A client who is experiencing vasomotor symptoms related to menopause receives a new prescription for estrogen replacement. Which client condition should the nurse report the healthcare provider prior to administering the first dose of the medication?

Colorectal cancer.

Pulmonary embolism.

Dyspareunia.

Osteoporosis.

Answer and Explanation

The Correct Answer is B

A) Colorectal cancer:
While a history of colorectal cancer is important to note in a client’s medical history, it is not typically a contraindication for estrogen replacement therapy. Estrogen replacement therapy may even have benefits in terms of reducing the risk of colorectal cancer in some cases. However, the primary concern in this scenario is the client’s history of pulmonary embolism, which presents a significant risk factor for adverse outcomes with estrogen therapy.

B) Pulmonary embolism:

A history of pulmonary embolism is a significant contraindication for estrogen replacement therapy. Estrogen therapy increases the risk of thromboembolic events, and individuals with a history of pulmonary embolism are already predisposed to such events. Administering estrogen replacement therapy to a client with a history of pulmonary embolism could further increase the risk of recurrent embolism or deep vein thrombosis, leading to potentially life-threatening complications.

C) Dyspareunia:

Dyspareunia, or painful sexual intercourse, is a symptom commonly associated with menopause and may be an indication for estrogen replacement therapy. However, it is not a contraindication for treatment unless there are other complicating factors that need to be considered.

D) Osteoporosis:

Osteoporosis, characterized by decreased bone density and increased susceptibility to fractures, is often treated with estrogen replacement therapy to help maintain bone health and reduce the risk of fractures. While it is important to consider the client’s osteoporosis diagnosis when initiating estrogen therapy, it is not typically a contraindication for treatment unless there are other specific concerns or complications present.

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Correct Answer is B

Explanation

A) Platelets:
Platelet levels are not directly affected by antidiuretic hormone (ADH) administration or diabetes insipidus. Platelet monitoring is important in assessing clotting function but is not specifically related to the management of diabetes insipidus or ADH therapy.

B) Osmolality:
This is the correct answer. Osmolality refers to the concentration of solutes in the blood and is a critical parameter to monitor in clients receiving ADH therapy for diabetes insipidus. ADH regulates water reabsorption in the kidneys, thereby affecting blood osmolality. Monitoring serum osmolality helps assess the effectiveness of ADH therapy in maintaining fluid balance and preventing excessive urine output.

C) Glucose:
While glucose monitoring is important in clients with diabetes mellitus, it is not directly related to diabetes insipidus or ADH therapy. Diabetes insipidus is characterized by excessive thirst and urination due to inadequate ADH production or response, which does not involve glucose metabolism.

D) Calcium:
Calcium levels are not typically affected by ADH therapy or diabetes insipidus. Monitoring calcium levels is important in conditions such as hyperparathyroidism or hypoparathyroidism but is not directly relevant to the management of diabetes insipidus.

A. Begin therapy 1 week before the next normal menstrual cycle. B. Use condoms and a backup method of birth control to prevent pregnancy. C. Ensure a negative pregnancy test result 2 weeks before therapy. D. Call the healthcare provider immediately if there is a chance of conception.

Correct Answer is A

Explanation

A) Begin therapy 1 week before the next normal menstrual cycle:
Misoprostol is often prescribed to prevent gastric ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) and is typically taken regularly with meals and at bedtime. The timing of therapy initiation is not necessarily linked to the menstrual cycle. Therefore, instructing the client to begin therapy specifically 1 week before the next normal menstrual cycle is incorrect and indicates a need for further teaching.

B) Use condoms and a backup method of birth control to prevent pregnancy:
Misoprostol is contraindicated during pregnancy due to its potential to induce uterine contractions and cause miscarriage or fetal abnormalities. Therefore, advising the client to use condoms and a backup method of birth control to prevent pregnancy while taking misoprostol is appropriate and aligns with safety precautions.

C) Ensure a negative pregnancy test result 2 weeks before therapy:
Confirming a negative pregnancy test result before initiating misoprostol therapy is essential because the medication can cause harm to a developing fetus. This instruction is correct and reinforces the importance of avoiding pregnancy while taking misoprostol.

D) Call the healthcare provider immediately if there is a chance of conception:
Given the teratogenic effects of misoprostol, advising the client to contact the healthcare provider immediately if there is a chance of conception is crucial. This instruction emphasizes the importance of avoiding pregnancy while taking the medication and seeking medical guidance promptly if pregnancy is suspected.

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A client who is experiencing vasomotor symptoms related to menopause receives a new prescription for estrogen replacement. Which client condition should the nurse report the healthcare provider prior to administering the first dose of the medication?

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