NR 566 Final Study Guide Questions with Verified Answers
(Correct Update)
Question 1: Menopause is the associated loss of estrogen which typically begins 2. During the
initial phase, the menstrual cycle becomes 3. Eventually, ovulation and menstruation
Answer: at approximately age 51 to 52 years, with 95% of women entering menopause between the ages
of 45 and 55 years. 2. irregular, anovulatory cycles may occur, and periods of amenorrhea may alternate
with menses 3. cease entirely
Question 2: Physiologic Alterations Accompanying Menopause 1. Vasomotor Symptoms; hot
flashes and night sweats) develop in approximately Genitourinary Syndrome of Menopause; the
urethra and vagina have the highest 3. Mental Changes; Many women report 4. Bone Loss; In
the absence 4. to of estrogen, bone resorption accelerates, leading 5. Altered Lipid Metabolism;
studies have shown increas- 5. LDL es in 6. Female Sexual Interest-Arousal Disorder
Answer: 1. 70% of postmenopausal women. Episodes are characterized by sudden skin flushing,
sweating, and a sensation of uncomfortable warmth. These episodes can occur at night, resulting in
drenching sweats 2. concentrations of ERs; when estrogen levels decline during menopause, these
structures begin to atrophy resulting in urge incontinence and urinary frequency; Urethritis and UTIs can
also occur 3. cognitive changes such as diflculty in problem solving and short-term memory loss. Others
experience depression or an increase in anxiety a 12% loss of bone density leading to Osteoporosis
which can cause compression fractures of the vertebrae causing a decrease in height and produce a
hump. In osteoporotic women, fractures of the hip and wrist can result from minimal trauma cholesterol
& decreases in HDL cholesterol. which play a role in the increase in CV disease after menopause. 6.
more common during this stage of life
Question 3: Estrogen Therapeutic Uses: 1. Menopausal hormone therapy- When estrogen is used
for this purpose, 2. Female hypogonadism-In the absence of ovarian estrogens, Acne-Estrogens,
in the form of 4. Cancer palliation-sometimes used for palliative therapy 5. Gender-affirmation
therapy-for
Answer: 1. it is usually accompanied by the use of progestins 2. pubertal transformation will not take
place. (variety of causes see pg 428) This treatment promotes breast development, maturation of the
reproductive organs, and pubic and axillary hair. This tx regimen consists of continuous low-dose
therapy (for approx a year) followed by cyclic administration of estrogen in higher doses 3. oral
contraceptives, can help control acne. Tx is limited to patients at least 14-15 years old who want
contraception 4. in management of advanced prostate CA in men and in a select type of metastatic breast
CA in men& women 5. transgender women; not approved by the FDA) but prescribed ott-label
Page 1
,Question 4: Forms of Estrogen 1. Estrogen is available in conjugated and esterified forms.
Esterified estrogens 2. Until mid-2016, synthetic conjugated estrogens A (Cenestin) and B
(Enjuvia) were available; however, 3. Phytoestrogens (plant-based compounds)-commonly used
by women as a Phytoestrogens are not as potent as estradiol, but they carry some of the same
risks. 5. Selective estrogen receptor modulators (SERMs) are drugs that activate ERs in some
tissues and block them in others. These drugs were developed in an effort
Answer: 1. are plant based; conjugated estrogens are natural preparations derived from the urine of
pregnant horses. 2. the manufacturer has withdrawn them from the market 3. "natural" way to manage
symptoms associated with menopause 4. Women should not use phytoestrogens if they have a history of
thromboembolic events or a personal or family history of breast, uterine, or ovarian cancer. 5. to provide
the benefits of estrogen (e.g., protection against osteoporosis, maintenance of the urogenital tract,
reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer, uterine
cancer, and thromboembolism) 1. endometrial hyperplasia, endometrial cancer, breast cancer,
Question 5: Estrogen-Adverse Effects 1. principal concerns with estrogen therapy are the po- 2.
tential for 2. endometrial hyperplasia and endometrial cancer can be resolved 3. Estrogens have
been associated with what common frequent SE 4. menopause may produce or uncover Nausea is
the most 6. (blank) a patchy brown facial discoloration, though not dangerous, may cause
significant distress
Answer: and cardiovascular thromboembolic events by prescribing a progestin 3. Fluid retention with
edema, gallbladder disease, jaundice, and headache; especially migraine headache 4. gallbladder
disease. Jaundice may develop in women with preexisting liver dysfunction, especially those who
experienced cholestatic jaundice of pregnancy undesired response to the estrogens 6. Chloasma,
Question 6: Contraindications of Estrogen 1. Estrogens should not be taken by patients with a
history of 2. They should not be prescribed to women who 3. Patients with a hx of
Answer: 1. DVT, pulmonary embolus, or conditions such as stroke or MI that occurred secondary to a
thromboembolic event. 2. are pregnant or who have vaginal bleeding without a known cause. 3. liver
disease, estrogen-dependent tumors, or breast cancer (except when indicated for management) also
should not take estrogens.
Question 7: Estrogen-Interactions 1. Estrogens are major substrates of 2. In addition, they may
decrease the effectiveness of some 3. Estrogens can also interact with
Answer: 1. CYP1A2 and CYP3A4; inducers/inhibitors of these isoenzymes may raise/lower estrogen
levels 2. antidiabetic drugs and thyroid preparations. 3. anticoagulants and other drugs that attect
clotting.
Page 2
,Question 8: Local vs. systemic estrogen options and why one would be chosen over the other 1.
Oral-Owing to convenience, the oral route is used 2. Transdermal estradiol is available in four
formulations: 3. Compared with oral formulations, transdermal formulations have four
advantages: 4. Intravaginal options come as inserts, creams, and vaginal rings & 5. The other
vaginal ring (Femring) is used for systemic effects to 6. Parenteral; is used only for emergencies
d/t
Answer: 1. more than any other. estradiol-is available alone and in combination with progestin 2.
Emulsion (Estrasorb), Spray, Gels & Patches 3a. The total dose of estrogen is greatly reduced 3b. There
is less nausea and vomiting. 3c. Blood levels of estrogen fluctuate less. 3d. There is a lower risk for
DVT, pulmonary embolism, and stroke. 4. are used only for local ettects, primarily treatment of vulval
and vaginal atrophy associated with menopause. 5. control of hot flashes and night sweats as well as
local ettects-Tx of vulval and vaginal atrophy 6. acute, emergency control of heavy uterine bleeding
Question 9: Clinical Practice Guidelines for menopause Not all women who experience
distressing symptoms of menopause should be treated with oral estrogen or combination
estrogen/progestin therapy. Key points include: 1. intravaginal preparations are most useful for
treating sx associated 2. transdermal estrogen preparations have fewer adverse effects, use lower
doses of estrogen, and have 3. progesterone is contraindicated in women who have undergone a
Answer: 1. with local estrogen deficiency such as vaginal and vulvar atrophy; these preparations are
assoc with a lower risk of systemic ettects 2. less fluctuation of estrogen levels than do oral preparations
3. hysterectomy but required in women with an intact uterus who undergone hormone replacement
therapy
Question 10: Summary of Key Prescribing 1. with Considerations -Estrogens 1. Therapeutic
Goal: Management of symptoms and structural changes associated 2. Baseline Data: Heart rate,
blood pressure, weight. Pregnancy test, thyroid-stimulating hormone (TSH), & 3. Monitoring:
Blood pressure, weight. Serum triglycerides, TSH if thyroid replacement required, & 4.
Identifying High-Risk Patients: Estrogen therapy should not be prescribed for vagina patients
with: 5. Evaluating Therapeutic Effects: Therapeutic effects depend on the reason prescribed.
Answer: decreased endogenous estrogen. (Other uses include palliation of metastatic breast cancer in
selected cases.) 2. serum triglyceride (or full lipid panel). Screening for breast CA and CV disease.
Gynecologic exam, if indicated. 3. Regular breast and pelvic exams as recommended for age. Schedule
endometrial biopsy for unscheduled bleeding that continues for 6 months. 4. Abnormal vaginal bleeding
of unknown cause
• Estrogen-dependent cancer or breast cancer (except when used as treatment for certain metastatic
cancers)
• History of DVT or pulmonary embolism
• Stroke, MI, or other arterial thromboembolism occurring within the past year
• Abnormal liver function or disease
• Pregnancy 5. For menopausal HT, patients report relief of symptoms and the is pink and moist on
gynecologic exam.
Page 3
, Question 11: 6. Minimizing Adverse Effects of Estrogen:
• Nausea is common early in raw treatment. Advise patients that this adverse effect
Answer: 6. diminishes with time. In the meantime, avoidance of cooking odors and warm, stutty
environments may help. Dry foods and fruits and vegetables help as well as Guided imagery with
muscle relaxation, yoga, and music therapy
• Menopausal HT with estrogen alone increases the risk for endometrial carcinoma. Adding a progestin
lowers this risk to the pretreatment level.
• Adverse ettects similar to those caused by OCs (abnormal vaginal bleeding, hypertension, benign
hepatic adenoma, reduced glucose tolerance)
Question 12: Black Box Warning for Estro- 1. uterus gen Therapy 1. Endometrial cancer risk is
3. cardiovascular increased in women with a 2. Estrogen may increase the risk for 3. Estrogen is
not indicated for
Answer: who take unopposed estrogen. 2. deep vein thrombosis and stroke. disease or dementia and
may increase the risk for dementia in women aged 65 years and older.
Question 13: Patient Education Estrogens 1. taking From textbook 1. Inform the patient that
nausea can be reduced by 2. Remind patients that estrogens present a small risk of 3. To
minimize risk of undetected breast cancer, remind patients of the need to receive 4. To reduce
cardiovascular risk, advise women to avoid smoking, perform regular exercise,
Answer: estrogens with food and by dosing at night. Explain that nausea diminishes over time. 2. breast
cancer and endometrial cancer. 3. periodic mammograms. Instruct the patient to report any persistent or
recurrent vaginal bleeding, to r/o endometrial carcinoma 4. decrease intake of saturated fats, and take
appropriate drugs for HTN, DM, and high cholesterol
Question 14: Patient-Centered Care Across The Life Span Estrogens 1. Children 2. Pregnant
women 3. Breastfeeding women 4. Older adults-Beers Criteria include estrogens among
Answer: 1. Estrogens are not indicated for prepubertal children. 2. Estrogens are contraindicated during
pregnancy. 3. Estrogens may attect infant development and may decrease both the quantity and quality
of milk produced. 4. those identified as potentially inappropriate for use in geriatric patients. >65 (may
increase dementia risk)
Question 15: Patient Education about Estrogen SE from lecture 1. Nausea is common early in
treatment but. 2. Menopausal HT with this hormone alone increases the risk for . 3. adverse
effects include abnormal
Answer: 1. diminishes with time. To reduce nausea: avoid cooking odors and warm, stutty
environments, consume dry foods and raw fruits and vegetables, use guided imagery with muscle
relaxation, yoga, and music therapy 2. endometrial carcinoma 3. vaginal bleeding, hypertension, benign
hepatic adenoma, and reduced glucose tolerance)
Page 4
(Correct Update)
Question 1: Menopause is the associated loss of estrogen which typically begins 2. During the
initial phase, the menstrual cycle becomes 3. Eventually, ovulation and menstruation
Answer: at approximately age 51 to 52 years, with 95% of women entering menopause between the ages
of 45 and 55 years. 2. irregular, anovulatory cycles may occur, and periods of amenorrhea may alternate
with menses 3. cease entirely
Question 2: Physiologic Alterations Accompanying Menopause 1. Vasomotor Symptoms; hot
flashes and night sweats) develop in approximately Genitourinary Syndrome of Menopause; the
urethra and vagina have the highest 3. Mental Changes; Many women report 4. Bone Loss; In
the absence 4. to of estrogen, bone resorption accelerates, leading 5. Altered Lipid Metabolism;
studies have shown increas- 5. LDL es in 6. Female Sexual Interest-Arousal Disorder
Answer: 1. 70% of postmenopausal women. Episodes are characterized by sudden skin flushing,
sweating, and a sensation of uncomfortable warmth. These episodes can occur at night, resulting in
drenching sweats 2. concentrations of ERs; when estrogen levels decline during menopause, these
structures begin to atrophy resulting in urge incontinence and urinary frequency; Urethritis and UTIs can
also occur 3. cognitive changes such as diflculty in problem solving and short-term memory loss. Others
experience depression or an increase in anxiety a 12% loss of bone density leading to Osteoporosis
which can cause compression fractures of the vertebrae causing a decrease in height and produce a
hump. In osteoporotic women, fractures of the hip and wrist can result from minimal trauma cholesterol
& decreases in HDL cholesterol. which play a role in the increase in CV disease after menopause. 6.
more common during this stage of life
Question 3: Estrogen Therapeutic Uses: 1. Menopausal hormone therapy- When estrogen is used
for this purpose, 2. Female hypogonadism-In the absence of ovarian estrogens, Acne-Estrogens,
in the form of 4. Cancer palliation-sometimes used for palliative therapy 5. Gender-affirmation
therapy-for
Answer: 1. it is usually accompanied by the use of progestins 2. pubertal transformation will not take
place. (variety of causes see pg 428) This treatment promotes breast development, maturation of the
reproductive organs, and pubic and axillary hair. This tx regimen consists of continuous low-dose
therapy (for approx a year) followed by cyclic administration of estrogen in higher doses 3. oral
contraceptives, can help control acne. Tx is limited to patients at least 14-15 years old who want
contraception 4. in management of advanced prostate CA in men and in a select type of metastatic breast
CA in men& women 5. transgender women; not approved by the FDA) but prescribed ott-label
Page 1
,Question 4: Forms of Estrogen 1. Estrogen is available in conjugated and esterified forms.
Esterified estrogens 2. Until mid-2016, synthetic conjugated estrogens A (Cenestin) and B
(Enjuvia) were available; however, 3. Phytoestrogens (plant-based compounds)-commonly used
by women as a Phytoestrogens are not as potent as estradiol, but they carry some of the same
risks. 5. Selective estrogen receptor modulators (SERMs) are drugs that activate ERs in some
tissues and block them in others. These drugs were developed in an effort
Answer: 1. are plant based; conjugated estrogens are natural preparations derived from the urine of
pregnant horses. 2. the manufacturer has withdrawn them from the market 3. "natural" way to manage
symptoms associated with menopause 4. Women should not use phytoestrogens if they have a history of
thromboembolic events or a personal or family history of breast, uterine, or ovarian cancer. 5. to provide
the benefits of estrogen (e.g., protection against osteoporosis, maintenance of the urogenital tract,
reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer, uterine
cancer, and thromboembolism) 1. endometrial hyperplasia, endometrial cancer, breast cancer,
Question 5: Estrogen-Adverse Effects 1. principal concerns with estrogen therapy are the po- 2.
tential for 2. endometrial hyperplasia and endometrial cancer can be resolved 3. Estrogens have
been associated with what common frequent SE 4. menopause may produce or uncover Nausea is
the most 6. (blank) a patchy brown facial discoloration, though not dangerous, may cause
significant distress
Answer: and cardiovascular thromboembolic events by prescribing a progestin 3. Fluid retention with
edema, gallbladder disease, jaundice, and headache; especially migraine headache 4. gallbladder
disease. Jaundice may develop in women with preexisting liver dysfunction, especially those who
experienced cholestatic jaundice of pregnancy undesired response to the estrogens 6. Chloasma,
Question 6: Contraindications of Estrogen 1. Estrogens should not be taken by patients with a
history of 2. They should not be prescribed to women who 3. Patients with a hx of
Answer: 1. DVT, pulmonary embolus, or conditions such as stroke or MI that occurred secondary to a
thromboembolic event. 2. are pregnant or who have vaginal bleeding without a known cause. 3. liver
disease, estrogen-dependent tumors, or breast cancer (except when indicated for management) also
should not take estrogens.
Question 7: Estrogen-Interactions 1. Estrogens are major substrates of 2. In addition, they may
decrease the effectiveness of some 3. Estrogens can also interact with
Answer: 1. CYP1A2 and CYP3A4; inducers/inhibitors of these isoenzymes may raise/lower estrogen
levels 2. antidiabetic drugs and thyroid preparations. 3. anticoagulants and other drugs that attect
clotting.
Page 2
,Question 8: Local vs. systemic estrogen options and why one would be chosen over the other 1.
Oral-Owing to convenience, the oral route is used 2. Transdermal estradiol is available in four
formulations: 3. Compared with oral formulations, transdermal formulations have four
advantages: 4. Intravaginal options come as inserts, creams, and vaginal rings & 5. The other
vaginal ring (Femring) is used for systemic effects to 6. Parenteral; is used only for emergencies
d/t
Answer: 1. more than any other. estradiol-is available alone and in combination with progestin 2.
Emulsion (Estrasorb), Spray, Gels & Patches 3a. The total dose of estrogen is greatly reduced 3b. There
is less nausea and vomiting. 3c. Blood levels of estrogen fluctuate less. 3d. There is a lower risk for
DVT, pulmonary embolism, and stroke. 4. are used only for local ettects, primarily treatment of vulval
and vaginal atrophy associated with menopause. 5. control of hot flashes and night sweats as well as
local ettects-Tx of vulval and vaginal atrophy 6. acute, emergency control of heavy uterine bleeding
Question 9: Clinical Practice Guidelines for menopause Not all women who experience
distressing symptoms of menopause should be treated with oral estrogen or combination
estrogen/progestin therapy. Key points include: 1. intravaginal preparations are most useful for
treating sx associated 2. transdermal estrogen preparations have fewer adverse effects, use lower
doses of estrogen, and have 3. progesterone is contraindicated in women who have undergone a
Answer: 1. with local estrogen deficiency such as vaginal and vulvar atrophy; these preparations are
assoc with a lower risk of systemic ettects 2. less fluctuation of estrogen levels than do oral preparations
3. hysterectomy but required in women with an intact uterus who undergone hormone replacement
therapy
Question 10: Summary of Key Prescribing 1. with Considerations -Estrogens 1. Therapeutic
Goal: Management of symptoms and structural changes associated 2. Baseline Data: Heart rate,
blood pressure, weight. Pregnancy test, thyroid-stimulating hormone (TSH), & 3. Monitoring:
Blood pressure, weight. Serum triglycerides, TSH if thyroid replacement required, & 4.
Identifying High-Risk Patients: Estrogen therapy should not be prescribed for vagina patients
with: 5. Evaluating Therapeutic Effects: Therapeutic effects depend on the reason prescribed.
Answer: decreased endogenous estrogen. (Other uses include palliation of metastatic breast cancer in
selected cases.) 2. serum triglyceride (or full lipid panel). Screening for breast CA and CV disease.
Gynecologic exam, if indicated. 3. Regular breast and pelvic exams as recommended for age. Schedule
endometrial biopsy for unscheduled bleeding that continues for 6 months. 4. Abnormal vaginal bleeding
of unknown cause
• Estrogen-dependent cancer or breast cancer (except when used as treatment for certain metastatic
cancers)
• History of DVT or pulmonary embolism
• Stroke, MI, or other arterial thromboembolism occurring within the past year
• Abnormal liver function or disease
• Pregnancy 5. For menopausal HT, patients report relief of symptoms and the is pink and moist on
gynecologic exam.
Page 3
, Question 11: 6. Minimizing Adverse Effects of Estrogen:
• Nausea is common early in raw treatment. Advise patients that this adverse effect
Answer: 6. diminishes with time. In the meantime, avoidance of cooking odors and warm, stutty
environments may help. Dry foods and fruits and vegetables help as well as Guided imagery with
muscle relaxation, yoga, and music therapy
• Menopausal HT with estrogen alone increases the risk for endometrial carcinoma. Adding a progestin
lowers this risk to the pretreatment level.
• Adverse ettects similar to those caused by OCs (abnormal vaginal bleeding, hypertension, benign
hepatic adenoma, reduced glucose tolerance)
Question 12: Black Box Warning for Estro- 1. uterus gen Therapy 1. Endometrial cancer risk is
3. cardiovascular increased in women with a 2. Estrogen may increase the risk for 3. Estrogen is
not indicated for
Answer: who take unopposed estrogen. 2. deep vein thrombosis and stroke. disease or dementia and
may increase the risk for dementia in women aged 65 years and older.
Question 13: Patient Education Estrogens 1. taking From textbook 1. Inform the patient that
nausea can be reduced by 2. Remind patients that estrogens present a small risk of 3. To
minimize risk of undetected breast cancer, remind patients of the need to receive 4. To reduce
cardiovascular risk, advise women to avoid smoking, perform regular exercise,
Answer: estrogens with food and by dosing at night. Explain that nausea diminishes over time. 2. breast
cancer and endometrial cancer. 3. periodic mammograms. Instruct the patient to report any persistent or
recurrent vaginal bleeding, to r/o endometrial carcinoma 4. decrease intake of saturated fats, and take
appropriate drugs for HTN, DM, and high cholesterol
Question 14: Patient-Centered Care Across The Life Span Estrogens 1. Children 2. Pregnant
women 3. Breastfeeding women 4. Older adults-Beers Criteria include estrogens among
Answer: 1. Estrogens are not indicated for prepubertal children. 2. Estrogens are contraindicated during
pregnancy. 3. Estrogens may attect infant development and may decrease both the quantity and quality
of milk produced. 4. those identified as potentially inappropriate for use in geriatric patients. >65 (may
increase dementia risk)
Question 15: Patient Education about Estrogen SE from lecture 1. Nausea is common early in
treatment but. 2. Menopausal HT with this hormone alone increases the risk for . 3. adverse
effects include abnormal
Answer: 1. diminishes with time. To reduce nausea: avoid cooking odors and warm, stutty
environments, consume dry foods and raw fruits and vegetables, use guided imagery with muscle
relaxation, yoga, and music therapy 2. endometrial carcinoma 3. vaginal bleeding, hypertension, benign
hepatic adenoma, and reduced glucose tolerance)
Page 4
