Question 1

A woman with a family history of breast cancer had her last menstrual period 12 months ago and is experiencing hot flashes.She has not had a hysterectomy.The primary care NP should recommend:

Accepted Answer

Hot flashes can be triggered by environmental conditions such as stress,excitement,anxiety,and alcohol and caffeine consumption.Black cohosh carries the same risks as estrogen.Estrogen-only therapy is not recommended for women with an intact uterus.Progesterone therapy is not recommended.

Question 2

Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months.She has a positive family history of breast cancer.The primary care NP should recommend:

Accepted Answer

Although estrogen slows the progression of osteoporosis,it also increases the risk of breast cancer when initiated early in menopause.This woman should receive a nonhormonal treatment for osteoporosis and may receive HT in 5 years if menopausal symptoms persist.Testosterone therapy,estrogen-only therapy,and estrogen-progesterone therapy are not indicated.

Question 3

A 50-year-old woman with a family history of CHD is experiencing occasional hot flashes and is having periods every 3 to 4 months.She asks the primary care NP about HT to relieve her symptoms.The NP should:

Accepted Answer

The timing hypothesis suggests that initiating HT at or very near to the time of menopause,which begins when a woman has not had a period for 12 months,reduces CHD in postmenopausal women.Estrogen-only therapy is indicated only for women who do not have a uterus.Oral contraceptive pills increase the risk of CHD.Bioidentical HT is not indicated.

Question 4

A 52-year-old woman reports having hot flashes and intense mood swings.After a year of having irregular menstrual periods,she has not had a period for 6 months.The primary care NP should diagnose:

Accepted Answer

Perimenopause usually occurs between ages 42 and 55 and is characterized by erratic ovulation and irregular periods,hot flashes,and intensified PMS symptoms.Menopause begins when periods have been absent for 12 months.Postmenopause describes the 5-year period after menopause.Dysmenorrhea is painful periods.

Question 5

A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP)that she is having increasingly frequent vasomotor symptoms.She has no family history or risk factors for coronary heart disease (CHD)or breast cancer but is concerned about these side effects of hormone therapy (HT).The NP should:

Accepted Answer

The current gap hypothesis regarding breast cancer supports initiating HT 5 years or more after menopause.To decrease risk for CHD,HT should begin at the time of menopause.HT will relieve vasomotor symptoms at all stages of menopause.Herbal supplements have estrogenizing effects and carry the same risks as estrogen therapy.

Question 6

A male patient tells the primary care NP he is experiencing decreased libido,lack of energy,and poor concentration.The NP performs an examination and notes increased body fat and gynecomastia.A serum testosterone level is 225 ng/dL.The NP's next action should be to:

Accepted Answer

To diagnose hypogonadism,two serum testosterone levels must be drawn,with serum collected in the morning.LH,FSH,and prolactin levels may be drawn as well.Testosterone replacement should not be prescribed until the diagnosis is definitive.

Question 7

A perimenopausal woman tells the primary care NP that she is having hot flashes and increasingly severe mood swings.The woman has had a hysterectomy.The NP should prescribe:

Accepted Answer

Estrogen-only regimens are used in women without a uterus and may be initiated to treat perimenopause symptoms if needed.Low-dose oral contraceptive pills are used to treat irregular menstrual bleeding in perimenopausal women.

Question 8

The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years.The NP decreases the dosage,and several weeks later,the woman calls to report having several hot flashes each day.The NP should:

Accepted Answer

The Women's Health Initiative results indicate that HT use for 3 to 5 years is safe and recommend slow weaning after women review HT with their providers at annual visits.If symptoms recur,the dose should be increased until symptoms improve.

Question 9

A patient who has diabetes mellitus and congestive heart failure takes insulin and warfarin.The patient will begin taking exogenous testosterone to treat secondary hypogonadism.The primary care NP should recommend:

Accepted Answer

Patients with diabetes may require a decrease in insulin dose because of the metabolic effects of androgens.More frequent blood glucose monitoring should be performed.Warfarin doses may need to be decreased because androgens increase sensitivity to anticoagulants.

Question 10

A man who has secondary hypogonadism associated with pituitary dysfunction will begin exogenous testosterone therapy.The patient asks the primary care NP about future chances of fathering children.The NP should tell him that:

Accepted Answer

Men with secondary hypogonadism may become fertile with exogenous testosterone.

Question 11

A 50-year-old woman reports severe,frequent hot flashes and vaginal dryness.She is having irregular periods.She has no family history of CHD or breast cancer and has no personal risk factors.The primary care NP should recommend:

Accepted Answer

Oral contraceptive pills are not approved by the U.S.Food and Drug Administration for management of perimenopausal symptoms except to treat irregular menstrual bleeding.This patient has a low risk for CHD and breast cancer,so oral contraceptive pills are relatively safe.She is also at risk for pregnancy,so oral contraceptive pills can help to prevent that.

Question 12

A thin 52-year-old woman who has recently had a hysterectomy tells the primary care NP she is having frequent hot flashes and vaginal dryness.A recent bone density study shows early osteopenia.The woman's mother had CHD.She has no family history of breast cancer.The NP should prescribe:

Accepted Answer

HT relieves symptoms of menopause and prevents osteoporosis.When started soon after menopause,HT can reduce CHD risk.Breast cancer risk may be decreased if HT is begun 5 years after onset of menopause.This woman has a higher risk of CHD and osteoporosis,so initiating therapy now is a good option.Because she has had a hysterectomy,estrogen-only therapy is indicated.

Quiz 55: Hormone Replacement Therapy