Unit 7: Medications Affecting the Reproductive System

A nurse is reviewing the route of administration for conjugated equine estrogens. Why is transdermal therapy often preferred over oral therapy for hormone replacement?

It reduces the incidence of nausea and vomiting, requires a smaller dose, and maintains more stable blood estrogen levels with fewer complications.

What is the primary expected pharmacological action of estrogens regarding bone health in postmenopausal clients?

Estrogens block bone resorption, which helps prevent postmenopausal osteoporosis.

A client taking estrogen therapy is concerned about cardiovascular risks. What specific lifestyle modification should the nurse emphasize to reduce the risk of thrombophlebitis?

The client must avoid all nicotine products, as smoking significantly increases the risk for blood clots.

To reduce the risk of endometrial cancer, a nurse should ensure that a client with an intact uterus who is prescribed estrogen also receives which medication?

Progestins.

A nurse is educating a postmenopausal client on estrogen-progestin therapy. How often should the client be instructed to schedule an endometrial biopsy?

Every 2 years.

A nurse is assessing a client on estrogen therapy for embolic events. What specific physical findings in the lower legs should the nurse monitor for?

Pain, swelling, warmth, or erythema (redness).

Which medication interaction occurs between estrogens and warfarin that requires monitoring of PT and INR?

Estrogens can reduce the effectiveness of warfarin, potentially requiring a dosage adjustment.

A client is prescribed an estrogen patch. Which two anatomical areas should the client be specifically instructed to avoid during application?

The breasts and the waistline.

A nurse is preparing a client for a scheduled hip replacement. Why should estrogen therapy be discontinued several weeks prior to this surgery?

To reduce the risk of thromboembolic events associated with extensive post-operative immobilization.

What instruction should the nurse provide to a client who missed a dose of their daily estrogen medication?

Take the medication at the same time each day, but notify the provider of any breakthrough bleeding or menstrual changes.

What is the primary therapeutic use of medroxyprogesterone in a postmenopausal client who is also taking estrogen?

To counter the adverse effects of estrogen on the endometrium, specifically reducing the risk of endometrial hyperplasia or cancer.

A client taking progestins reports yellowing of the skin and eyes. Which laboratory values should the nurse expect the provider to order?

Liver enzymes (to monitor for jaundice and liver dysfunction).

How soon after stopping a progestin medication should a client expect withdrawal bleeding to occur?

3 to 7 days.

A client taking oral contraceptives is also prescribed rifampin. What specific teaching should the nurse provide regarding pregnancy prevention?

Use a secondary or backup form of contraception because rifampin decreases the effectiveness of oral contraceptives.

A nurse is teaching a group of clients about the mechanism of action of combination oral contraceptives. What are the three primary ways these prevent pregnancy?

Inhibiting ovulation, thickening the cervical mucus, and altering the endometrial lining.

Which type of oral contraceptive is considered safe for a client who is currently lactating?

Progestin-only oral contraceptives (minipills).

A client taking a combination oral contraceptive containing drospirenone is at increased risk for which electrolyte imbalance?

Hyperkalemia.

What instruction should a nurse give a client who missed one pill of their oral contraceptive during the first week of the cycle?

Take the missed pill as soon as possible, continue the pack, and use an additional form of contraception for 7 days.

A client using a vaginal contraceptive ring (ethinyl estradiol and etonogestrel) informs the nurse the ring fell out 4 hours ago. What instruction is necessary?

Rinse and replace the ring, but use backup contraception for the next 7 days.

When should a client be instructed to apply a new transdermal contraceptive patch?

Once a week for 3 weeks, followed by one week without a patch to allow for menstruation.

Within what timeframe must levonorgestrel (emergency contraceptive) be taken following unprotected intercourse to be effective?

Within 72 hours.

What is the mechanism of action of mifepristone (RU 486) when used for the medical termination of pregnancy?

It binds to progesterone receptors and prevents the action of progesterone, which is necessary to maintain pregnancy.

A client is prescribed testosterone gel for hypogonadism. What safety precaution must the client take regarding the application site?

Wash hands after application and cover the site with clothing to prevent skin-to-skin transfer to others.

How does testosterone therapy affect the growth of a client who has not reached skeletal maturity?

It can cause premature epiphyseal closure, potentially reducing the client's mature height.

A nurse is monitoring a client taking testosterone. Which laboratory results would indicate the development of polycythemia?

Increased hemoglobin and hematocrit levels.

Why is finasteride (a 5-alpha reductase inhibitor) used to treat benign prostatic hyperplasia (BPH)?

It decreases usable testosterone, which reduces the size of the prostate and improves urinary flow.

How long should a client expect to take finasteride before noticing therapeutic effects on BPH symptoms?

6 months or longer.

Why should a nurse who is pregnant or of childbearing age avoid handling crushed or broken finasteride tablets?

The medication can be absorbed through the skin and cause harm to a developing male fetus.

A client taking tamsulosin for BPH should be monitored for which common cardiovascular complication?

Hypotension and dizziness (orthostatic hypotension).

A client taking tamsulosin is scheduled for cataract surgery. What should the nurse instruct the client to do regarding their medication?

Notify the ophthalmologist, as the medication must be held to prevent 'floppy iris syndrome' during surgery.

A client with a history of angina asks for a sildenafil prescription. Which medication in the client's record would strictly contraindicate the use of sildenafil?

Any nitrates, such as nitroglycerin or isosorbide dinitrate (can lead to fatal hypotension).

What is a critical teaching point for a client taking sildenafil regarding the duration of an erection?

If an erection lasts longer than 4 hours (priapism), seek immediate medical attention to avoid irreversible tissue damage.

A nurse is administering oxytocin to induce labor. What specific finding regarding uterine contractions should prompt the nurse to stop the infusion?

Uterine tachysystole (more than five contractions in 10 minutes or contractions lasting longer than 60 seconds).

A client receiving high doses of oxytocin is showing signs of confusion and reports a headache. Which complication should the nurse suspect?

Water intoxication (hyponatremia).

What is the primary therapeutic use for methylergonovine maleate in the postpartum period?

Emergency intervention for serious postpartum hemorrhage.

A client is scheduled for methylergonovine for postpartum hemorrhage. Which vital sign must the nurse assess prior to administration, and what finding would contraindicate its use?

Blood pressure; hypertension contraindicates use as it can cause a hypertensive crisis.

A nurse is administering dinoprostone gel for cervical ripening. What position should the client maintain after administration and for how long?

Supine with a lateral tilt for 30 to 40 minutes (gel) or 2 hours (vaginal insert).

What is the primary purpose of administering terbutaline during preterm labor?

To delay labor for up to 48 hours by relaxing uterine smooth muscle (beta2 activation).

A nurse is assessing a client receiving terbutaline. At what maternal heart rate should the nurse withhold the next dose and notify the provider?

Greater than $120$ beats per minute.

What is the primary indication for administering magnesium sulfate to a client with preeclampsia?

To prevent seizures (CNS depressant).

Which assessment finding is an early indicator of magnesium sulfate toxicity and requires immediate cessation of the infusion?

Loss of deep tendon reflexes.

What is the minimum acceptable hourly urine output for a client receiving magnesium sulfate?

$25$ to $30$ mL per hour.

A client in preterm labor at 30 weeks gestation is prescribed betamethasone. What is the intended therapeutic effect for the fetus?

To stimulate the production of lung surfactant and enhance fetal lung maturity.

How is betamethasone typically administered to the mother to ensure fetal benefit?

Two deep IM injections administered 24 hours apart.

A nurse is considering the administration of opioid analgesics (e.g., fentanyl) to a client in labor. What cervical dilation is typically required before administration to avoid slowing labor?

At least $4$ cm (labor must be well established).

If a newborn experiences respiratory depression due to maternal opioid administration, which medication should the nurse have available for the infant?

Naloxone.

A client is prescribed nifedipine to suppress preterm labor. Why should the nurse avoid concurrent administration of nifedipine and magnesium sulfate?

Concurrent use increases the risk of skeletal muscle blockade and severe hypotension.

Why is indomethacin generally reserved for early preterm labor (before 32 weeks)?

Because it can cause premature closure of the fetal ductus arteriosus at higher doses or later gestations.

What common gastrointestinal side effect should a nurse warn a client about when administering carboprost tromethamine for postpartum hemorrhage?

Nausea, vomiting, and diarrhea (may require antiemetics or antidiarrheals).

Which vital signs should a nurse monitor most closely when increasing the dose of an oxytocin infusion?

Blood pressure, respiratory rate, and pulse every 30 to 60 minutes and with every dosage change.