Question

The muscle relaxant, baclofen, is prescribed for a female client with multiple sclerosis. The client calls the clinic nurse, reporting that she has been having trouble sleeping since she started the medication and wants to stop taking the medication. Which response by the nurse takes priority?

Answer 1

Correct Answers:

Remind the client not to stop taking the baclofen abruptly.

Rationale :

⏩ Baclofen should not be discontinued suddenly, especially after regular use, because abrupt withdrawal can cause serious neurologic effects.

⏩ Sudden withdrawal may result in rebound spasticity, hallucinations, confusion, agitation, and seizures.

⏩ Severe withdrawal can also produce hyperthermia and autonomic instability, making this an immediate safety concern.

⏩ The client's report of difficulty sleeping should be evaluated, but the priority is preventing abrupt discontinuation of the medication.

⏩ The nurse should instruct the client to continue baclofen until the prescriber provides a gradual tapering schedule if discontinuation is indicated.

⏩ Baclofen acts primarily as a GABA-B receptor agonist in the spinal cord, reducing excitatory neurotransmission and muscle spasticity.

⏩ Clients with multiple sclerosis may receive baclofen to decrease painful muscle spasms and improve mobility.

⏩ After addressing the immediate safety concern, the nurse should further assess the client's insomnia and notify the provider if medication adjustment is needed.

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Answer 2

Correct Answers:

Report of nausea
Blood pressure
Headache 2 on a 0 to 10 scale

Rationale :

Report of nausea — ✅ Requires follow-up

✅ Nausea is a known adverse effect of combined hormonal contraceptives (CHCs) containing estrogen and progestin.

✅ The concern is greater because the nausea occurs repeatedly with headaches and visual changes around the menstrual cycle.

✅ The cluster of nausea, headache, and visual disturbances may be associated with a migraine syndrome, rather than simple gastrointestinal upset.

✅ Estrogen-containing contraceptives can worsen some migraine patterns and may increase vascular complications in susceptible clients.

✅ The client has experienced similar symptoms while previously taking ethinyl estradiol and norethindrone, strengthening the possible relationship to the medication.

✅ Persistent or recurrent nausea should therefore be assessed for timing, severity, associated neurologic symptoms, and relationship to contraceptive use.

✅ The nurse should report the pattern to the provider because the client's current contraceptive method may need to be reassessed or changed.

✅ Nausea alone may be minor, but in this case its association with headache, visual symptoms, and hypertension makes it clinically significant.

Blood pressure 150/92 mm Hg — ✅ Requires follow-up

✅ A blood pressure of 150/92 mm Hg is abnormally elevated and represents hypertension.

✅ Combined hormonal contraceptives contain estrogen, which can increase blood pressure in some clients.

✅ Estrogen can increase hepatic production of angiotensinogen, contributing to activation of the renin-angiotensin-aldosterone system and elevation of blood pressure.

✅ Persistent hypertension while taking combined hormonal contraception increases the risk of stroke and other cardiovascular complications.

✅ The client already has a history of developing elevated blood pressure while previously taking this contraceptive, making recurrence particularly significant.

✅ Blood pressure in the range of 140–159 systolic or 90–99 diastolic generally makes combined hormonal contraceptive use inappropriate unless safer alternatives are unavailable.

✅ The nurse should ensure the elevated measurement is rechecked and communicated to the provider.

✅ The provider may need to discontinue the estrogen-containing method and discuss a progestin-only or nonhormonal contraceptive alternative.

Headache 2/10 — ✅ Requires follow-up

✅ The headache is currently mild at 2/10, but its repeated occurrence is more important than its present intensity.

✅ The client reports headaches occurring regularly approximately 1 week before menstruation, demonstrating a recurrent pattern.

✅ The headaches are sometimes accompanied by visual changes, which raises concern for a possible migraine with aura.

✅ Visual disturbances associated with migraine can represent a focal neurologic symptom that requires further assessment.

✅ Estrogen-containing combined hormonal contraceptives are generally contraindicated in clients with migraine with aura because of increased ischemic stroke risk.

✅ The client's concurrent blood pressure of 150/92 mm Hg adds another vascular risk factor and increases concern.

✅ The client has previously experienced headaches and elevated blood pressure while using the same contraceptive, suggesting the medication may be contributing to her symptoms.

✅ The nurse should report the headache and visual-change history to the provider for evaluation and possible change in contraceptive method.

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Answer 3

Correct Answers

Blank 1 Correct Option: discontinue

Rationale :

➡️ The client has a blood pressure of 150/92 mm Hg, which is significantly elevated while taking a combined hormonal contraceptive.

➡️ Ethinyl estradiol can increase blood pressure and cardiovascular risk in susceptible clients.

➡️ The client also reports recurrent headaches with visual changes, which raises concern for migraine with aura.

➡️ Estrogen-containing contraceptives are generally contraindicated with migraine with aura because of the increased risk of ischemic stroke.

➡️ The combination of hypertension and possible aura symptoms makes continued estrogen exposure particularly concerning.

➡️ The client previously experienced headaches and elevated blood pressure while taking this contraceptive, further supporting a medication-related problem.

➡️ Increasing the dose could worsen estrogen-related adverse effects and would therefore be inappropriate.

➡️ The provider should discontinue the combined hormonal contraceptive and evaluate the client for an appropriate non-estrogen contraceptive alternative.

Increase the dosage — Incorrect

➡️ Increasing the dose would increase exposure to estrogen and could worsen hypertension and vascular risk.

➡️ There is no indication that the contraceptive is therapeutically ineffective.

Maintain the dosage — Incorrect

➡️ Continuing the current medication would leave the client exposed to a contraceptive associated with increased risk in the setting of hypertension and possible migraine with aura.

➡️ The client's recurring symptoms warrant reassessment rather than continued use without modification.

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Answer 4

Correct Answers:

Changes to the menstrual cycle are likely with the use of hormonal contraceptives.
An additional method of birth control should be utilized when changing medications.
Some medications will require specific start dates and dosing schedules.

Rationale :

Changes to the menstrual cycle are likely with the use of hormonal contraceptives — ✅ Correct

⏩ Hormonal contraceptives commonly alter menstrual bleeding patterns, especially during the first several months of use.

⏩ Clients may experience spotting, breakthrough bleeding, lighter menstrual periods, irregular bleeding, or amenorrhea, depending on the method used.

⏩ Progestin-containing implants and hormonal IUDs are particularly associated with changes in bleeding patterns.

⏩ These menstrual changes are usually not harmful, although they may be bothersome and should be discussed before starting the contraceptive.

⏩ Providing anticipatory teaching helps prevent clients from assuming that irregular bleeding means the contraceptive is ineffective or dangerous.

⏩ With a levonorgestrel IUD, spotting or light bleeding commonly occurs during the first 3–6 months, and bleeding frequently decreases over time.

⏩ Implant users can also experience spotting, irregular bleeding, or amenorrhea, and the pattern may remain unpredictable.

⏩ The nurse should therefore include possible menstrual-cycle changes when discussing contraceptive options with this client.

An additional method of birth control should be utilized when changing medications — ✅ Correct

⏩ When switching contraceptive methods, the client may temporarily require a backup contraceptive method, such as condoms.

⏩ The need for backup contraception depends on the new method and when it is started in relation to menstruation.

⏩ For example, an implant started more than 5 days after menstrual bleeding began generally requires abstinence or barrier contraception for the next 7 days.

⏩ A levonorgestrel IUD inserted more than 7 days after menstruation began generally requires backup protection for 7 days.

⏩ Norethindrone or norgestrel progestin-only pills started more than 5 days after menstruation begins generally require backup contraception for 2 days.

⏩ Using backup contraception during the appropriate transition period decreases the risk of an unintended pregnancy.

⏩ This teaching is particularly important for this client because she states she does not want another pregnancy for 1½–2 years.

⏩ The exact duration of backup contraception should be based on the specific contraceptive selected and its start date.

Some medications will require specific start dates and dosing schedules — ✅ Correct

⏩ Different hormonal contraceptives have different initiation instructions and dosing schedules, making this an important part of contraceptive counseling.

⏩ Combined hormonal contraceptives may generally be started whenever the provider is reasonably certain the client is not pregnant, but backup contraception may be required depending on cycle timing.

⏩ Progestin-only pills require regular daily dosing, and their backup requirements differ according to the specific progestin formulation.

⏩ Depot medroxyprogesterone acetate (DMPA) is administered on a scheduled injection interval rather than taken daily.

⏩ A contraceptive implant provides long-acting contraception without requiring the client to remember a daily pill.

⏩ A hormonal IUD similarly provides long-term contraception without daily medication administration.

⏩ Because this client reports difficulty remembering her pill, methods requiring less frequent administration may be important options for the provider to discuss.

⏩ Teaching about when to start the method, when backup protection is necessary, and when repeat doses or replacement are due is essential for effective contraception.

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Answer 5

Correct Answers

Blank 1 Correct Option: levonorgestrel
Blank 2 Correct Option: intrauterine device

Rationale :

✅ Levonorgestrel — Correct

✅ Levonorgestrel is a progestin-only contraceptive, meaning it does not expose the client to estrogen.

✅ Avoiding estrogen is particularly important for this client because her blood pressure is 150/92 mm Hg, and she has a history of elevated blood pressure while using combined hormonal contraception.

✅ The client's recurrent headaches associated with visual changes also raise concern for migraine with aura, another major reason to avoid estrogen-containing contraceptives.

✅ A levonorgestrel-containing IUD provides long-acting reversible contraception (LARC) without requiring the client to remember a medication every day.

✅ This characteristic directly addresses her statement that caring for her baby has made it difficult to take her contraceptive pill at the same time each day.

✅ The method is highly suitable for her goal of preventing pregnancy for approximately 1½ to 2 years, even though the device itself can remain effective for considerably longer depending on the specific product.

✅ The IUD can be removed whenever the client decides she wants another pregnancy, making it appropriate for someone who wants temporary but reliable contraception.

✅ Levonorgestrel primarily works by thickening cervical mucus, making sperm penetration difficult, and by producing endometrial thinning that creates an unfavorable environment for fertilization.

✅ It may also decrease sperm survival and movement within the reproductive tract, further contributing to its contraceptive effectiveness.

✅ Many users experience lighter menstrual bleeding and decreased dysmenorrhea over time, although irregular bleeding and spotting can occur during the first several months.

✅ Because the method requires little ongoing user action, it has a much lower chance of contraceptive failure caused by forgetfulness or inconsistent medication use.

✅ Fertility generally returns relatively quickly following IUD removal, which is advantageous because this client wants another pregnancy in the future.

✅ Intrauterine device — Correct

✅ A levonorgestrel contraceptive can be delivered through a hormonal intrauterine device placed inside the uterus.

✅ The IUD releases a small amount of levonorgestrel locally within the reproductive tract, providing highly effective contraception.

✅ Once inserted, the client does not need to remember a daily pill, weekly patch, or periodic injection.

✅ This feature is especially beneficial because the client specifically reports difficulty remembering her current daily oral contraceptive.

✅ An IUD is considered a long-acting reversible contraceptive, meaning it provides prolonged pregnancy prevention while remaining reversible.

✅ The method fits the client's plan to delay pregnancy for approximately 18 to 24 months, because it can simply be removed when she is ready to conceive.

✅ A hormonal IUD does not contain estrogen, avoiding the estrogen-related concern associated with the client's hypertension and possible migraine with aura.

✅ Insertion is performed through the cervix into the uterus by a trained healthcare professional and does not require abdominal surgery.

✅ Cramping and light bleeding can occur shortly after insertion, and irregular spotting is common during the first several months.

✅ Clients should be taught to report symptoms such as severe pelvic pain, fever, unusually heavy bleeding, suspected pregnancy, or possible IUD expulsion.

❌ Ethinyl estradiol and levonorgestrel — Not the best choice

✅ This contraceptive combines ethinyl estradiol, an estrogen, with levonorgestrel, a progestin, making it a combined hormonal contraceptive.

✅ The client's blood pressure of 150/92 mm Hg makes continued estrogen-containing contraception concerning because estrogen can contribute to increased blood pressure and thromboembolic risk.

✅ Her history of recurrent headaches associated with visual changes is even more significant because this presentation may indicate migraine with aura.

✅ Estrogen-containing contraceptives are generally avoided in clients with migraine with aura because of the increased risk of ischemic stroke.

✅ Switching from an estrogen-containing pill to another estrogen-containing formulation would therefore fail to address the major safety concern identified in this case.

✅ A combined hormonal method may also continue or worsen adverse effects such as headache and nausea in susceptible clients.

✅ The client's history is particularly significant because she previously developed headaches and elevated blood pressure when using hormonal contraception containing estrogen.

✅ Her contraceptive plan should therefore emphasize a non-estrogen method rather than another combined hormonal preparation.

❌ Transdermal patch — Not the best route

✅ A transdermal contraceptive patch can eliminate the need to take a daily pill, which might initially seem helpful for this client's adherence problem.

✅ The problem is that combined contraceptive patches usually contain both estrogen and progestin, meaning they still expose the client to systemic estrogen.

✅ Applying the medication through the skin does not eliminate estrogen-associated vascular risks.

✅ This client has hypertension and possible migraine with aura, making an estrogen-containing patch inappropriate compared with a progestin-only option.

✅ The patch therefore solves the forgetfulness problem but does not adequately address the more important safety problem.

✅ A safer contraceptive choice should ideally address both concerns: avoid estrogen and require minimal ongoing adherence.

❌ Depot medroxyprogesterone acetate — Alternative, but not best fit

✅ Depot medroxyprogesterone acetate (DMPA) is a progestin-only contraceptive, so it does not contain estrogen.

✅ It is typically given as an intramuscular or subcutaneous injection approximately every 3 months, depending on the formulation.

✅ DMPA would solve the client's difficulty remembering a daily pill because she would only need contraceptive administration at scheduled intervals.

✅ It also avoids the estrogen-related concerns associated with her hypertension and possible migraine with aura.

✅ DMPA can therefore be an acceptable contraceptive option for some clients with similar risk factors.

✅ A disadvantage is that the client must remember to return for repeat injections, whereas an IUD requires essentially no ongoing adherence after placement.

✅ Another important consideration is that return to fertility can be delayed after stopping DMPA, sometimes for several months after the last injection.

✅ Because this client plans to try for pregnancy again in approximately 1½ to 2 years, a method with a more predictable and rapid return of fertility after discontinuation may better match her reproductive goals.

✅ DMPA can also cause irregular menstrual bleeding or amenorrhea, particularly during the first year.

✅ Longer-term use can cause a reversible decrease in bone mineral density, another factor considered during counseling.

❌ Intramuscular injection — Not the best route for this client

✅ An intramuscular contraceptive injection refers primarily to DMPA, which is administered periodically rather than every day.

✅ This route would improve adherence compared with a daily pill because the client does not need to remember medication each morning or evening.

✅ The client would still need to remember appointments approximately every 3 months to maintain contraceptive effectiveness.

✅ Missing or delaying an injection could reduce contraceptive protection and require additional counseling regarding backup contraception.

✅ The potential for a delayed return to fertility makes it somewhat less aligned with her plan to conceive again in the relatively near future.

✅ An IUD provides equally convenient or greater adherence benefits while allowing rapid reversibility after removal.

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Answer 6

Correct Answers

May experience withdrawal bleeding after 21 days. [ not include ]
Need to return for the injection every 12 weeks. [ include ]
Report any incidence of progressive weight gain. [ include ]
Increase consumption of calcium containing foods. [ include ]
Begin regular regimen of weight-bearing exercise. [ include ]
Back up contraception if prescribed an antibiotic. [ not include ]
Fertility impacted up to 6 months after stopping. [ not include ]

Rationale :

✅ Need to return for the injection every 12 weeks — INCLUDE

➡️ DMPA is a long-acting progestin-only injectable contraceptive, so it does not require daily administration.

➡️ The standard DMPA-IM dose is 150 mg intramuscularly approximately every 3 months.

➡️ Current CDC guidance describes the routine reinjection interval as 13 weeks; many nursing resources describe this generally as approximately 12–13 weeks or every 3 months.

➡️ Maintaining the injection schedule is important because contraceptive effectiveness depends on receiving subsequent doses at the appropriate intervals.

➡️ CDC guidance allows a repeat DMPA injection to be given up to 15 weeks after the previous injection without requiring additional contraceptive protection.

➡️ If the client presents later than the recommended grace period, pregnancy should be reasonably excluded and temporary backup contraception may be necessary.

➡️ This method is particularly useful for this client because she has difficulty remembering a daily contraceptive pill.

➡️ The injection also avoids estrogen, which is important given her elevated blood pressure and history of headaches with visual symptoms.

✅ Report progressive weight gain — INCLUDE

➡️ Weight gain is a recognized adverse effect of DMPA and should be discussed during client teaching.

➡️ Clinical trials have demonstrated progressive average weight gain among some clients receiving DMPA.

➡️ Pfizer reports an average gain of approximately 5.4 lb during the first year among women completing one year of treatment.

➡️ Weight gain can become more substantial with continued treatment, although individual responses vary considerably.

➡️ The nurse should encourage the client to monitor changes in body weight during therapy.

➡️ Significant or progressive weight gain should be discussed with the healthcare provider so that nutrition, activity, other medical causes, and continued contraceptive choice can be reviewed.

➡️ Healthy dietary habits and regular physical activity can help support appropriate weight management.

➡️ Weight gain does not automatically require discontinuation, but unexpected or excessive changes warrant evaluation.

✅ Increase consumption of calcium-containing foods — INCLUDE

➡️ DMPA is associated with a reduction in bone mineral density (BMD) during use.

➡️ The effect occurs because DMPA suppresses ovarian estrogen production, and estrogen plays an important role in maintaining bone mass.

➡️ Clinical studies have demonstrated decreases in bone mineral density of the lumbar spine and hip during prolonged DMPA use.

➡️ Adequate dietary calcium helps support bone mineralization and skeletal health.

➡️ Appropriate sources include milk, yogurt, cheese, calcium-fortified foods, and certain green vegetables, depending on the client's diet.

➡️ Adequate vitamin D is also important because it facilitates intestinal calcium absorption.

➡️ Pfizer prescribing information specifically recognizes bone mineral density loss as an important consideration with DMPA therapy.

➡️ Therefore, maintaining adequate calcium and vitamin D intake is appropriate health teaching for a client receiving DMPA.

✅ Begin regular weight-bearing exercise — INCLUDE

➡️ Weight-bearing exercise is encouraged because DMPA can decrease bone mineral density.

➡️ Exercises such as walking, jogging, stair climbing, dancing, and resistance training place healthy mechanical stress on bones.

➡️ This stimulation helps support bone remodeling and maintenance of bone strength.

➡️ Exercise works together with adequate calcium and vitamin D intake to support bone health.

➡️ Regular activity also provides cardiovascular and metabolic benefits and may assist with weight management, another relevant concern with DMPA.

➡️ Bone-density loss tends to be more pronounced during the earlier years of DMPA use, although some recovery can occur after discontinuation.

➡️ Clients with other osteoporosis risk factors may require additional individualized assessment.

➡️ Therefore, regular weight-bearing activity is an important component of DMPA client education.

❌ May experience withdrawal bleeding after 21 days — DO NOT INCLUDE

➡️ Predictable withdrawal bleeding after approximately 21 active pills is associated with traditional cyclic combined oral contraceptive regimens.

➡️ DMPA is an injectable progestin-only contraceptive and is not administered on a 21-day oral medication cycle.

➡️ DMPA commonly causes irregular spotting or light bleeding, particularly during the early months of use.

➡️ Some clients can also experience heavy or prolonged bleeding.

➡️ With continued use, many clients eventually develop amenorrhea.

➡️ These bleeding changes are generally not harmful but should be explained before treatment to reduce concern.

➡️ CDC guidance specifically identifies amenorrhea, spotting, and irregular bleeding as expected patterns with DMPA.

➡️ Therefore, teaching the client to expect withdrawal bleeding specifically after 21 days would be inaccurate.

❌ Back-up contraception if prescribed an antibiotic — DO NOT INCLUDE as a general rule

➡️ Routine broad-spectrum antibiotics do not significantly reduce the effectiveness of DMPA.

➡️ The client therefore does not automatically need an additional contraceptive method merely because an antibiotic has been prescribed.

➡️ CDC guidance classifies broad-spectrum antibiotic use with DMPA as having no restriction related to contraceptive effectiveness.

➡️ Even medications such as rifampin or rifabutin, which can reduce the effectiveness of some hormonal contraceptives, do not have the same clinically important effect on DMPA's contraceptive effectiveness.

➡️ Backup contraception is needed in certain circumstances related to when DMPA is initiated or when injections are substantially late, rather than simply because an antibiotic is prescribed.

➡️ For example, when the first DMPA injection is given more than 7 days after menstrual bleeding started, CDC recommends abstinence or barrier contraception for the next 7 days.

➡️ Condoms remain appropriate for STI prevention, because DMPA does not protect against sexually transmitted infections.

➡️ Therefore, the broad statement that antibiotics require backup contraception should not be included.

❌ Fertility impacted up to 6 months after stopping — DO NOT INCLUDE because the timeframe is inaccurate

➡️ DMPA can cause a delayed return of ovulation and fertility after the injections are stopped.

➡️ The delay is clinically important for this client because she plans another pregnancy in approximately 1½–2 years.

➡️ The statement saying fertility is affected only up to 6 months understates how long the delay can last.

➡️ Pfizer reports that the median time to conception is approximately 10 months after the last DMPA injection among clients who eventually conceived.

➡️ Approximately 68% of those who conceived did so within 12 months, 83% within 15 months, and 93% within 18 months after their last injection.

➡️ CDC evidence also shows substantial variation in the return of ovulation after the final injection.

➡️ Therefore, clients should understand that fertility may remain delayed for many months, potentially longer than 6 months.

➡️ This delayed return to fertility is different from permanent infertility; DMPA is reversible, but fertility may not return immediately.

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Answer 7

Correct Highlights :

Decreased blood pressure toward the normal range.
Fewer or no headaches.
Resolution or reduction of visual changes.
Decreased nausea.
No new significant adverse effects from DMPA.
Client is able to maintain contraception without needing to remember a daily pill.

Rationale :

✅ 1. Decreased blood pressure — Demonstrates improvement

➡️ The client's initial blood pressure was 150/92 mm Hg, which was abnormally elevated.

➡️ Elevated blood pressure was one of the major concerns while she was using an estrogen-containing contraceptive.

➡️ Estrogen can contribute to increased blood pressure in susceptible clients through effects on the renin-angiotensin-aldosterone system.

➡️ DMPA is a progestin-only contraceptive and does not expose the client to estrogen.

➡️ A blood pressure trending downward toward the client's usual or normal range would therefore indicate improvement after discontinuation of the combined contraceptive.

➡️ Improvement in blood pressure also reduces concern for complications such as stroke and other cardiovascular events.

➡️ Blood pressure should still be monitored over time because hypertension can have causes unrelated to contraceptive use.

➡️ A lower blood pressure at the follow-up visit would be one of the strongest indicators that the plan of care is working.

✅ 2. Fewer or no headaches — Demonstrates improvement

➡️ The client initially experienced frequent headaches for approximately 2 months.

➡️ The headaches occurred repeatedly around her menstrual cycle while she was taking a combined hormonal contraceptive.

➡️ Headaches can occur as an adverse effect of estrogen-containing contraception.

➡️ The client's headaches were particularly important because she also reported episodes of visual changes, requiring further evaluation for a possible migraine pattern.

➡️ A decrease in the frequency, duration, or intensity of the headaches would demonstrate improvement.

➡️ Complete resolution of the headaches would provide even stronger evidence that stopping the estrogen-containing medication was beneficial.

➡️ The nurse should compare the client's present headache pattern with her baseline symptoms before the medication change.

➡️ New, severe, or worsening headaches would not represent improvement and would require further assessment.

✅ 3. Resolution of visual changes — Demonstrates improvement

➡️ Before the medication change, the client reported visual changes associated with her headaches.

➡️ Visual symptoms associated with recurrent headaches can represent a neurologic warning symptom and require careful assessment.

➡️ Such symptoms are especially important in clients using estrogen-containing contraceptives because of associated vascular concerns.

➡️ Absence of visual disturbances after changing contraceptive therapy would therefore be reassuring.

➡️ The nurse should ask whether the client has experienced flashing lights, blind spots, blurred vision, or other visual disturbances since the medication change.

➡️ Resolution of these symptoms would indicate that the client's previous symptom pattern is improving.

➡️ Persistent or worsening visual symptoms would require continued evaluation rather than being attributed automatically to contraception.

➡️ Sudden visual loss or a major new neurologic change would require urgent medical evaluation.

✅ 4. Decreased or resolved nausea — Demonstrates improvement

➡️ The client initially reported recurrent nausea, particularly approximately 1 week before menstruation.

➡️ Nausea is a common adverse effect associated with estrogen-containing hormonal contraceptives.

➡️ Her nausea occurred in the same general pattern as the headaches and visual symptoms, increasing concern that the medication contributed to her symptoms.

➡️ A reduction in nausea after discontinuing the combined hormonal contraceptive would therefore demonstrate improvement.

➡️ The nurse should determine whether nausea is less frequent, less severe, or completely absent.

➡️ Improvement should also include the client's ability to eat and drink normally without significant gastrointestinal discomfort.

➡️ Persistent nausea would require consideration of other causes because not all nausea is contraceptive-related.

➡️ Resolution of nausea combined with improvement in headaches and blood pressure would strongly support a positive response to the new plan.

✅ 5. No recurrence of significant neurologic symptoms — Demonstrates improvement

➡️ The previous combination of headache and visual changes represented the most concerning neurologic pattern in the client's history.

➡️ Improvement would include absence of new visual disturbances, severe headaches, weakness, numbness, speech changes, or other focal neurologic symptoms.

➡️ DMPA does not contain estrogen, which removes the estrogen-related vascular exposure present with the previous medication.

➡️ The nurse should specifically ask about neurologic symptoms rather than relying only on the client's general statement that she feels better.

➡️ Stable neurologic findings such as normal movement, orientation, and pupil responses are reassuring.

➡️ A normal neurologic assessment supports improvement when compared with the client's previous symptom history.

➡️ New focal neurologic findings would require immediate evaluation rather than routine follow-up.

➡️ Continued absence of neurologic warning symptoms would be an important positive outcome.

✅ 6. Improved contraceptive adherence — Demonstrates improvement in the plan of care

➡️ The client previously stated that caring for her baby made it difficult to remember her daily contraceptive pill.

➡️ DMPA removes the need for daily medication because it is administered approximately every 3 months.

➡️ This substantially reduces the risk of contraceptive failure caused by missed daily doses.

➡️ The client should understand when her next injection is due and the importance of returning on schedule.

➡️ Successful transition to a method that fits her lifestyle represents an improvement in the overall contraceptive plan.

➡️ The new method also aligns with her goal of avoiding pregnancy for approximately 1½ to 2 years.

➡️ Effective contraception without the stress of daily pill-taking may improve the client's confidence and satisfaction with treatment.

➡️ Adherence to the injection schedule is still necessary, even though daily medication is no longer required.

✅ 7. Absence of troublesome DMPA adverse effects — Supports a good response

➡️ DMPA can cause irregular bleeding, spotting, headaches, and weight changes, particularly early in therapy.

➡️ Mild bleeding changes can be expected and do not necessarily indicate treatment failure.

➡️ Lack of severe or troublesome adverse effects suggests that the client is tolerating the medication well.

➡️ The nurse should ask about bleeding pattern, headaches, weight changes, mood changes, and injection-site problems.

➡️ No heavy or prolonged bleeding is a reassuring finding.

➡️ No severe headache or new neurologic symptoms is particularly important given the client's previous history.

➡️ The client's satisfaction with the method should also be assessed because tolerability affects continued use.

➡️ Good tolerance combined with improvement of the original symptoms indicates a successful response to therapy.

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Answer 8

Correct Answers:

0.8

Rationale :

Formula:

Desired dose ÷ Dose on hand × Volume on hand

1 mg ÷ 2 mg × 1.5 mL

= 0.5 × 1.5 mL

= 0.75 mL

Rounded to the nearest tenth:

= 0.8 mL

✅ Answer: 0.8 mL

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Answer 9

Correct Answers:

Relief of epigastric pain.

Rationale :

❇️ Misoprostol is a prostaglandin E₁ analog used to prevent and treat gastric mucosal injury associated with long-term NSAID use.

❇️ Long-term ibuprofen use decreases prostaglandin synthesis, which reduces protective gastric mucus and bicarbonate secretion.

❇️ Misoprostol helps restore gastric mucosal protection by increasing mucus and bicarbonate production.

❇️ It also decreases gastric acid secretion, helping reduce irritation and ulcer formation.

❇️ Epigastric pain is a common manifestation of NSAID-induced gastritis or peptic ulcer disease.

❇️ Relief of epigastric pain therefore suggests that the gastric mucosa is healing and the medication is producing the desired therapeutic effect.

❇️ Misoprostol is commonly prescribed for clients who must continue NSAID therapy and are at increased risk for gastric ulcers.

❇️ A reduction in upper abdominal discomfort is therefore the best indication that the medication has been effective.

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Answer 10

Correct Answers:

Osmolality

Rationale :

⏭️ Diabetes insipidus (DI) causes inadequate antidiuretic hormone activity, leading to excretion of large amounts of dilute urine.

⏭️ Excessive water loss causes the blood to become more concentrated, which increases serum osmolality.

⏭️ Intranasal antidiuretic hormone therapy, such as desmopressin, increases water reabsorption by the kidneys.

⏭️ As treatment becomes effective, serum osmolality should move toward the normal range as the client's water balance improves.

⏭️ Monitoring serum osmolality helps determine whether therapy is correcting the client's fluid concentration abnormality.

⏭️ Excessive antidiuretic hormone replacement can cause too much water retention, producing low serum osmolality and hyponatremia.

⏭️ Serum osmolality therefore helps detect both undertreatment and overtreatment of DI.

⏭️ The nurse should also monitor serum sodium, urine output, urine specific gravity, daily weight, and fluid balance during therapy.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Laboratory Test	Result	Reference Range
Human chorionic gonadotropin (hCG), urine	Negative	Negative

Laboratory Test	Result	Reference Range
Human chorionic gonadotropin (hCG), urine	Negative	Negative

Laboratory Test	Result	Reference Range
Human chorionic gonadotropin (hCG), urine	Negative	Negative

Laboratory Test	Result	Reference Range
Human chorionic gonadotropin (hCG), urine	Negative	Negative

Laboratory Test	Result	Reference Range
Human chorionic gonadotropin (hCG), urine	Negative	Negative

NSG520 Pathophysiology & Pharmacology Final Exam 2026 Summer C

No.

1 :
The muscle relaxant, baclofen, is prescribed for a female client with multiple sclerosis. The client calls the clinic nurse, reporting that she has been having trouble sleeping since she started the medication and wants to stop taking the medication. Which response by the nurse takes priority?

2 :
Patient Data

Answer Options

3 :
Patient Data

Correct Answers

Increase the dosage — Incorrect

Maintain the dosage — Incorrect

4 :
Patient Data

Answer Options

5 :
The nurse is prioritizing care based on the client's needs.

Correct Answers

6 :
Patient Data

Correct Answers

7 :
Patient Data

Correct Highlights :

8 :
The nurse prepares semaglutide 1 mg subcutaneously. Available is semaglutide 2 mg/1.5 mL. How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

9 :
A client with a history of long term use of ibuprofen receives a prescription for misoprostol. Which finding indicates to the nurse that the medication was effective?

10 :
When caring for a client with diabetes insipidus (DI) who is receiving an antidiuretic hormone intranasally, which serum laboratory test is most important for the nurse to monitor?

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Potential teaching	include	not include
May experience withdrawal bleeding after 21 days.
Need to return for the injection every 12 weeks.
Report any incidence of progressive weight gain.
Increase consumption of calcium containing foods.
Begin regular regimen of weight-bearing exercise.
Back up contraception if prescribed an antibiotic.
Fertility impacted up to 6 months after stopping.

NSG520 Pathophysiology & Pharmacology Final Exam 2026 Summer C

No.

1 : The muscle relaxant, baclofen, is prescribed for a female client with multiple sclerosis. The client calls the clinic nurse, reporting that she has been having trouble sleeping since she started the medication and wants to stop taking the medication. Which response by the nurse takes priority?

2 : Patient Data

Answer Options

3 : Patient Data

Correct Answers

Increase the dosage — Incorrect

Maintain the dosage — Incorrect

4 : Patient Data

Answer Options

5 : The nurse is prioritizing care based on the client's needs.

Correct Answers

6 : Patient Data

Correct Answers

7 : Patient Data

Correct Highlights :

8 : The nurse prepares semaglutide 1 mg subcutaneously. Available is semaglutide 2 mg/1.5 mL. How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

9 : A client with a history of long term use of ibuprofen receives a prescription for misoprostol. Which finding indicates to the nurse that the medication was effective?

10 : When caring for a client with diabetes insipidus (DI) who is receiving an antidiuretic hormone intranasally, which serum laboratory test is most important for the nurse to monitor?

1 :
The muscle relaxant, baclofen, is prescribed for a female client with multiple sclerosis. The client calls the clinic nurse, reporting that she has been having trouble sleeping since she started the medication and wants to stop taking the medication. Which response by the nurse takes priority?

2 :
Patient Data

3 :
Patient Data

4 :
Patient Data

5 :
The nurse is prioritizing care based on the client's needs.

6 :
Patient Data

7 :
Patient Data

8 :
The nurse prepares semaglutide 1 mg subcutaneously. Available is semaglutide 2 mg/1.5 mL. How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

9 :
A client with a history of long term use of ibuprofen receives a prescription for misoprostol. Which finding indicates to the nurse that the medication was effective?

10 :
When caring for a client with diabetes insipidus (DI) who is receiving an antidiuretic hormone intranasally, which serum laboratory test is most important for the nurse to monitor?