Week 14

Question 1

The nurse or midwife would anticipate an order for a loop diuretic as the drug of choice for a person with:

a. Hypertension
b. Shock
c. Pulmonary oedema
d. Fluid retention of pregnancy

Answer 1

c. Pulmonary oedema

Question 2

The nurse is teaching a group of clients with cardiac conditions who are taking diuretic therapy. The nurse explains that individuals prescribed frusemide should:

a. Avoid consuming large amounts of cabbage, cauliflower, and kale.
b. Rise slowly from sitting or lying position
c. Count their pulse for 1 full minute before taking the medication
d. Restrict fluid intake to no more than 1000mL in a 24 hour period.

Answer 2

b. Rise slowly from sitting or lying position

Question 3

A person with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the person

a. A loop diuretic
b. A thiazide diuretic
c. A carbonic anhydrase inhibitor
d. An osmotic diuretic

Answer 3

d. An osmotic diuretic

Question 4

Clients prescribed spironolactone are often at risk for electrolyte imbalance. The nurse assesses for this adverse effect because this drug may cause the body to:

a. Retain potassium
b. Release magnesium
c. Excrete potassium
d. Bind calcium

Answer 4

a. Retain potassium

Question 5

Routine Care of a person receiving a diuretic would include which of the following?

a. Daily weighing
b. Tight fluid restrictions
c. Periodic electrolyte evaluations
d. Monitoring of urinary output
e. Regular intraocular pressure testing
f. Teaching the person to report muscle cramping

Answer 5

a. Daily weighing
b. Tight fluid restrictions
c. Periodic electrolyte evaluations
d. Monitoring of urinary output

f. Teaching the person to report muscle cramping

Question 6

Combination oestrogens and progestins are commonly used as oral contraceptives. It is thought that this combination has its effect by:

a. Acting to block the release of FSH and LH, preventing follicle development
b. Directly suppressing the ovaries and preventing ovulation
c. Keeping the endometrium constantly lush and blood filled
d. Preventing menstruation, which prevents pregnancy

Answer 6

a. Acting to block the release of FSH and LH, preventing follicle development

Question 7

Oxytocin, a synthetic form of the hypothalamic hormone, is used to:

a. Induce labour by stimulating uterine contraction
b. Stimulate milk production in the lactating woman
c. Increase fertility and the chance of conception
d. Relax the gravid uterus to prevent preterm labour

Answer 7

a. Induce labour by stimulating uterine contraction

b. Stimulate milk production in the lactating woman

Question 8

Testosterone is approved for use in:

a. Treatment of breast cancers
b. Increasing muscle strength in athletes
c. Oral contraceptives
d. Increasing hair distribution in male pattern baldness

Answer 8

a. Treatment of breast cancers

Question 9

List the symptoms of the following fluid and electrolyte imbalances;
Hypovolaemia –

Answer 9

hypotension, weak pulse, tachycardia, clammy skin, rapid resps, reduced urinary output

Question 10

List the symptoms of the following fluid and electrolyte imbalances;
Hyponatraemia –

Answer 10

low sodium concentration, lethargy, disorientation, muscle tenseness, seizures and coma

Question 11

List the symptoms of the following fluid and electrolyte imbalances;
Hypokalaemia –

Answer 11

low potassium concentration – weakness, abnormal ECG, postural hypotension and flaccid paralysis

Question 12

List the symptoms of the following fluid and electrolyte imbalances;
Hypocalcaemia –

Answer 12

low calcium concentration – irritability, vomiting, diarrhoea, twitching, hyperactive reflexes, cardiac dysrhythmias, tetany and seizures

Question 13

List the symptoms of the following fluid and electrolyte imbalances;
Hypochloraemia –

Answer 13

low chloride concentration –

Question 14

List the symptoms of the following fluid and electrolyte imbalances;
Hypomagnesaemia –

Answer 14

low magnesium concentration - nausea and vomiting, lethargy, muscle weakness, tremors and tetany

Question 15

List the symptoms of the following fluid and electrolyte imbalances;
Hyperkalaemia –

Answer 15

nausea, diarrhoea, muscle weakness, postural hypotension, ECG changes

Question 16

Compare the sites and mechanism of action of the thiazide diuretics with those of the loop diuretics

Answer 16

Thiazides are well absorbed orally
they inhibit reabsorption of sodium and chloride in the proximal segment of the convoluted tubule by binding to the chloride binding site of the Na+-Cl- symporter.

Loop diuretics act on the ascending limb of Henle, they inhibit Na+-K+-2Cl- o transporter; preventing reabsorption of sodium, potassium and chloride

Question 17

Describe three serious drug interactions with loop diuretics

Answer 17

Lithium – increased risk of lithium toxicity because of reduced renal clearance

Digoxin – increased risk of digoxin induced arrhythmias in people with diuretic induced hypokalaemia and hypomagnesaemia

Cisplatin – increased risk of nephrotoxicity in combination with frusimide

Question 18

Outline the action of oestrogen

Answer 18

• Assisting in follicle development
• Stimulating the mid-cycle LH surge.
• Stimulating the growth of myometrium and endometrium
• Stimulating mucus production in the cervix
• Metabolic actions – salt & fluid retention, mild anabolic actions, decreased risk of atheroma, decreased LDLc, increased coagulability of blood, decreased rate of bone reabsorption.
• Inhibits secretion of FSH and LH from the pituitary.

Question 19

give two examples of endogenous oestrogen

Answer 19

oestradiol, oestrone, oestriol

Question 20

indications and administration.

Oestrogen –

Answer 20

They are used for
1. Contraception
2. HRT
They are administered via tablets, implants, injections, patches creams, nasal inhilations and pessaries.

Question 21

Outline the action of progesterone

Answer 21

• Stimulate the secretory phase of the menstrual cycle
• Maintain the endometrium to prepare for the implantation and nourishment of the embryo
• Cause relaxation of the uterine smooth muscles
• Decrease levels of LH and ERs

Question 22

give two examples of endogenous progesterone

Answer 22

Progestogen – produced by the ovaries

Hydroxyprogesterone- produced by the ovaries

Question 23

indications and administration.

Progesterone

Answer 23

Commonly used in contraception and HRT

via tablets, implants, injections, patches creams, nasal inhilations and pessaries.

Question 24

. There are significant implications for the administration of medication in women who are pregnant or lactating. It is important to understand these implications. Discuss the risks for the mother and the foetus of drugs taken during pregnancy.

Answer 24

Most drugs can cross the placental barrier, it is important to know the harmful effects of medicine on the foetus, and balance these against the need of the pregnant woman for drug therapy.
Generally a drug, substance or medication can cause harm by:
• interfering with normal fetal development
• damaging the baby’s organs
• damaging the placenta and putting the baby’s life at risk
• increasing the risk of miscarriage
• bringing on premature labour.

Question 25

6. Oxytocin is secreted by the posterior pituitary and has a role in causing contractions in the pregnancy uterus and facilitating milk ejection during lactation. Describe the effects that oxytocin has on both the non-pregnant and pregnant uterus.

Answer 25

Oxytocin means rapid birth, because it causes the pregnant uterus to contract. Oxytocin has little effect on the non-pregnant uterus.

Question 26

Following childbirth drugs can still be passed from mother to child through breastfeeding. Describe how drugs can pass into breast milk, and outline guidelines for use of drugs by lactating women.

Answer 26

Drugs enter milk by diffusion and secretory methods. They pass from the maternal plasma compartment through the capillary walls into the alveolar cell lining the milk buds. • The benefits of breastfeeding are important to both mother and child • Optimising mums health is in the best interests of the infant • Older drugs should be prescribed over newer ones • Take a drug after a feed will minimise amount in the breast milk • Only essential drugs should be taken • Surgeries should be delayed if possible • If surgery necessary first breast milk after surgery should be discarded • The least likely drug to transfer into the milk should be prescribed • Localised drug administration would be less likely to transfer into the milk • Give the mother the drug before the infants longest sleep • Withhold feeding if a one off drug is needed • For some drugs the milk to plasma ratio has been determined

Question 27

Define infertility

Answer 27

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

Question 28

Discuss the possible aetiology of infertility in men

Answer 28

40% male cases – abnormalities of sperm production, duct obstruction, hypothalamic/pituitary dysfunction, disorders of ejaculation or exposure to radiation.

Question 29

discuss infertility treatment in women

Answer 29

Treatment – HRT or stimulation, IVF, insemination

Question 30

discuss infertility treatment in men

Answer 30

Treatment – IVF, gonadotrophin therapy and hormone therapy

Question 31

Discuss the possible aetiology of infertility in women

Answer 31

40% women – an-ovulatory cycle, hypothalamic/pituitary dysfunction or ovarian dysfunction, tubule damage, endometriosis, uterine/vaginal abnormalities.

Question 32

Discuss why an oestrogen is combined with a progestogen in oral contraceptives.

Answer 32

he combined pill (‘the Pill’) contains synthetic versions of oestrogen and progesterone, which are similar to the hormones occurring naturally in women. It works by preventing the uterus (womb) from releasing an ovum (egg) each month. It also thickens the mucus in the cervix (entrance to the womb), preventing sperm from getting through.

Question 33

Describe the main types of combination oestrogen-progestogen contraceptives.

Answer 33

1. pills with fixed dose combinations 2. pills that vary in dose throughout the cycle 3. pills that contain different types of synthetic oestrogen and progesterone.