Chapter 39: Gonadal Hormones My Nursing Test Banks

Chapter 39: Gonadal Hormones

Test Bank

MULTIPLE CHOICE

1. A female patient with a history of endometriosis presents with bilateral lower quadrant pain reportedly at midcycle. Which gonadal drug is indicated for treating symptoms of endometriosis?

a.

Estrogen

b.

Progesterone

c.

Androgens

d.

Gonadotropins

ANS: B

Progesterones are used to treat secondary amenorrhea, breakthrough uterine bleeding, and endometriosis. They may be combined with estrogens as contraceptives. Estrogen products are used for relieving the hot flash symptoms of menopause; for contraception; for hormone replacement therapy after an oophorectomy; in conjunction with appropriate diet, calcium, and physical therapy in the treatment of osteoporosis; for treatment of severe acne in females; and to slow the disease progress (and minimize discomfort) in patients with advanced prostatic cancer and certain types of breast cancer. Androgens are used to treat hypogonadism, eunuchism, androgen deficiency, and palliation of breast cancer in postmenopausal women with certain cell types of cancer. When androgens are used for palliation of cancer in women, they suppress cancer cell growth. Gonadotropin is a hormone secreted in the pituitary; it regulates the release of the gonadal hormones.

DIF: Cognitive Level: Comprehension REF: p. 616 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. What is the rationale for using an androgen as part of breast cancer treatment?

a.

For maintenance of fat stores

b.

To promote nutrition

c.

To prevent wasting resulting from cancer growth

d.

For palliative treatment to suppress cancer cell growth

ANS: D

When androgens are used for palliation of breast cancer in women, they suppress cancer cell growth. Androgens affect muscle growth, not fat stores. Estrogen affects fat stores. Although androgens may be used to stimulate appetite and improve nutrition, this is not the indication in this case. Although androgens may be used to prevent wasting, this is not the indication in this case.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 | 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. The health of a patient receiving androgen therapy for breast cancer declines and she becomes bed bound. Which condition will this patient be at risk of developing?

a.

Electrolyte imbalances

b.

Hypercalcemia

c.

Hyperglycemia

d.

Fluid overload

ANS: B

Immobilized patients receiving androgens for palliative breast cancer treatment are at risk for hypercalcemia. The nurse should monitor patients for nausea, vomiting, constipation, poor muscle tone, and lethargy. Immobilization does not affect electrolyte balance, blood glucose, or fluid balance in this case.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which patient on oral contraceptive therapy will be at greatest risk for heart attack?

a.

A 34-year-old woman with a history of osteoporosis

b.

A 28-year-old woman with a history of eczema

c.

A 36-year-old woman who smokes half a pack per day

d.

A 36-year-old woman who has a history of abnormal Pap smears

ANS: C

The incidence of fatal heart attacks is increased for women older than 35 years of age who use gonadal hormones and smoke. Osteoporosis, eczema, and cervical dysplasia do not increase risk for heart attack.

DIF: Cognitive Level: Application REF: p. 613 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which is most important for the nurse to remember when instructing the patient about treatment with gonadal hormones?

a.

Dosage, schedule, and adverse effects

b.

Cost, storage, and route of administration

c.

Drug interactions and food interactions

d.

Scheduling follow up appointments and lab studies

ANS: A

Most gonadal hormones are prescribed to patients for prolonged self administration. Therefore, planning should stress patient education specific to the type of gonadal hormone prescribed and its intended actions, including monitoring of adverse effects to expect and report. Cost, storage, and route of administration are lesser concerns. There are few, if any, interactions between gonadal hormones and food or other drugs. Follow up appointments and lab studies are lesser concerns.

DIF: Cognitive Level: Application REF: p. 613 OBJ: 2 | 4 | 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

6. The nurse is teaching a young woman about birth control pills. For which situation will the patient need to seek immediate follow up with the health care provider?

a.

Breakthrough bleeding

b.

Nausea

c.

Missed dose

d.

Light menstrual flow

ANS: A

Breakthrough bleeding is not an expected adverse effect and should be reported to a health care provider immediately to consider alternatives in therapy. Nausea is an expected adverse effect of contraceptive therapy. Missed doses are common and do not require notification of the provider. Light menstrual flow is common with contraceptive therapy.

DIF: Cognitive Level: Application REF: p. 614 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

7. Which statement is true regarding androgen therapy?

a.

Androgen use may cause hyperglycemia.

b.

Androgen should be administered with food or milk to avoid gastric irritation.

c.

Signs of masculinization will appear and are reversible.

d.

Electrolyte imbalances are extremely rare.

ANS: B

Androgens may cause gastric irritation and therefore can be given with food or milk. Androgens cause hypoglycemia. Treatment is often stopped once signs of masculinization appear, because these may not be reversible. Androgens cause electrolyte imbalances.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

8. Which is the most potent of the natural estrogenic hormones produced in the ovaries?

a.

Estradiol

b.

Estrone

c.

Estriol

d.

Estrogen

ANS: A

The natural estrogenic hormone released from the ovaries comprises several closely related chemical compounds: estradiol, estrone, and estriol. The most potent is estradiol.

Estradiol is metabolized to estrone, which is half as potent. Estrone is metabolized to estriol, which is considerably less potent. Estrogens are a group of steroid compounds named for their importance in the estrus cycle, functioning as the primary female sex hormone.

DIF: Cognitive Level: Comprehension REF: p. 613 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which information will the nurse include when teaching a patient with seizures about estrogen therapy?

a.

Phenytoin reduces the effectiveness of estrogen.

b.

Estrogen reduces the effectiveness of phenytoin.

c.

Phenytoin may inhibit the metabolism of estrogen.

d.

Estrogen may inhibit the metabolism of phenytoin.

ANS: D

Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Phenytoin does not reduce the effectiveness of estrogen. Estrogen does not reduce the effectiveness of phenytoin. Phenytoin does not inhibit the metabolism of estrogen.

DIF: Cognitive Level: Application REF: p. 614 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. When preparing a female patient for the endocrine changes that may occur as a result of androgen changes, the nurse will include information regarding:

a.

priapism.

b.

voice changes.

c.

gynecomastia.

d.

fluid retention.

ANS: B

Women should be monitored for signs of masculinization, such as deepening of the voice. Males should be carefully monitored for priapism and development of gynecomastia. Fluid retention is a metabolic effect, not an endocrine change, that may occur.

DIF: Cognitive Level: Application REF: pp. 617-618 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

11. What is progestin therapy used for? (Select all that apply.)

a.

Contraception

b.

Endometriosis

c.

Amenorrhea

d.

Abnormal uterine bleeding

e.

Cancer

ANS: A, B, C, D

Progestin therapy is used in combination with estrogens as a contraceptive, to relieve symptoms of endometriosis, for hormonal balance to relieve amenorrhea, and for hormonal balance to relieve abnormal uterine bleeding. Progestin is not used in cancer treatment.

DIF: Cognitive Level: Application REF: p. 616 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

12. The nurse is completing discharge teaching to a new mother who will begin oral contraceptives. Which common adverse effect(s) should be expected? (Select all that apply.)

a.

Elevated blood pressure

b.

Breast tenderness

c.

Weight gain

d.

Edema

e.

Increased thirst

ANS: B, C, D

Breast tenderness, weight gain, and edema are adverse effects to expect when beginning oral contraceptives. Elevated blood pressure and increased thirst are not adverse effects to expect from oral contraceptives.

DIF: Cognitive Level: Application REF: p. 614 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. Why is estrogen therapy used in postmenopausal women? (Select all that apply.)

a.

To meet contraceptive needs

b.

To treat acne

c.

To prevent osteoporosis

d.

To treat hot flashes

e.

To maintain hormonal balance

ANS: C, E

Estrogen therapy is used in conjunction with diet, calcium, and physical therapy in the prevention and treatment of osteoporosis and to slow the disease progression in patients with advanced prostate cancer and certain types of breast cancer. Postmenopausal females would take estrogen to maintain hormonal balance. Women of childbearing age use estrogen to meet contraceptive needs. Women who use estrogen to treat acne are not postmenopausal. Estrogen therapy is used to reduce the frequency of hot flashes of menopausal (not postmenopausal) women.

DIF: Cognitive Level: Analysis REF: pp. 613-614 OBJ: 3

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

14. Which condition(s) would be of special concern when evaluating a patient for treatment with gonadal hormones? (Select all that apply.)

a.

Sexually transmitted disease

b.

Hypertension

c.

Liver disease

d.

Cancer of the reproductive organs

e.

Smoking

ANS: B, C, D, E

Hypertension, liver disease, and cancer of the reproductive organs may be contraindications for treatment with gonadal hormones. Smoking increases the risk of heart attacks, stroke, and embolic disorders in patients taking gonadal hormones. Sexually transmitted diseases are not affected by treatment with gonadal hormones.

DIF: Cognitive Level: Application REF: p. 612 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

15. When teaching a patient about estrogen therapy, which drug(s) will the nurse identify as causing drug interactions? (Select all that apply.)

a.

Diazepam (Valium)

b.

Warfarin (Coumadin)

c.

Thyroid hormones

d.

Phenytoin (Dilantin)

e.

Acetaminophen (Tylenol)

ANS: B, C, D

Estrogen may diminish the anticoagulant effects of warfarin. Monitor the prothrombin time and increase the dosage of warfarin, if necessary. Patients who have no thyroid function and who start estrogen therapy may require an increase in thyroid hormone dosage. Estrogens increase thyroid binding globulin levels, which reduce the level of circulating free T4. The total level of T4 is either normal or increased. Do not adjust the thyroid dosage until the patient shows clinical signs of hypothyroidism. Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Monitor patients with concurrent therapy for signs of phenytoin toxicity (e.g., nystagmus, sedation, lethargy). Serum levels may be ordered, and a reduced dosage of phenytoin may be required. There are no drug interactions with estrogen and diazepam or acetaminophen.

DIF: Cognitive Level: Application REF: p. 614 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. The nurse is discussing estrogen therapy with a patient education group. When relaying information, the nurse may explain that therapeutic outcomes of estrogen therapy include: (Select all that apply.)

a.

contraception.

b.

hormonal balance.

c.

treatment of severe facial acne.

d.

appetite suppression.

e.

prevention of heart disease.

ANS: A, B, C

The primary therapeutic outcomes expected from estrogen therapy include contraception, hormonal balance, prevention of osteoporosis, palliative treatment of prostate and breast cancer, and treatment of severe acne in females. Appetite suppression and prevention of heart disease are not expected therapeutic outcomes of estrogen therapy.

DIF: Cognitive Level: Application REF: p. 614 OBJ: 3 | 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

17. The nurse is preparing to administer an estrogen containing medication to a patient. This medication will be held if the nurse assesses that the patient: (Select all that apply.)

a.

may be pregnant.

b.

has a blood pressure of 130/70.

c.

has a history of phlebitis.

d.

reports breast tenderness.

e.

is taking thyroid hormones.

ANS: A, C

The nurse must determine whether the patient is pregnant before starting estrogen therapy and the medication withheld if there is a possibility of pregnancy. Estrogen should be held and the health care provider contacted if the patient has a history of thromboembolitic disorders. A blood pressure of 130/70 is considered within normal limits. Breast tenderness is not a contraindication of estrogen administration. Thyroid hormones may need adjustment, but a patient taking estrogen can take thyroid hormones.

DIF: Cognitive Level: Analysis REF: p. 614 OBJ: 2 | 5

TOP: Nursing Process Step: Assessment, Implementation, Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

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