Which hormonal change causes the breakdown of the endometrium and resultant menstrual bleeding? Show C. Decreased level of progesterone The breakdown of the endometrium and the resultant menstrual bleeding are caused by the fall of the progesterone level at the end of the menstrual cycle. The decline in estrogens plays a role, but the decrease in progesterone is responsible for bleeding. The increase in estrogens after menstruation is responsible for the restoration of the endometrium. LH and FSH are not directly related to menstrual bleeding. A female patient who is 65 years old receives hormonal therapy. Which therapy will increase the risk of endometrial cancer in this patient? A. Estrogen The prolonged use of unopposed estrogens by postmenopausal women is related to an increased risk of endometrial cancer because, when they are used alone, estrogens cause endometrial proliferation and hyperplasia. Estrogen in combination with progesterone causes little or no risk of uterine cancer because the progestin reduces the risk of endometrial cancer by decreasing estrogen-mediated endometrial proliferation. A female patient is taking estrogen with progesterone. What instruction should the nurse include in patient teaching to facilitate the monitoring of the risks associated with this therapy? A. Have a yearly mammogram Estrogen in combination with progesterone increases the risk of breast cancer, so the nurse instructs the patient to have a yearly mammogram. The risk of osteoporosis decreases for women who take estrogen therapy. Although patients taking estrogen with progestin are at increased risk of thromboembolic events, the effect on serum lipids is unclear. Pregnancy is generally not a concern when women take this combination as hormone replacement therapy, and missed periods are common. An increased progesterone level promotes a pregnancy by doing what? C. Suppressing uterine contractions The progesterone level increases during pregnancy and helps sustain a pregnancy by suppressing uterine contractions. Estrogen thins the cervical mucosa, thickens the vaginal mucosa, and stimulates the development of breast tissue. Which medication is not indicated for a patient who has undergone a hysterectomy and bilateral oophorectomy? A. Megestrol (Megace) Megestrol, a progestin, is not indicated in hormonal therapy for patients who have undergone a total hysterectomy; instead, it is indicated in the palliative management of recurrent, inoperable, or metastatic endometrial or breast cancer. The primary role of progestin in hormonal therapy is to counterbalance the risk of estrogen-mediated endometrium hyperplasia. Because the patient does not have an endometrium since undergoing hysterectomy, she does not need this medication. Alendronate and calcium citrate for osteoporosis and estradiol transdermal may be suitable therapies after hysterectomy. Which medication is suitable therapy for oral contraception in women who cannot take estrogen? D. Medroxyprogesterone (Provera) Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers. Estropipate and estrone are synthetic estrogens. What information should the nurse include when preparing an educational session about cancer risks in postmenopausal women? C. Unopposed estrogen increases the risk of endometrial cancer. The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer; however, when estrogen is combined with progestin, the risk diminishes. Estrogens used alone are not associated with increased risk of breast cancer; however, estrogen in combination with progestin is associated with an increased risk of breast cancer. Which hormonal change is responsible for clinical indicators of menopause? C. Decline in estrogen production The decline in estrogen production by the ovaries is associated with clinical indicators of menopause, including vasomotor instability, vaginal dryness and atrophy, and declining bone density. This decline is caused because the ovarian follicles, which are the primary source of estrogen, decline as women grow older. Which factor has the greatest potential to increase the risk of thromboembolic phenomena in a patient taking norethindrone and ethinyl estradiol (Loestrin)? B. Smoking heavily every day Women taking oral contraceptives are at increased risk of thromboembolic events if they smoke heavily or have a history of thromboembolism; this higher risk is partially due to an increase in circulating levels of clotting factors. Consumption of saturated fats is likely to increase the risk of a thromboembolic event in a patient who takes an oral contraceptive, but not as much as smoking. Sedentary living increases the risk of several health problems and can contribute to the development of thromboemboli, but that risk is secondary to the risk resulting from concurrent smoking and use of oral contraceptives. Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? A. Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease because they provide the most barrier protection. A female patient complains of irritability, fatigue, and decreased ability to enjoy things that she used to enjoy. Which contraceptive should this patient avoid using? D. Norethindrone and ethinyl estradiol (Necon) The patient has clinical indicators consistent with depression, so the nurse encourages her to avoid using oral contraceptives to prevent pregnancy because these drugs can cause depression. The cervical cap, male condom, and progestin are reasonable alternatives for the prevention of pregnancy in this patient. Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol (Ortho-Novum)? A. Rifampin (Rifadin) A variety of drugs, including rifampin, ritonavir, troglitazone, carbamazepine, phenobarbital, phenytoin, tetracyclines, and ampicillin, can decrease the effectiveness of oral contraceptives. A female patient with strep throat is taking amoxicillin with clavulanate (Augmentin) to eliminate the infection. Because the patient also takes an oral contraceptive (OC), the nurse instructs her to use a different method of birth control for how long? D. For at least a month during and after starting the antibiotic Because antibiotics, especially penicillins and cephalosporins, can impair the action of OCs, the nurse instructs the patient to use another method of birth control for at least 1 month during and after starting the antibiotic. Which type of oral contraceptive (OC) delivers hormones for more than 30 days? D. Extended-cycle Extended-cycle oral contraceptives deliver hormones for 84 to 365 consecutive days, shortening or eliminating the hormone-free period. Biphasic OCs, which deliver estrogen in a fixed amount for 21 or 28 days, contain a low dose of progestin for the first 10 days and a higher dose of progestin for the remainder of the cycle. Triphasic OCs deliver three different estrogen-progestin combinations over the course of the cycle. Monophasic OCs deliver an unchanging combination of estrogen and progestin. Which medication is most likely to promote follicular maturation in an infertile female patient? A. Clomiphene (Clomid) Clomiphene facilitates follicular maturation by promoting the release of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Ethinyl estradiol is a steroidal estrogen used in hormone replacement. Progesterone is more likely to be used to maintain a pregnancy. Choriogonadotropin alfa causes ovulation from mature follicles. To
be a suitable candidate for clomiphene (Clomid) therapy, the patient must have what? B. At least one ovary For clomiphene to be effective, the patient needs at least one ovary because the drug stimulates maturation of the ovarian follicle, leading, it is hoped, to ovulation and an increased chance of conception. Endometriosis, extrauterine growth of endometrial tissue, can cause infertility. It has no effect on follicular maturation unless the extrauterine endometrial tissue grows on the ovary. Depending on the individual patient and her infertility problem, some infertility clinics require a psychological examination, but clomiphene may be one of the first treatments used to facilitate conception in infertile woman. Estrogen-replacement therapy is not an effective fertility treatment. A patient at 26
weeks' gestation who has diabetes mellitus starts to experience preterm labor. Which treatment is the best initial therapy for the prevention of uterine contractions and complications in this patient's pregnancy? D. Bedrest and hydration The best initial therapies for preterm labor (bedrest and hydration) do not involve the use of medication. Bedrest and hydration are especially good choices in this patient because they do not carry the risk of increased blood sugar that terbutaline therapy does. Hydration can be an effective therapy for preterm labor, but its mechanism of action is unknown. Because pressure on the cervix or cervical incompetence can stimulate uterine contractions, bedrest may also be effective in relieving pressure on the cervix and inhibiting uterine activity. Generally terbutaline, the drug of choice for preterm labor, is used after conservative measures have failed. Magnesium sulfate is used as an off-label therapy for preterm labor; ritodrine is generally reserved for when conservative measures and terbutaline have failed. Which assessment finding indicates that a patient is a suitable candidate for oxytocin (Pitocin) therapy? D. Ineffective contractions in a term pregnancy A patient whose pregnancy is full term but who has ineffective contractions is a suitable candidate for oxytocin therapy to augment the strength and increase the frequency of contractions. Vaginal bleeding in a patient near term is an obstetric emergency, and oxytocin is contraindicated because it is likely to increase the bleeding, increase and strengthen the contractions, and cause fetal distress. In the patient with cephalopelvic disproportion, the fetus's head may be too large for the patient's pelvis; harm to both patient and fetus could occur if oxytocin were administered. Oxytocin is indicated for the induction of labor in a post-term patient, but the patient must have a soft cervix. A patient is receiving IV methylergonovine (Methergine) after a vaginal
delivery. Which postpartum assessment is the nurse's priority to prevent complications of therapy? A. Hypertension The therapeutic goal is contraction of the fundus to stop postpartum bleeding. Hypertension is likely to increase the severity of postpartum bleeding, so the prevention of hypertension is the nurse's priority for a postpartum patient receiving an ergot alkaloid because ergot alkaloids can increase blood pressure. Hypoglycemia is not an adverse effect of methylergonovine. Decreased lochia rubra is the therapeutic goal. Uterine contractions are expected during methylergonovine therapy because this is the mechanism of action behind the cessation of postpartum uterine bleeding. Which patient assessment finding should the nurse expect after the vaginal administration of dinoprostone
(Cervidil)? C. Softened cervix Dinoprostone is indicated to ripen the cervix in preparation for labor induction. If labor induction is attempted without sufficient preparation of the cervix, cervical injury may occur. A midline fundus is expected during the postpartum period. Dinoprostone is without analgesic properties and should not stimulate uterine contractions. A postmenopausal patient who has undergone a total abdominal hysterectomy needs treatment for osteoporosis. Which prescription should the nurse administer as suitable therapy? C. Estradiol transdermal (Climara) 0.025-mg patch/wk The prescription for the patient receiving estrogen-replacement therapy involving the use of a transdermal patch is within the dosing range for the medication. Estrogen is effective and is indicated in the treatment of osteoporosis for women who are willing to accept the risks of therapy. Raloxifene is administered at a dosage of 60 mg/day, alendronate is administered at a dosage of 35 mg/week or 5 mg/day, and calcitonin is administered at a dosage of 200 units nasally. Which comorbidity must be ruled out before a postmenopausal patient seeking hormone-replacement therapy may use estradiol (Estrace)? C. Fibroid tumors Fibroid tumors must be ruled out before a postmenopausal patient may be prescribed estradiol therapy because the presence of fibroid tumors indicates that the patient has a uterus and because fibroid tumors are associated with uterine bleeding. If the patient has a uterus, hormone replacement therapy must include a progestin to prevent endometrial hyperplasia. Hypertension, reflux, and discoloration of the face are not contraindications to estradiol therapy. Which method of contraception requires the least amount of patient adherence to therapy for therapy to be effective? B. Progesterone-filled intrauterine device (IUD) The progesterone-filled IUD, which is inserted by a physician, is replaced on a yearly basis to prevent conception, meaning that the patient must adhere to the yearly schedule for replacement. Medroxyprogesterone (Depo-Provera) requires the patient to schedule an intramuscular injection on a quarterly basis, or every 3 months. The transdermal patch requires the patient to remove the old patch and apply a new patch once a week. The triphasic oral contraceptive requires the greatest degree of patient adherence because the pills are taken for 21 or 28 days per cycle. Which medication may decrease the effectiveness of norethindrone?phenobarbital will decrease the level or effect of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration unless benefit outweighs risk. When coadministered, hormonal contraceptives are not a reliable method of effective birth control.
What medications decrease OCP effectiveness?Antibiotics more likely to reduce OCP effectiveness include azithromycin (Zithromax), erythromycin, ketoconazole, penicillin (and derivatives), rifampin, rifabutin (Mycobutin), and tetracycline antibiotics. Rifampin, an inducer of enzymes that metabolizes estrogens, decreases the effectiveness of OCPs.
How effective is norethindrone and ethinyl estradiol?Like other combined birth control pills, Estrostep and other norethindrone/ethinyl estradiol birth control pills are highly effective at preventing pregnancy when used properly. Estrostep has a success rate higher than 99% when used according to the medication's instructions.
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Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol?
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