Drugs Affecting the Male Reproductive System

1.

A nurse is caring for an adolescent with hypogonadism who has been prescribed fluoxymesterone (Androxy) for replacement. What adverse effect of this drug will the nurse alert the patient to that could result in self-esteem concerns?
A)
Acne
B)
Dizziness
C)
Insomnia
D)
Fatigue
Ans:
A

Feedback:

All these options are possible adverse effects of the drug. However, for the adolescent, acne is the only one that could cause image concerns, which could lead to low self-esteem. Dizziness, insomnia, and fatigue would not cause self-esteem concerns.

2.

A postmenopausal patient has been diagnosed with breast cancer. The patient is being treated with methyltestosterone (Testred). What assessment finding would the nurse suspect is a complication from the medication?
A)
Increased blood pressure
B)
Jaundice
C)
Weight loss
D)
High-pitched voice
Ans:
B

Feedback:

A potentially life-threatening effect of an androgen is hepatocellular cancer. Jaundice would indicate that the liver function has been compromised. Usually weight gain and deepening of the voice are adverse effects of this drug. An increase in blood pressure is not associated with methyltestosterone.

3.

The nurse administers an androgen and assesses the patient for what action caused by this drug?
A)
Decreased production of red blood cells
B)
Decreased protein anabolism
C)
Increased protein catabolism
D)
Increased retention of nitrogen
Ans:
D

Feedback:

Androgens act to increase the retention of nitrogen, sodium, potassium, and phosphorous. They increase production of red blood cells and protein anabolism and decrease protein catabolism.

4.

An older male patient, who has difficulty swallowing pills and tablets, will begin taking an androgen. What drug would the nurse identify as a good choice for this patient?
A)
Danazol (Danocrine)
B)
Fluoxymesterone (Androxy)
C)
Methyltestosterone (Testred)
D)
Testosterone (Androderm)
Ans:
D

Feedback:

A good choice for this patient would be testosterone because the drug can be administered in long-acting depository forms and by dermatologic patch. These forms would eliminate the need for the patient to swallow a pill or tablet. The other options shown here are available only in oral form.

5.

A 28-year-old female patient is taking danazol (Danocrine) as treatment for endometriosis. The patient is upset about increased facial hair, a weight gain of 15 pounds, and a change in her voice; she discusses her concerns with the nurse. What nursing diagnoses would be most appropriate for this patient?
A)
Acute pain related to need for injections
B)
Deficient knowledge regarding drug therapy
C)
Disturbed body image related to drug therapy
D)
Sexual dysfunction related to androgenic effects
Ans:
C

Feedback:

The patient is concerned about the way she looks and the sound of her voice. The most appropriate nursing diagnosis would be disturbed body image. Danazol is not administered by injections; therefore, acute pain would not be applicable. Sexual dysfunction and deficient knowledge would be possible nursing diagnoses for this patient, but the concerns expressed by the patient fail to support these diagnoses.

6.

A child in renal failure is taking androgens to promote red blood cell production and is seen in the clinic every other month. What adverse drug effect would the nurse monitor for with this child?
A)
Epiphyseal closure
B)
Acne
C)
Skin color
D)
Weight gain
Ans:
A

Feedback:

Because of the effects of androgens on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. The other options are also adverse effects and require monitoring but are not as serious as premature epiphyseal closure.

7.

A patient has high blood pressure and penile erectile dysfunction. He asks the nurse if he could try tadalafil (Cialis) after seeing an advertisement on television. What medications, if taken by the patient, would the nurse recognize as increasing the risk associated with taking tadalafil?
A)
Beta-blockers
B)
Angiotensin-converting enzyme (ACE) inhibitors
C)
Alpha-adrenergic blockers
D)
Calcium channel blockers
Ans:
C

Feedback:

Serious drops in blood pressure, leading to potentially fatal myocardial infarction or cerebrovascular event, have been reported when Cialis is combined with alpha-adrenergic blockers. This reaction has not been reported with beta-blockers, calcium channel blockers, or ACE inhibitors.

8.

A patient will begin taking sildenafil (Viagra) for penile erectile dysfunction (ED). What is the nurse’s priority teaching point about this drug?
A)
He will have an erection exactly 1 hour after taking the drug.
B)
The drug should not be taken with a penile implant or any anatomic penile obstruction.
C)
Avoid drinking grapefruit juice for 2 days before and after taking the drug.
D)
It is important to know the cause of ED because sildenafil does not treat all causes.
Ans:
C

Feedback:

Patients who are using sildenafil need to be advised to avoid drinking grapefruit juice while using the drug. Grapefruit juice can cause a decrease in the metabolism of the PDE5 inhibitor, leading to increased serum levels and a risk of toxicity. They need to know that it takes 48 hours for grapefruit juice to be processed by the body, so they need to avoid it for several days before and after taking the drug. The patient should be screened for penile implants, anatomic penile obstruction, and the cause of ED before the drug is prescribed. Sildenafil has a median onset of 27 minutes and duration of 4 hours so the patient may have an erection as early as 27 minutes after taking it.

9.

A patient is prescribed oxymetholone (Anadrol-50) for treatment of angioedema. The nurse knows the patient has type 2 diabetes and will instruct the patient that the combination of oxymetholone with antidiabetic agents may lead to what?
A)
Hyperglycemia
B)
Hypoglycemia
C)
Jaundice
D)
Urinary retention
Ans:
B

Feedback:

Because of its effects on the liver, oxymetholone (Anadrol-50) may interact with antidiabetic agents to decrease their metabolism and increase their effectiveness, leading to hypoglycemia. The dosage of the antidiabetic agents should be reduced and the patient monitored closely. It would not lead to hyperglycemia, jaundice, and urinary retention.

10.

A student athlete presents at the clinic for his physical checkup. The athlete tells the nurse that he is using large doses of creatine to increase muscle size and strength. What should the nurse instruct the student to do while taking this medication?
A)
Take nonsteroidal anti-inflammatory drugs (NSAIDs) to stop pain from expanding muscles.
B)
Drink plenty of fluids while using this drug and watch for swelling.
C)
Stop eating red meat or other animal products.
D)
Take cimetidine (Tagamet) to relieve the stomach upset associated with the use of this therapy.
Ans:
B

Feedback:

Creatine is a protein by-product that has to be processed through the kidneys. If an athlete is using it to try to increase muscle size, he should be advised to drink plenty of fluids to help flush it through the kidney and to watch for any swelling that could indicate change in renal function. NSAIDs could aggravate renal problems and cause more swelling. Getting protein from food sources is a natural way to provide the body with proteins. If stomach upset occurs, the athlete should stop using the herbal therapy and not add another drug to his regimen, especially cimetidine that can increase risk of kidney damage.

11.

A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child?
A)
Liver function test (LFT)
B)
Cholesterol level
C)
Vision
D)
Hand and wrist radiographs
Ans:
D

Feedback:

Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure LFTs, cholesterol levels, or the child’s vision.

12.

The nurse assesses the patient taking anabolic steroids for what serious adverse effects?
A)
Elevated blood urea nitrogen (BUN)
B)
Elevated blood glucose level
C)
Bradycardia
D)
Jaundice
Ans:
D

Feedback:

Anabolic steroids all have black box warnings as alerts to the potentially serious effects of liver tumors, hepatitis, and blood lipid level changes that might be associated with increased risk of coronary artery disease. As a result, the nurse should assess for jaundice that could be an early indication of liver dysfunction. Elevated BUN, blood glucose levels, and bradycardia are not commonly reported adverse effects.

13.

What therapeutic effect will the nurse assess for in the male patient taking anabolic steroids?
A)
Thinning of the skin
B)
Body hair loss
C)
Increase in red blood cells (RBCs) and hemoglobin
D)
Gynecomastia
Ans:
C

Feedback:

Therapeutic effects include promotion of body tissue-building processes, reverse catabolic or tissue-destroying processes, and increased hemoglobin and red blood cell mass. Thinning of the skin and body hair loss are not associated effects of anabolic steroids. Gynecomastia is an adverse effect and would not be a therapeutic effect for which the drug was administered.

14.

An woman is prescribed androgens. The nurse teaches the patient to anticipate what effect from the drug?
A)
Atrophy of breasts
B)
Rapid bone growth
C)
Loss of pubic hair
D)
Nervousness
Ans:
D

Feedback:

Antiestrogen effects—flushing, sweating, vaginitis, nervousness, and emotional lability—can be anticipated when these drugs are used in women. When androgens are administered to women you would not expect the results to include atrophy of the breasts, rapid bone growth, or loss of pubic hair.

15.

The nurse is caring for a patient who has been taking androgens and has been admitted to the ICU following a car accident. What lab results will the nurse interpret as more indicative of androgen therapy than actual disease states? (Select all that apply.)
A)
Decreased thyroid function
B)
Increased creatinine levels
C)
Increased creatinine clearance
D)
Elevated liver enzymes
E)
Increased white blood cell (WBC) count
Ans:
A, B, C

Feedback:

While a patient is taking androgens, thyroid function may be decreased, as well as increased creatinine and creatinine clearance, results that are not associated with disease states. These effects can last up to 2 weeks after the discontinuation of therapy. Elevated liver enzymes may indicate a potentially life-threatening effect that has been documented is hepatocellular cancer. Increased WBC count would indicate an infection. Increased liver enzymes and WBC are not associated with androgen therapy but instead indicate a disease state.

16.

The 63-year-old male patient receives a prescription for androgens. The nurse evaluates that the patient understood drug teaching when he makes what statement?
A)
“If I experience acne, I will contact my physician immediately.”
B)
“If I experience flushing, sweating, nervousness, or emotional lability I’ll know it’s the drug.”
C)
“I will report any difficulty urinating such as trouble starting my flow.”
D)
“These pills may make my skin turn yellow but it will go away when the drug is stopped.”
Ans:
B

Feedback:

Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. Nurses should teach these men the signs and symptoms of prostatic enlargement and the importance of reporting these manifestations immediately to prevent worsening of symptoms. Acne need not be reported immediately. Flushing, sweating, nervousness, and emotional lability are more usually experienced by women. Yellowing of the skin may be an indication of liver disease, which should be reported immediately.

17.

A female athlete is using high doses of anabolic steroids to enhance her performance. The nurse warns this patient that such use of anabolic steroids is likely to result in what?
A)
Masculinization
B)
Immobility of joints
C)
Obesity
D)
Hypotension
Ans:
A

Feedback:

Adverse effects in women include masculinization effects, hirsutism, and deepening of the voice. A woman using anabolic steroids would not expect it to result in joint immobility, obesity, or hypotension.

18.

The nurse attributes what assessment finding to the use of androgens by the male patient?
A)
Testicular atrophy
B)
Increased fertility
C)
Increased urination
D)
Hoarseness
Ans:
A

Feedback:

In adult men, adverse effects include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido. Increased fertility, increased urination, and hoarseness would not be expected assessment findings.

19.

The nurse administers danazol (Danocrine) be a woman for what purpose?
A)
Reverse folic acid deficiencies
B)
Increase hair growth
C)
Decrease symptoms of endometriosis
D)
Prevent toxic shock syndrome.
Ans:
C

Feedback:

Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome.

20.

The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance his performance. What findings would the nurse associate with this practice? (Select all that apply.)
A)
Personality changes
B)
Sexual dysfunction
C)
Increased serum lipid levels
D)
Cardiomyopathy
E)
Weight loss
Ans:
A, B, C, D

Feedback:

Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off-label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss.

21.

The nurse learns a patient receiving a new prescription for oxandrolone takes a lipid-lowering medication daily. What will the nurse tell the patient about this drug interaction?
A)
Lipid-lowering drug becomes much less effective.
B)
Increased risk of oxandrolone toxicity with this combination of drugs
C)
Increased risk of liver damage with this combination of drugs
D)
Oxandrolone becomes less effective with this combination of drugs.
Ans:
A

Feedback:

Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid-lowering agents. Lipid-lowering medications do not impact anabolic steroids and there is no increased risk for toxicity of either drug.

22.

What supplement would be safest for a diabetic female athlete wishing to improve athletic performance?
A)
Bee pollen
B)
Damiana
C)
Wild yam
D)
Spirulina
Ans:
C

Feedback:

Wild yam is an estrogen-like herb used to increase athletic performance, slow the aging process, and improve energy and stamina. It can be toxic to the liver and may cause breast pain but is the safest of these supplements. Bee pollen is associated with serious allergic reactions and random studies have found wide variety of ingredients in each product. Damiana interferes with antidiabetic agents so it would not be appropriate for this patient. Spirulina may contain toxic metals and can cause serious reactions in children and pets. It interferes with vitamin B12absorption and there are no studies to prove it is effective in the claims it makes.

23.

When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered?
A)
Long-term
B)
Short-term
C)
Continuous
D)
Intermittent
Ans:
D

Feedback:

Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy.

24.

The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what?
A)
Renal stones
B)
Death
C)
Cirrhosis
D)
Malignant hyperthermia
Ans:
B

Feedback:

Prolonged use of high doses may cause potentially life-threatening conditions, placing the patient at risk of death. Conditions such as peliosis hepatis, hepatic neoplasms, and hepatocellular carcinoma are often seen with high-dose street use of these drugs. Renal stones, cirrhosis, and malignant hyperthermia are not associated with the use of anabolic steroids.

25.

When fluoxymesterone (Androxy) is administered to a 14-year-old boy for hypogonadism, what is the expected result?
A)
Enlarged sex organs
B)
Decreased skin thickness
C)
Increased protein metabolism
D)
Increased sperm production
Ans:
A

Feedback:

In prepubertal boys, administration of male sex hormone-like drugs will stimulate development of masculine characteristics and cause development of the male sexual organs. Production of sperm will occur when the boy enters puberty. These drugs are not administered to decrease skin thickness or increase protein metabolism.

26.

A 69-year-old man is prescribed testosterone. The patient is found to have hypertension and a history of congestive failure after assessment by the nurse. What is this patient at increased risk for?
A)
Fluid retention
B)
Impotence
C)
Liver failure
D)
Kidney failure
Ans:
A

Feedback:

Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but since that is not indicated by the question, this would be a lower risk than fluid retention.

27.

The nurse is caring for a patient with cryptorchidism who is 28 years old and taking testosterone to treat his condition. What statement by this patient would lead the nurse to believe that he has understood the teaching provided about the drug?
A)
“My body hair may increase.”
B)
“My sexual desire may increase.”
C)
“My voice may become higher.”
D)
“My skin may become clear and soft.”
Ans:
A

Feedback:

Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and testicular atrophy. Testosterone does not make the skin clear and soft, it does not make the voice higher, and the testicular atrophy is more likely to decrease rather than increase libido.

28.

A 16-year-old boy is diagnosed with delayed onset of puberty and the physician has ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the patient?
A)
Discuss changes that will occur in his body.
B)
Have patient fast before injection.
C)
Have patient reduce protein intake.
D)
Decrease exercise while on this hormonal treatment.
Ans:
A

Feedback:

It is important for this patient to understand what will happen and the changes he will see to reduce the anxiety that could occur if he didn’t understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the patient fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.

29.

A patient has been prescribed sildenafil citrate. What should the nurse teach the patient about this medication?
A)
Take the medication with a glass of grapefruit juice.
B)
The drug should be taken 1 hour before attempting intercourse.
C)
Facial flushing or headache should be reported to the physician immediately.
D)
A dose exceeding 80 mg will result in a change of vision, making everything appear blue.
Ans:
B

Feedback:

The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. The “blue haze” that occurs with the 100-mg dosage is transient (it lasts about 1 hour). Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion.

30.

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient’s history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)?
A)
Cataracts
B)
Penile implant
C)
Hypotension
D)
Lung cancer
Ans:
B

Feedback:

Patients with a penile implant should not take tadalafil. Patients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects.

31.

For what reason might the nurse administer sildenafil to a woman?
A)
Pulmonary arterial hypertension
B)
Sexual dysfunction
C)
Breast cancer
D)
Endometriosis
Ans:
A

Feedback:

Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women.

32.

A 68-year-old male patient tells the nurse that he has been unable to get an erection for the past 6 months and he guesses his sex life is over. The provider orders diagnostic testing to determine whether sildenafil (Viagra) is appropriate for the patient. What is the most correct nursing diagnosis for this patient?
A)
Sexual dysfunction
B)
Disturbed body image
C)
Ineffective sexuality pattern
D)
Disturbed tactile sensory perception
Ans:
A

Feedback:

The patient is experiencing sexual dysfunction so that would be the most appropriate nursing diagnosis. The patient did not discuss feeling let down by or unhappy with his body so disturbed body image is incorrect. The effectiveness of sexual pattern is not known. No problem with sensory perception is indicated by this question.

33.

The 22-year-old patient tells the nurse he doesn’t have trouble obtaining and maintaining an erection but wonders if taking Viagra would improve the sexual experience anyway. What is the nurse’s best response?
A)
“The only thing Viagra does is improve blood flow to the penis to make it erect.”
B)
“Viagra improves stamina and sensation, making the sexual experience better.”
C)
“Viagra has its greatest effect if both the man and woman take it at the same time.”
D)
“Viagra does nothing to improve the sexual experience.”
Ans:
A

Feedback:

Viagra improves blood flow into the penis and that is its only effect. It does not improve stamina or sensation. Research has indicated it has no effect on women’s sexual response. To say only that Viagra does nothing would not provide adequate information for the patient.

34.

The patient is prescribed oxandrolone 2.5 mg twice a day and is told to increase the dosage to gain weight to a maximum of 20 mg/d. If each tablet contains 2.5 mg, how many tablets would the nurse tell the patient he may take per day to avoid exceeding the 20 mg/d maximum?
A)
4
B)
6
C)
8
D)
10
Ans:
C

Feedback:

Calculate the number of tablets required to administer 20 mg by dividing 20 mg by 2.5 mg. 20/2.5 = 8 tablets

35.

The patient is prescribed sildenafil 25 mg PO one hour before sexual intercourse is planned. The patient returns for follow-up care and says that 25 mg did not produce an erection so he increased the dosage. How much of an increase would be enough to concern a nurse?
A)
50 mg
B)
75 mg
C)
100 mg
D)
25 mg
Ans:
C

Feedback:

Normal dosage range is 25 to 100 mg so the nurse should not be concerned unless the dosage exceeded 100 mg.