Nokea
The nurse is caring for a patient with endometriosis who is treated with medroxyprogesterone. Which of the following information related to this therapy should the nurse explain to the patient?
- A. Suppresses the menstrual cycle by mimicking pregnancy.
- B. May cause symptoms such as vaginal atrophy and hot flashes.
- C. Is associated with loss of bone density and increased fracture risk.
- D. Will lead to permanent suppression of abnormal endometrial tissues.
Correct Answer: A
Rationale: Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GnRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss.
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A patient requests a prescription for birth control pills to decrease abdominal cramping and headaches during her menstrual periods. Which of the following actions should the nurse take first?
- A. Determine whether the patient is sexually active.
- B. Suggest that the patient use nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief.
- C. Take a personal and family health history from the patient.
- D. Teach the patient about the adverse effects of oral contraceptives.
Correct Answer: C
Rationale: Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may reveal contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Since the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive adverse effects at this time.
A patient who is 45 years of age tells the nurse that she has not had a menstrual period for 3 months and asks whether she is going into menopause. Which of the following responses is best by the nurse?
- A. Have you thought about using hormone therapy?
- B. Most women feel a little depressed about entering menopause
- C. What was your menstrual pattern before your periods stopped?
- D. Since you are in your mid-40s, it is likely that you are menopausal.
Correct Answer: C
Rationale: The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy (HT) may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.
Which of the following assessment findings in a patient who is taking premarin is most important for the nurse to report to the health care provider?
- A. Breast tenderness
- B. Weight gain of 1.4 kg
- C. Intermittent spotting
- D. Unilateral calf swelling
Correct Answer: D
Rationale: The patient taking premarin (estrogen) has an increased risk for stroke and emboli therefore unilateral calf swelling should be reported to the health care provider. The adverse effects of estrogen include nausea, fluid retention, headache, and breast enlargement. Breast tenderness, weight gain, and intermittent spotting do not indicate a need to report these findings to the health care provider.
A 33-year-old female patient who uses oral contraceptives tells the nurse, 'I want to have children in a few years.' Which of the following responses by the nurse is best?
- A. You may have more difficulty becoming pregnant after about age 35.
- B. You have many years of fertility left, so there is no rush to have children.
- C. You should plan to stop taking oral contraceptives several years before you want to become pregnant.
- D. If you do not have children within the next few years, it will be very difficult for you to become pregnant.
Correct Answer: A
Rationale: The probability of successfully becoming pregnant decreases after age 35 although some patients may have no difficulty in becoming pregnant, this probability further decreases after age 40. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving.
The nurse is caring for a patient who is diagnosed with stage 0 cervical cancer using a punch biopsy. Which of the following treatments should the nurse include in the teaching plan?
- A. Radiation
- B. Conization
- C. Chemotherapy
- D. Radical hysterectomy
Correct Answer: B
Rationale: Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.