Drugs Affecting the Reproductive System Exam: NURS 3310/ NURS3310 (Answered + Rationales) | A+ Graded - Hunter College - CUNY.

Drugs Affecting the Reproductive System Exam: NURS 3310/ NURS3310 (Answered + Rationales) | A+ Graded - Hunter College - CUNY. Drugs Affecting the Reproductive System Exam Q&A’s + Rationales 2025. Question 1. Which hormones are secreted by the ovaries at menarche? 1.Insulin and glucagon 2.Estrogen, progestin, and androgen 3.Oxytocin and estrogen 4.Dopamine and vasopressin Rationales Option 1:These hormones are secreted by the pancreas. Option 2:At menarche, the ovaries start production of three steroids: estrogen, progestin, and androgen. Option 3:Oxytocin is secreted by the hypothalamus. Estrogen is secreted by the ovaries at menarche. Option 4:These hormones are secreted by the hypothalamus. Question 2. Patients with seizure disorders need careful monitoring if prescribed progestins because increased fluid retention may have which effect? 1.Amenorrhea 2.Peptic ulcer disease 3.Sebaceous cyst development 4.Lowered seizure threshold Rationales Option 1:For these patients, progestins can cause amenorrhea. However, this is not the most important potential effect to monitor for. Option 2:There is not a correlation between the use of progestins and peptic ulcer disease. Option 3:There is no correlation between sebaceous cyst development and the use of progestins. Option 4:Patients can experience increased fluid retention with the use of progestins. Patients who have seizure disorders require careful monitoring because the increased fluid retention may lower the seizure threshold. Question 3. Which physiological changes occur systemically after menopause? 1.Cancer risk decreases 2.Decreased risk of urinary tract infections (UTIs) 3.Increase in cardiovascular events 4.Increase in respiratory congestion Rationales Option 1:Cancer risk increases after menopause. Option 2:There is no correlation between UTIs and menopause, but there is a greater likelihood of incontinence. Option 3:After menopause, cardiovascular disorders can increase. Option 4:There is no correlation between respiratory congestion after menopause. Question 4. Which statement is accurate as it relates to the impact of congenital syphilis (CS) transmission on the fetus? 1.Macrosomia 2.Likelihood of postdates delivery 3.Seizures 4.Apgar score of 9 Rationales Option 1:Macrosomia is associated with the impact of maternal diabetes mellitus on the fetus. Option 2:Prematurity is associated with the impact of CS on the fetus. Option 3:CS can lead to the development of neurological problems such as seizures on the fetus. Option 4:The impact of CS can lead to multiple problems in the fetus (prematurity, low birth weight, bone deformities, severe anemia, neurological problems, and neonatal death); therefore, an Apgar score of 9 would indicate a healthy baby with no immediate problems. Question 5. A patient presents today for a follow-up visit to receive her third DepoProvera injection. The APN notes that she is 16 days late in receiving her scheduled Depo-Provera injection. Which statement by the APN is most appropriate? 1."You can receive your injection today without any problem." 2."You do not need to use alternative contraception protection right now." 3."You will need a repeat pregnancy test before restarting injections." 4."You will need to return for your injection in 4 weeks." Rationales Option 1:The injectable form requires administration every 12 weeks. In this scenario, the patient has not had an injection in 14 weeks. Unless the patient has a negative pregnancy test, then the injection should not be administered. Option 2:Any time that the woman has a longer than 2-week window that Depo-Provera injection is late, alternative protection should be used. Option 3:The injectable form requires administration every 12 weeks. If a woman is outside the 2-week window to receive the Depo-Provera injection, she must repeat a pregnancy test with a negative result. Option 4:In this scenario, the patient would have received her injection over the recommended period. This gap increases the possibility that the patient could have a return in fertility. Question 6. A female patient presents for evaluation of vomiting and diarrhea associated with a recent gastrointestinal illness. She uses combination oral contraception as her only method of contraception. Which action taken by the APN is most appropriate? 1.Advise the use of a backup contraceptive method for at least 7 days after a gastrointestinal illness. 2.Suggest taking the oral contraception at night to decrease the associated nausea, diarrhea, and vomiting. 3.Stop the oral contraceptives because this can exacerbate the current illness. 4.Take no action because none is required at this time. Rationales Option 1:Vomiting and diarrhea that accompany gastrointestinal illness can decrease oral contraceptive effectiveness by decreasing absorption. An important part of patient education is to use a backup method for at least 7 days after a gastrointestinal illness. Option 2:Although taking the oral contraception at night can decrease symptoms of a gastrointestinal illness, this is not the most appropriate action to take at this time. Option 3:Stopping oral contraceptives is not recommended because this may result in unintended pregnancy. Option 4:Action by the APN is appropriate at this time, because vomiting and diarrhea that are associated with a gastrointestinal illness can decrease oral contraceptive effectiveness by decreasing absorption. Question 7. Which type of herbal supplement should the APN recommend for a female patient who is perimenopausal to help decrease vasomotor symptoms based on reported clinical studies? 1.Red clover 2.Soy 3.Black cohosh 4.Chasteberry Rationales Option 1: Studies have been inconsistent in demonstrating efficacy of red clover–based products in improving hot flashes and other menopausal symptoms. Option 2:Supplemental soy is of no benefit over placebo, especially in the anticipated bone health or suppression of vasoactive effects. Option 3:Black cohosh fails to relieve vasomotor symptoms and does not reduce the frequency and severity of hot flashes and night sweats in menopausal and perimenopausal participants. Option 4:Chasteberry contains hormone-like substances with antiandrogenic effects. It also has significant binding affinities for both estrogen receptor alpha and estrogen receptor beta. Question 8. A patient has a chlamydia infection and is allergic to erythromycin and penicillin. Which drug is most appropriate for this patient? 1.Doxycycline 2.Azithromycin 3.Acyclovir 4.Ceftriaxone Rationales Option 1:Doxycycline is a recommended treatment for chlamydia infection, as recommended by the Centers for Disease Control and Prevention. Option 2:Azithromycin is a treatment recommended for the treatment of chlamydia infection; however, it should not be used in this case due to the erythromycin allergy. Option 3:Acyclovir is an antiviral that is used for herpes simplex 1 and 2. It is not recommended for chlamydia infection. Option 4:This drug is not recommended by the Centers for Disease Control and Prevention to treat chlamydia infection. Also, this patient has reported a penicillin allergy. Question 9. Which of these represents the main difference among the phosphodiesterase type 5 (PDE5) inhibitors? 1.Duration of action 2.Efficacy in treating erectile dysfunction 3.Different absolute contraindications 4.Formulation Rationales Option 1:All PDE5 inhibitors have been shown to have equal efficacy in treating erectile dysfunction. The main difference between the agents is the duration of action. Option 2:The PDE5 inhibitors are noted to have equal efficacy. Option 3:The PDE5 inhibitors share the same contraindication in patients who are using nitrates because of the risk of severe hypotension. Option 4:There are no significant differences in the formulations of the PDE5 inhibitors. Question 10. Which is the drug of choice for the treatment of scabies, especially in pregnant women or young children older than 2 months? 1.Lindane 2.Oral ivermectin 3.Permethrin 5% cream 4.Permethrin 1% cream Rationales Option 1:Although treatment of lindane is an option, it is not first-line therapy. Use of lindane is discouraged due to the adverse-effect profile. It is contraindicated in pregnant women and children. Option 2:Oral ivermectin is an option; however, it is not the drug of choice and is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of scabies. Option 3:Permethrin 5% cream is the drug of choice for the treatment of scabies, especially in pregnant women or young children older than 2 months. Option 4:Permethrin 1% cream is not the drug of choice for scabies. At this dose, it is the first choice for pubic lice. Question 11. Which of these represents a mechanism of pregnancy prevention of progestin? 1.Increasing transport of the ovum and sperm through contractions of the fallopian tube 2.Exhibiting a negative effect in the hypothalamic–pituitary–ovarian axis to suppress the luteinizing hormone (LH) surge 3.Causing hypertrophy of the endometrium 4.Increasing production of follicle-stimulating hormone (FSH) and preventing growth of a dominant follicle Rationales Option 1:The effect of progestin regarding pregnancy prevention is to slow tubal motility and delay transport of the ovum and sperm. Option 2:One of the mechanisms of pregnancy prevention of progestins is to exhibit a negative effect in the hypothalamic–pituitary–ovarian axis to suppress the LH surge. Option 3:Progestins cause atrophy, which prevents implantation. Option 4:The estrogen component of hormonal contraception improves efficacy by suppressing FSH release and development of a dominant follicle. Question 12. Which physiological changes are seen during the perimenopausal cycles? 1.Decreased inhibin 2.Increased luteinizing hormone (LH) 3.Decreased follicle-stimulating hormone (FSH) 4.Continued regular menstrual cycle Rationales Option 1:Perimenopausal cycles are correlated with elevated and irregular follicle-stimulating hormone (FSH), decreased inhibin, normal luteinizing hormone (LH), and slightly elevated estradiol levels. Option 2:Normal luteinizing hormone (LH) levels are seen in perimenopausal cycles. Option 3:Elevated and irregular FSH levels are seen in perimenopausal cycles. Option 4:Irregularities in the menstrual cycle occur as part of the perimenopausal cycle. Question 13. A 19-year-old female patient is being treated today for bacterial vaginosis (BV). Which information would the APN include in patient education? 1.Because BV is considered a sexually transmitted infection, it is important to use a barrier method with sexual activity. 2.Avoid consuming alcohol during and for at least 1 day after completion of metronidazole therapy. 3.Cryotherapy of the affected area may be required in resistant cases. 4.Use of over-the-counter butoconazole 2% cream 5 g intravaginally is recommended for persistent cases. Rationales Option 1:BV is not considered a sexually transmitted infection. However, most women who are infected are sexually active. There are no guidelines for barrier methods during sexual activity. Option 2:Patients should be educated to avoid consuming alcohol during and for at least 1 day after completion of metronidazole therapy due to a possible disulfiram-like reaction. Option 3:Cryotherapy is not indicated for BV. Option 4:Butoconazole 2% cream 5 g intravaginally is recommended in prescription form for Candida albicans and is not a recommended therapy for BV. Question 14. Which of these is an effect of progestin on the reproductive system? 1.Thickening of the endometrium and increasing its complexity in preparation of pregnancy 2.Thinning of the cervical mucus 3.Thickening of the vaginal mucosa 4.Contraction of the smooth muscles of the uterus and fallopian tubes Rationales Option 1:The effect of progestin is to thicken the endometrium and increase its complexity in preparation of pregnancy. Option 2:Progestin's impact on the cervical mucus is to thicken the consistency. Option 3:Thinning of the vaginal mucosa occurs in response to progestin. Option 4:Progestin causes relaxation of smooth muscles of the uterus and fallopian tubes. Question 15. Which outcome measure should the APN focus on after patient goals and safety when discussing types of birth control methods with a patient? 1.Type of insurance 2.Age of the patient 3.Compliance with birth control method 4.Health history Rationales Option 1:Although insurance coverage may be a concern, compliance with therapy is more important as a focus. Most oral contraceptive devices are provided free based on the Affordable Care Act. Option 2:Age of the patient is a factor in assessment and choice of birth control method. Compliance with therapy is more important as a focus. Option 3:The most important of these considerations after goals and safety is adherence; any method will offer very little protection from pregnancy if use of the method does not fit well with lifestyle. Option 4:Although health history is a factor in assessment and choice of birth control method, compliance with therapy is more important as a focus. Question 16. A patient has had long-term use of gonadotropin-releasing hormone (GnRH). Which of these should be ordered as part of monitoring? 1.Yearly full-body skin assessment 2.Dual-energy x-ray absorptiometry (DEXA) scans 3.Radiographs of the patella 4.Sodium levels Rationales Option 1:There is not an indication for a full-body skin assessment in patients who use GnRH long term. Option 2:Ongoing treatment of GnRH may result in bone demineralization. DEXA scans should be ordered to monitor for bone demineralization in any patient undergoing long-term use. Option 3:Bone demineralization may cause some changes that are noted on radiographs; however, radiographs do not provide detailed information regarding the degree of possible demineralization due to the long-term use of GnRH agents. Option 4:Periodic monitoring of sodium levels is not recommended for patients who undergo long-term treatment of GnRH. Question 17. The APN is treating a pregnant patient who has recently been diagnosed with syphilis. Which is the preferred drug of treatment for this patient? 1.Doxycycline 100 mg for 14 days 2.Benzathine penicillin G 2.4 million units intramuscularly (IM) in a single dose 3.Tetracycline 500 mg qid for 14 days 4.Metronidazole 500 mg bid for 7 days Rationales Option 1:Doxycycline can be used in nonpregnant patients for 14 days if they are allergic to penicillin. Option 2:Parenteral penicillin G (rather than oral penicillin) has been used effectively for 50 years and is the preferred drug for the treatment of all stages of syphilis. It is the only therapy with documented efficacy during pregnancy. If a woman has a penicillin allergy, the recommendation is that she should be desensitized and treated with penicillin. Option 3:Tetracycline can be used in nonpregnant patients for 14 days if they are allergic to penicillin. Due to the increase in gastrointestinal upset, doxycycline is used more often than tetracycline. Option 4:Metronidazole is not recommended as a treatment for syphilis. Question 18. Which of these is considered a noncontraceptive benefit of using an intrauterine device (IUD)? 1.Ability to become pregnant once removed 2.Increased bone density 3.Decrease in fibrocystic breasts 4.Decrease in weight Rationales Option 1:Removal of IUD leads to a rapid return to fertility compared with oral contraceptive methods. Option 2:An IUD has no effect on bone density. Option 3:An IUD has no impact on fibrocystic development in breasts. Option 4:An IUD has no impact on weight. Question 19. Which information should the APN include in patient education before prescribing a phosphodiesterase type 5 (PDE5) inhibitor? 1.Ingestion of high-fat, high-protein meals greatly increases the rate of the drug's absorption. 2.An initial starting dose of 100 mg should be used in men older than 65 years. 3.The drug should result in a long-lasting spontaneous erection. 4.Concomitant use with any form of nitrates can result in severe hypotension. Rationales Option 1:Ingestion of food reduces the rate of absorption of PDE5 drugs, especially with high-fat, high-protein meals. Option 2:The initial starting dose for men older than 65 years is 25 mg. Option 3:The PDE5 should not have a drug effect in the absence of sexual stimulation. Any spontaneous, long-lasting erection should be evaluated immediately because this indicates priapism, a medical emergency. Option 4:Patients should be educated that there is an absolute contraindication with concomitant use with any form of nitrates because of the risk of severe hypotension, cardiovascular collapse, and death. Question 20. Which hormone is primarily responsible for the genitourinary syndrome of menopause? 1.Progesterone 2.Estrogen 3.Follicle-stimulating hormone (FSH) 4.Relaxin Rationales Option 1:Progesterone is known as a hormone of pregnancy. Option 2:Estrogen maintains lubrication regulation of the vagina; decline in this function results in vulvovaginal dryness, dyspareunia, and vaginal atrophy, known collectively as genitourinary syndrome of menopause. Option 3:FSH assists with the menstrual cycle and production of eggs by the ovaries. Option 4:Relaxin helps to relax muscles and joints during pregnancy. Question 1. A 50-year-old male patient presents for an appointment for follow-up on his laboratory report and to initiate testosterone therapy. The APN notices that his prostate-specific antigen is elevated at 6 ng/mL and his hematocrit is greater than 60%. Which is the most appropriate action? 1.Instruct him that initiation of testosterone therapy is contraindicated due to the elevated prostate-specific antigen and hematocrit levels. 2.Initiate testosterone therapy and make an appointment for the patient to repeat his prostatespecific antigen and testosterone in 1 month. 3.Initiate testosterone therapy and make a follow-up appointment in 6 months. 4.Examine the prostate and initiate testosterone therapy if no prostate nodules or indurations are noted. Rationales Option 1:Testosterone is contraindicated if the prostate-specific antigen is greater than 4 ng/mL or greater than 3 ng/mL in men at high risk of prostate cancer. It is also contraindicated if the hematocrit is greater than 50%. Option 2:In this case, testosterone is contraindicated due to the elevated prostate-specific antigen and hematocrit. Option 3:Testosterone is contraindicated due to the elevated prostate-specific antigen and hematocrit. The elevation of the hematocrit is also a contraindication. Option 4:If both the prostate-specific antigen and hematocrit are elevated, then the appropriate action is not to initiate testosterone. Question 2. Which is considered a positive effect of estrogen on the body? 1.Increases insulin levels 2.Increases serum triglycerides 3.Stimulates coagulation pathways 4.Increases bone mass Rationales Option 1:Progesterone, not estrogen, increases insulin levels in the body. Option 2:Increasing serum triglycerides is not considered a positive effect on the body. Option 3:Estrogen stimulates coagulation and fibrinolytic pathways, which increases hypercoagulability; this is not considered a positive effect on the body. Option 4:Estrogen has a positive impact on increasing bone mass in the body. Question 3. Which information should the APN provide to a patient who has been diagnosed with human papillomavirus virus (HPV)? 1.HPV is an acute disease; with treatment it is curative. 2.The patient should have cervical cytology screenings because they are considered to be at high risk. 3.There are minimal long-term effects with HPV as long as it is treated. 4.Take the drug crushed and mixed with food to increase the bioavailability. Rationales Option 1:HPV is a chronic disease. Even with treatment, it will present with lifelong exacerbations and remissions. Option 2:The U.S. Preventive Services Task Force (USPSTF) made the following cervical cancer screening recommendations: age 21 to 29 years, cervical cytology only every 3 years; age 30 to 65 years, either cervical cytology every 3 years or high-risk HPV (hrHPV) testing every 5 years or cotesting with hrHPV testing with cytology every 5 years. Option 3:Even with treatment of HPV, there are increased risks of infertility and/or potential to develop other comorbidities such as cancer. Option 4:There are no clear benefits in taking the drug with food or crushing to prevent breakthrough bleeding. Question 4. Which age group is recommended to have HPV vaccination? 1.26 to 45 2.9 to 26 3.1 to 6 4.65 years and older Rationales Option 1:HPV vaccination in adults aged 26 to 45 years is based on risk and shared decision making between the provider and patient. Option 2:The recommendation is to vaccinate all males and females at ages 9 to 26. Option 3:The recommendation is to vaccinate all males and females at ages 9 to 26. Option 4:HPV vaccination is not recommended for older adults and the elderly population. Question 5. Which of these is a primary clinical use for androgens? 1.Hypogonadism 2.Infertility in males 3.Height stimulator in pediatric patients 4.Increased libido Rationales Option 1:The primary use for testosterone and androgens is to replace or augment endogenous androgens for primary hypogonadal males or hypogonadotropic hypogonadism and for male climacteric. Option 2:Use of androgens can decrease sperm counts in males by altering the normal feedback mechanism, thereby negatively affecting fertility. Option 3:There is mixed discussion regarding the use of androgens for stimulating height in the pediatric patient. Androgens are primarily used in patients who are deficient in androgens. Option 4:Androgens are used in rare situations for patients who have low libido. The clinician should avoid using androgen replacement in patients who have high libido because it is likely there is a presence of a high androgen state. Question 6. Which of these is currently an indication approved by the U.S. Food and Drug Administration (FDA) for menopausal hormonal therapy? 1.Vasomotor symptoms 2.Sleep apnea 3.Generalized anxiety disorder 4.Gallbladder disease Rationales Option 1:Vasomotor symptoms are an approved indication for menopausal hormonal therapy. Option 2:Sleep apnea is not an approved indication for menopausal therapy; not enough data support it. Option 3:Although hormonal therapy has shown positive effects on mood, depression, and cognition, there has not been enough research to provide a basis for use for generalized anxiety disorder. Option 4:Estrogen therapy can have negative effects on gallbladder disease. Question 7. Which recommendation should the APN provide to a female patient taking oral contraceptive (OC) therapy who has recently recovered from flulike symptoms including nausea and vomiting? 1."As long as you have taken your OC, it should be effective." 2."Use a backup method of birth control for at least 7 days." 3."You should have a pregnancy test." 4."Double up on OC for the next day or two." Rationales Option 1:A backup method is recommended after GI illnesses for at least 7 days based on EBP research. Option 2:Vomiting and diarrhea that accompany gastrointestinal illnesses can decrease oral contraceptive effectiveness by decreasing absorption; women should be advised to use a backup method for at least 7 days after a gastrointestinal illness. Option 3:There is no need to perform a pregnancy test based on the provided clinical data. Option 4:There is no need to double up on the OC regimen as there is no evidence of missed doses. Question 8. An APN plans to initiate estrogen therapy in a 56-year-old patient. Which should be included in her plan? 1.Start at a higher dose of conjugated equine estrogen (Premarin) at 0.3 mg daily. 2.Dosage increases should occur at 6- to 8-week intervals. 3.Increase the dose by 1-week increments if the patient continues to have vasomotor symptoms. 4.Instruct the patient that estrogen requires lifelong treatment once the therapy is initiated. Rationales Option 1:Suppression of hot flashes can commonly occur at the lower dose at 0.625 mg, so the APN should start lower and titrate up as needed. Option 2:It is noted that symptoms decrease by the second week of estrogen therapy; however, it may take 8 weeks of therapy to determine the maximal effect. The APN should avoid increasing the medication dose too early to provide enough time for the medication to provide maximal effects. Option 3:Although relief of symptoms can be dramatic, the full effect of the therapy may not be evident for 6 to 8 weeks after the initiation of therapy. Option 4:To decrease adverse effects, it is advisable to use estrogen for the shortest duration possible. Estrogen is not required to be taken lifelong; however, some of the beneficial effects may not continue after the medication is discontinued. Question 9. As part of gender-affirming therapy for transgender men, androgens are used to create which effect? 1.Overall decreased muscle mass 2.Increases in both estrogen and testosterone 3.Suppressed or minimized female secondary sex characteristics 4.Promotion of fertility Rationales Option 1:The use of androgens in gender-affirming therapy for transgender men can result in an increase in muscle mass. Option 2:The goal of therapy is to reduce the endogenous sex hormone levels and replace them with hormone levels consistent with the person's gender identity. Option 3:The use of androgens for transgender men will suppress or minimize female secondary sex characteristics and is intended to foster the development of male secondary sex characteristics. Option 4:Promotion of fertility is not a goal of treatment; use of androgens can decrease fertility. Question 10. Which mechanism leads to the LH surge in the menstrual cycle? 1.Positive feedback during the luteal phase 2.Increase in progesterone and estrogen during the luteal phase 3.Negative feedback to decrease follicle-stimulating hormone (FSH) during the follicular phase 4.Negative feedback during the secretory phase Rationales Option 1:Estradiol levels peak and exert positive feedback to induce an LH surge in the ovulatory phase. Option 2:Progesterone dominates along with a small amount of estrogen during the luteal phase to prevent new follicle development. Option 3:During the follicular phase, FSH stimulates several follicles in the ovary to develop, with one ultimately becoming dominant. The dominant follicle synthesizes enough estradiol to create negative feedback and decrease FSH levels. Option 4:The endometrium in the secretory phase becomes thick and cushion-like to prepare for implantation. Question 11. Impairment of fertility can occur in men taking large doses of exogenous testosterone through which process? 1.Increase in estrogen levels 2.Paradoxical suppression of testosterone 3.Decrease in total hematocrit levels 4.Suppression of follicle-stimulating hormone (FSH) Rationales Option 1:Large doses of exogenous testosterone do not increase estrogen levels in men. Option 2:Exogenous testosterone in high levels is not associated with a paradoxical suppression of testosterone. Option 3:Testosterone is noted to possibly increase hematocrit levels. Option 4:Large doses of exogenous testosterone can affect the normal feedback mechanism and reduce spermatogenesis through suppression of FSH. Question 12. Which herbal therapy may be associated with decreased bone loss during the postmenopausal period? 1.Soy products 2.Green tea 3.Black cohosh 4.Chasteberry Rationales Option 1:Supplemental soy is of no benefit over placebo, especially in the anticipated bone health or suppression of vasoactive effects. Option 2:The polyphenols in green tea, already recognized for their antioxidant effects, may be an active ingredient explaining why women who drink green tea appear to have a slower progression of postmenopausal bone loss. This is not certain evidence. Option 3:Black cohosh does not relieve vasomotor symptoms. It has not been shown to reduce the frequency and severity of hot flashes and night sweats in menopausal and perimenopausal women. Option 4:Chasteberry contains hormone-like substances with antiandrogenic effects. Question 13. A pregnant patient has been diagnosed with chlamydia. Which treatment plan should the APN prescribe? 1.Treatment provided in the postpartum period 2.Oral amoxicillin 3.Doxycycline 4.Parenteral penicillin G Rationales Option 1:Pregnant women can be treated with either azithromycin or amoxicillin; one does not have to wait until delivery. Option 2:Pregnant women can be treated with either azithromycin or amoxicillin. Option 3:This treatment is indicated for nonpregnant individuals. Option 4:This is the preferred treatment for syphilis. Question 14. Which treatment protocol should the APN initiate for a 75-year-old female patient who started menopause at age 62 and complains of vasomotor symptoms? 1.Short-term estrogen therapy (ET) 2.Short-term menopausal hormone therapy (MHT) 3.Limited fluid intake 4.Herbal therapies rather than hormone therapy Rationales Option 1:ET should not be prescribed for this patient based on age and current Women's Health Initiative (WHI) recommendations. Option 2:MHT should not be prescribed for this patient based on age and current Women's Health Initiative (WHI) recommendations. Option 3:Hydration should be maintained and/or increased in elderly patients to avoid dehydration. Option 4:Replacement therapy for up to 5 years or to age 65 is reasonably safe. Because this patient is older than 65, hormone therapy would not be recommended. Question 15. Which drug class is least likely to be associated with drug interactions with androgens? 1.Penicillins 2.Diabetes agents 3.Anticoagulants 4.Corticosteroids Rationales Option 1:This drug class does not have an established drug interaction with androgens. Option 2:Diabetes agents have been associated with drug interactions with androgens. Option 3:Anticoagulants such as warfarin (Coumadin) with the 17-alkyl testosterone derivatives pose a significant potential problem. Option 4:Corticosteroids have the potential for drug interactions with androgens. Question 16. Which patient should the APN diagnose as being in menopause? 1.49-year-old female with cessation of menses for 15 months and prior irregular cycle for 2 years 2.45-year-old female with irregular cycles once every 3 months with decreased flow 3.50-year-old female who has had 2 menstrual cycles in 1 year 4.51-year-old female who has not had a menstrual cycle for 6 months Rationales Option 1:Menopause is a period in which no menses occur for 12 consecutive months when estrogen and progestin are low, despite FSH and LH levels that are increased due to lost ovary function. Option 2:This patient would not be considered to be in menopause due to continued presence of irregular menstrual cycles even with decreased flow. Option 3:Menopause is a period in which no menses occurs for 12 consecutive months. Option 4:Menopause is a period in which no menses occurs for 12 consecutive months. Question 17. Based on evidence-based practice (EBP), which statement best identifies the correlation between use of oral contraceptives (OCs) and venous thromboembolism (VTE) events? 1.Estrogen remains the primary initiator of VTE events. 2.Estrogen and progestin lead to increased risk of VTE. 3.There are no general conclusions based on limited nature of studies. 4.Age plays a more significant factor than other variables when researching the relationship between OC use and VTE events. Rationales Option 1:The primary initiator rests with the use of OCs rather than the identification of estrogen as the primary component. The overall risk of thrombosis in COC users is anywhere from 2 to 9 times higher compared with nonusers. Option 2:Increased risks once thought to be primarily associated with estrogen are now also being correlated with progestin. Given the popularity and widespread use of estrogen– progestin combinations, any increase in the relative risk of VTE for particular formulations has the potential to translate into a significant increase in absolute risk across all users. Option 3:There are many studies looking at the impact of OCs and VTEs with reported conclusions indicating the increased risk of having a VTE when using OC therapy compared with nonusers. Option 4:Age is but one factor that may contribute to the occurrence of VTEs as a result of OC therapy. EBP research has not specified which variable plays a more significant role at this time. Question 18. Which variable reflects the third goal of sexually transmitted infection (STI) therapy management? 1.Patient education 2.Eradication of the organism 3.Decreased morbidity 4.Cost-effective treatment Rationales Option 1:The first goal of therapy is to educate patients about prevention and high-risk behaviors and screen those at risk. Option 2:Prevention of long-term sequelae due to unsafe sex practices and, where possible, eradicating the responsible organism(s) is the second goal of therapy. Option 3:The fourth goal of therapy is to reduce morbidity and provide comfort for those chronic conditions that are not curable. Option 4:The third goal of therapy is to choose the most specific, cost-effective drug with the best regimen for adherence after verifying pregnancy status in all women of childbearing age. Question 19. Which statement about biologic sex differences in sexually transmitted infections (STIs) is accurate? 1.Congenital syphilis is transmitted paternally rather than maternally. 2.Chlamydia infections are seen more in females than in males. 3.Primary syphilis infections occur more in females than in males. 4.Gonorrhea infections occur more in females than in males . Rationales Option 1:Women with syphilis can pass the infection to the fetus during pregnancy, resulting in congenital syphilis (CS). Option 2:Rates of chlamydia are higher in women than in men (616.5 vs. 339.4 per 100,000), especially those ages 20 to 24. Option 3:Men are more likely than women to acquire primary and secondary syphilis (20.8 vs. 4.7 per 100,000). Option 4:Men are more likely than women to acquire gonorrhea (238.5 vs. 174.5 per 100,000). Question 20. Which action of progesterone leads to prevention of pregnancy? 1.Thickening of cervical mucus 2.Facilitating tubal mobility 3.Increasing vascularity of the endometrium 4.Enhancing LH surge Rationales Option 1:Progesterone causes thickening of cervical mucus, making penetration by sperm difficult. Option 2:Progesterone leads to a decrease in tubal motility which delays transport of the ovum and sperm to prevent pregnancy. Option 3:Progestins cause atrophy of the endometrium, preventing implantation (Bastianelli, et al., 2020). Option 4:Progestins exhibit a negative effect in the hypothalamic–pituitary–ovarian axis, essentially suppressing the LH surge necessary for ovulation.