis gravidarum is not a contraindication that must be ruled out.
Category: Uterine Motility Drugs
Question 17
A patient taking raloxifene is scheduled for surgery that will require prolonged bed rest. What should the nurse anticipate?
Stopping the drug beforehand to lower clot risk
✓
Doubling the dose to protect bone
Adding estrogen to prevent hot flashes
Continuing the drug without any change
Correct Answer
Stopping the drug beforehand to lower clot risk
Raloxifene raises the risk of venous thromboembolism, and labeling advises stopping it ahead of and during prolonged immobilization. Doubling the dose to protect bone would add clot risk and is not done. Adding estrogen to prevent hot flashes is not recommended with raloxifene. Continuing the drug without any change ignores the added clot risk of immobility.
Category: Bone and SERM Drugs
Question 18
A few days after her first IV zoledronic acid infusion for osteoporosis, a patient reports fever, muscle aches and joint pain. What should the nurse explain?
This means the jaw bone has started to die
This is a common flu-like acute-phase reaction
✓
This is the start of an anaphylactic reaction
This shows the drug has stopped working
Correct Answer
This is a common flu-like acute-phase reaction
An acute-phase reaction with fever, myalgia, arthralgia and flu-like symptoms is common in the days after an IV bisphosphonate infusion, especially the first, and it usually resolves; acetaminophen can ease it. The jaw bone starting to die describes osteonecrosis of the jaw, which presents as jaw pain or exposed bone, not fever and body aches. Anaphylaxis develops soon after exposure with airway or circulation signs such as wheezing, throat swelling and low blood pressure. The drug having stopped working is not what these symptoms mean.
Category: Bone and SERM Drugs
Question 19
A patient who uses topical testosterone gel lives with young children. Which teaching is essential?
Apply the gel to the hands and face
Let the children help apply the gel
Wash hands and cover the site with clothing
✓
Hug the children right after applying it
Correct Answer
Wash hands and cover the site with clothing
Children exposed to testosterone gel through skin contact can develop virilization, so patients wash their hands after applying it, cover the dried site with clothing and wash the site before skin-to-skin contact. Applying the gel to the hands and face increases transfer and is not where it is applied. Letting the children help apply the gel exposes them directly. Hugging the children right after applying it transfers the drug to their skin.
Category: Androgens
Question 20
A patient asks why sildenafil seemed to work more slowly after a large, high-fat dinner. What should the nurse explain?
Fat inactivates the drug in the stomach
Fat speeds removal of the drug by the kidneys
The meal made the drug more potent
The meal slowed absorption of the drug
✓
Correct Answer
The meal slowed absorption of the drug
A high-fat meal reduces the rate of sildenafil absorption and delays its peak effect, so patients are taught to avoid taking it right after such a meal. Fat inactivating the drug in the stomach is not how the effect occurs. Fat speeding removal by the kidneys is false, since the drug is cleared mainly by liver metabolism. The meal making the drug more potent is the opposite of what the patient noticed.
Category: Erectile Dysfunction Drugs