Chapter 61 Estrogens and Progestins Basic Pharmacology and Noncontraceptive Applications

Chapter 61: Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications Test Bank MULTIPLE CHOICE 1. A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that: a. an estrogen-progesterone product will reduce side effects. b. an intravaginal preparation may be best for her. c. side effects of ET are uncommon among women her age. d. transdermal preparations have fewer side effects. ANS: D Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient’s age as for other women using ET. PTS: 1 DIF: Cognitive Level: Application REF: p. 736 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication? a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug. ANS: D Raloxifene can induce hot flashes in patients taking the drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer. PTS: 1 DIF: Cognitive Level: Application REF: pp. 736-737 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching? a. “Because I am not at risk for uterine cancer, I can take hormones indefinitely.” b. “I can take estrogen to reduce my risk of cardiovascular disease.” c. “I should take the lowest effective dose for the shortest time needed.” d. “I will need a progestin/estrogen combination since I have had a hysterectomy.” ANS: C For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens. PTS: 1 DIF: Cognitive Level: Application REF: p. 741 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching? a. “ET can provide protection against coronary heart disease and reverse osteoporosis.” b. “EPT is generally safer than ET, especially in women who have undergone hysterectomies.” c. “In women with established coronary heart disease, EPT can protect against myocardial infarction.” d. “Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss.” ANS: D ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease. PTS: 1 DIF: Cognitive Level: Application REF: p. 741 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn’t want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: a. Depo Provera. b. Estraderm. c. low-dose estrogens. d. Premarin vaginal. ANS: D Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects. Depo Provera is a progesterone and is not indicated. Transdermal estrogen is used to treat hot flushes. Low-dose estrogens still have systemic effects. PTS: 1 DIF: Cognitive Level: Application REF: p. 736 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct? a. “Estrogen can help reverse bone loss.” b. “Hormone therapy increases bone resorption.” c. “Hormone therapy does not decrease fracture risk.” d. “When hormone therapy is discontinued, bone mass is quickly lost.” ANS: D Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount. PTS: 1 DIF: Cognitive Level: Application REF: p. 742 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can’t take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to: a. decrease her risk of endometrial cancer. b. increase bone resorption to prevent fractures. c. lower her risk of myocardial infarction (MI). d. prevent deep vein thrombosis (DVT). ANS: A In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT. PTS: 1 DIF: Cognitive Level: Application REF: pp. 742-743 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? “I should apply this medication to my: a. waistline and shoulders.” b. abdomen and arms.” c. breasts and abdomen.” d. thighs and calves.” ANS: D The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen. PTS: 1 DIF: Cognitive Level: Application REF: p. 736 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MULTIPLE RESPONSE 1. According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.) a. Cardiovascular protection in older patients b. Decreased osteoporosis risk c. Glycemic control d. Improved wound healing e. Prevention of colorectal cancer ANS: B, C, D EPT can lower osteoporosis risk, improve glycemic control, and aid in wound healing. Preparations with estrogen alone can provide cardiovascular protection or help prevent colorectal cancer, but not preparations containing progestin. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 741-742 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.) a. Increased colon cancer b. Stroke c. Deep vein thrombosis d. Ovarian cancer e. Decreased bone density ANS: B, C, D Risk factors for EPT include stroke, deep vein thrombosis, and ovarian cancer. A decreased risk of colon cancer is associated with EPT. EPT preserves bone mineral density. PTS: 1 DIF: Cognitive Level: Application REF: pp. 742-743 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential