1. A young woman is being seen in the gynecology clinic of the local health department.
She has decided to begin hormonal contraceptives. What action is specific to hormonal
contraceptives and should be taught to this woman?
A) The cervical mucus is made resistant to penetration by spermatozoa.
B) The follicle-stimulating hormone release is increased to block fertility.
C) The maturation of the endometrial lining is activated by contraceptive.
D) The pituitary gland increases the synthesis and release of luteinizing hormone.
Ans: A
Feedback:
Hormonal contraceptives inhibit the hypothalamic secretion of gonadotropin-releasing
hormone, which inhibits FSH and LH. The drugs produce cervical mucus that resists
penetration of spermatozoa into the upper reproductive tract. Hormonal contraceptives
inhibit the release of follicle-stimulating hormone and luteinizing hormone. The drugs
interfere with endometrial maturation and reception of ova that are released and
fertilized.
2. During patient teaching, a young woman asks the nurse the following question: “If I get
pregnant on the 'pill,' should I continue to take it?” What is the nurse's best response?
A) “The pill has no effect on pregnancy.”
B) “The pill will cause miscarriage.”
C) “This is a personal choice for each woman.”
D) “The pill can be harmful to the fetus and should be discontinued.”
Ans: D
Feedback:
If pregnancy does occur, estrogens are contraindicated because their use during
pregnancy has been associated with the occurrence of vaginal cancer in female
offspring. The pill will affect the pregnancy and should be discontinued. The pill will
not cause miscarriage. The pill can cause harmful effects on male offspring if it is
continued through pregnancy.
3. A woman suffers from amenorrhea. Which of the following medications will most
likely be prescribed?
A) Testosterone
B) Follicle-stimulating hormone
C) Estrogen
D) Lactate
Ans: C
Feedback:
Estrogen is prescribed in woman of reproductive age to treat amenorrhea. Testosterone
and FSH are not used for amenorrhea. Lactate is not used to treat amenorrhea.
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4. A patient suffers from dysmenorrhea. Which oral medication will be prescribed that has
the ability to provide physiological actions on the neuroendocrine control of ovarian
function?
A) Estrogen
B) Progestins
C) Naprosyn (Naproxen)
D) Ibuprofen (Motrin)
Ans: B
Feedback:
Progestins are used to suppress ovarian function in dysmenorrhea, endometriosis,
endometrial cancer, and uterine bleeding. Estrogen is not administered alone, but in
combination with progestins. Nonsteroidal anti-inflammatory agents, such as naproxen
and ibuprofen, decrease pain and inflammation but do not affect ovarian function.
5. A woman of childbearing age is diagnosed with breast cancer. She is currently taking
hormonal contraceptives. What information should the woman be given regarding the
hormonal contraceptives?
A) The hormonal contraceptives do not affect the course of the disease.
B) The hormonal contraceptives will stimulate uterine bleeding.
C) The hormonal contraceptives will impair uterine bleeding.
D) The hormonal contraceptives will stimulate tumor growth.
Ans: D
Feedback:
With known or suspected cancers of the breast or genital tissues, hormonal
contraceptives may stimulate tumor growth. The hormonal contraceptives should be
discontinued due to adverse reactions and stimulated tumor growth. The hormonal
contraceptives will not inhibit tumor growth. The hormonal contraceptives can decrease
uterine bleeding, but this action is not related to the breast tumor. The hormonal
contraceptives will not stimulate or impair uterine bleeding in relation to the breast
mass.
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6. A female patient is taking combined hormonal contraceptives to prevent pregnancy. She
visits the gynecology clinic and is noted to have a blood pressure of 176/102 mm Hg.
The patient is started on enalapril mesylate 10 mg. In collaboration with the primary
care provider, what other patient teaching should be provided based on her current
medication regimen?
A) Instruct on a no-salt diet.
B) Instruct to discontinue the contraceptives.
C) Instruct on the use of relaxation to decrease stress.
D) Instruct on the rationale for increasing contraceptive dose.
Ans: B
Feedback:
Because of widespread effects on the body tissues and reported adverse reactions, the
patient should be instructed to discontinue hormonal contraceptives that contribute to
hypertension. The patient should restrict salt but not eliminate salt. The implementation
of relaxation techniques is important but not crucial to the current medical regimen.
7. A patient taking hormonal contraceptives will soon turn 35 years of age. She is
moderately obese and has smoked for 15 years. Which of the following is most
important?
A) Begin an exercise regime.
B) Begin smoking cessation.
C) Begin daily aspirin therapy.
D) Begin taking a loop diuretic to aid weight loss.
Ans: B
Feedback:
Women older than 35 years of age who smoke cigarettes are at greater risk for
thromboembolic disorders. The patient should be instructed on smoking cessation. The
patient should not begin an exercise regime unless prescribed by her physician. The
patient should not begin daily aspirin or diuretic therapy unless prescribed by her
physician.
8. A woman is prescribed hormonal contraceptives. What aspect of this treatment places
her at greatest risk for the development of blood clots?
A) Hormonal contraceptives increase serum triglyceride and cholesterol.
B) Hormonal contraceptives increase platelet levels.
C) Hormonal contraceptives increase blood levels of clotting factors.
D) Hormonal contraceptives cause injury to blood vessel lumens.
Ans: C
Feedback:
The administration of estrogen in hormonal contraceptives increases hepatic production
of blood clotting factors. Hormonal contraceptives will not increase serum triglyceride
and cholesterol or platelet levels. Hormonal contraceptives will cause injury to blood
vessels.
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9. A postmenopausal woman is administered estradiol (Estraderm). What condition will be
prevented in this patient?
A) Endometriosis
B) Amenorrhea
C) Osteoporosis
D) Uterine cancer
Ans: C
Feedback:
Conjugated estrogens are used to prevent osteoporosis in postmenopausal women.
Conjugated estrogens are not administered in postmenopausal women to treat
endometriosis, amenorrhea, or uterine cancer.
10. A woman has been prescribed Climara, a transdermal estradiol patch. Which of the
following should she be instructed by the nurse regarding the administration?
A) Avoid prolonged sun exposure at the patch site due to increased plasma
concentrations.
B) The application of heat at the patch site will decrease effectiveness and result in
pregnancy.
C) The medication, when exposed to sunlight, can increase the risk of breast cancer
development.
D) Exposure of the medication to occasional cold will increase effectiveness with
application once a month.
Ans: A
Feedback:
The total amount of drug absorbed and the resulting plasma drug concentrations from
transdermal estrogen can increase during exposure to heat, so patients should be advised
to avoid prolonged sun exposure in the area of the patch. The application of heat at the
patch site will increase effectiveness. The medication's exposure to sunlight will not
increase the risk of breast cancer. The medication's exposure to cold will not change its
effectiveness.
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11. A patient with a complex medical history is considering the use of oral contraceptives.
The nurse should be aware that many antibiotics and antiseizure medications cause what
effect when combined with oral contraceptives?
A) Increased risk of pregnancy
B) Increased blood pressure
C) Increased risk of thromboembolism
D) Increased gastric acid
Ans: A
Feedback:
Several medications may reduce the effectiveness of oral contraceptives (i.e., increase
the likelihood of pregnancy). These include several antibiotics and antiseizure
medications. This combination does not increase blood pressure, risk of
thromboembolism, or gastric acid secretion.
12. An insulin-dependent diabetic patient has begun taking an oral contraceptive. What
effect will this medication regime have on her physiologically?
A) Increase risk of hypoglycemia
B) Increase heart rate
C) Increase blood glucose
D) Increase risk of metabolic alkalosis
Ans: C
Feedback:
A patient who has begun oral contraceptives and is insulin dependent will require more
insulin due to increased blood glucose. The combination of oral contraceptives and
insulin will not increase blood pressure or heart rate or cause metabolic alkalosis.
13. A 34-year-old woman has presented to the clinic for the first time, and the nurse learns
that she has been taking Depo Provera for the past 13 years. This aspect of the woman's
medical history should prompt what assessment?
A) Cardiac stress testing
B) Renal ultrasound
C) Bone density testing
D) Evaluation of triglyceride levels
Ans: C
Feedback:
There is a black box warning regarding the use of Depo Provera and Depo-SubQ
Provera that relates to its being associated with the loss of stored calcium from bones,
which increases the risk of broken bones and osteoporosis, especially after menopause.
There is a greater risk of bone loss with long-term use. Consequently, bone density
testing may be warranted. There is no particular indication for this patient to undergo
stress testing, renal ultrasound, or triglyceride testing.
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14. A 74-year-old woman states that many of her peers underwent hormone replacement
therapy (HRT) in years past. The woman asks the nurse why her primary care provider
has not yet proposed this treatment for her. What fact should underlie the nurse's
response to the woman?
A) The risks of stroke and breast cancer are unacceptably high in women taking
HRT.
B) HRT was found to cause mood disturbances in many of the women who used it
long term.
C) HRT was found to be a significant risk factor for bone fractures and osteoporosis.
D) The risks of chronic obstructive pulmonary disease were found to be significantly
higher in women taking HRT.
Ans: A
Feedback:
Studies have demonstrated no evidence for HRT in secondary prevention of heart
disease and showed increased rates of CHD, thromboembolic stroke, venous
thromboembolism, dementia, and breast cancer, which outweigh the benefits of
decreased risk of fracture and colon cancer. Mood disturbances and COPD were not
significant factors.
15. A 37-year-old woman has a 10 pack-year smoking history and has been using oral
contraceptives for the past 2 years. The nurse should plan health education interventions
in the knowledge that this patient faces an increased risk of
A) osteoporosis.
B) dementia.
C) myocardial infarction.
D) deep vein thrombosis.
Ans: C
Feedback:
For women 35 years of age and older who smoke, there is an increased risk of
myocardial infarction and other cardiovascular disorders, even with low-dose oral
contraceptives. The increase in this risk supersedes that of osteoporosis, dementia, or
DVT.
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16. A 20-year-old college student has presented to the campus medical clinic seeking to
begin oral contraceptive therapy. The nurse has recognized the need for adequate health
education related to the patient's request. The nurse should emphasize the fact that
successful prevention of pregnancy depends primarily on the patient's
A) current health status.
B) vigilant adherence to the drug regimen.
C) knowledge of sexual health.
D) risk factors for adverse effects.
Ans: B
Feedback:
It is necessary to assess each patient's need and desire for contraception, as well as her
willingness to comply with the prescribed regimen. Compliance is essential for effective
contraception. Health status, knowledge, and risk factors are all valid focuses for health
education, but these do not primarily determine success of therapy.
17. A nurse is teaching a young adult patient about oral contraceptives, which the patient
will soon begin taking. The patient's primary concern is the effectiveness of the
medication in preventing pregnancy. The nurse should teach the patient that oral
contraceptives, when taken consistently, are how effective in preventing pregnancy?
A) Between 96% and 98%
B) Approximately 98.5%
C) Highly effective, but partially dependent on genetic factors
D) Nearly 100%
Ans: D
Feedback:
When taken correctly, estrogen–progestin contraceptive preparations are nearly 100%
effective in preventing pregnancy. Genetics do not significantly affect treatment.
18. A 22-year-old woman began using oral contraceptives several months ago and has
presented for an appointment to discuss recent worrisome changes in her health status.
Which of the following changes in the woman's health may the nurse potentially
attribute to the use of oral contraceptives?
A) Fatigue
B) Frequent high blood pressure readings
C) Frequent headaches without aura
D) Nausea and vomiting
Ans: B
Feedback:
It is very important to monitor for adverse drug effects such as high blood pressure,
gallbladder disease, and blood-clotting disorders, which may be associated with oral
contraceptive use. Headaches, nausea, and fatigue are not among the more common
adverse effects of oral contraceptives.
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19. A 37-year-old woman has just experienced the end of a long-term relationship and has
expressed a desire to begin using oral contraceptives. What aspect of this woman's
current health status would contraindicate this treatment?
A) The woman has a diagnosis of type 2 diabetes.
B) The woman has asthma and uses inhaled corticosteroids and bronchodilators.
C) The woman has a family history of breast cancer.
D) The woman takes an antiplatelet medication for coronary artery disease.
Ans: D
Feedback:
Coronary artery disease is a contraindication to the use of oral contraceptives. Diabetes
and asthma do not necessarily contraindicate this treatment. A family history of breast
cancer is relevant but would not absolutely contraindicate oral contraceptive use.
20. Medroxyprogesterone acetate (Provera) is indicated for the treatment of women with
A) uterine bleeding.
B) cervical cancer.
C) ovarian cancer.
D) fibromyalgia.
Ans: A
Feedback:
Health care providers use progestins to suppress ovarian function in dysmenorrhea,
endometriosis, endometrial cancer, and uterine bleeding. Progestins are not normally
used to treat cervical cancer, ovarian cancer, and fibromyalgia.
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