A 14-year-old male patient has not begun puberty. His parents ...

[joe]

A 14-year-old male patient has not begun puberty. His parents tell the nurse that their son does not want to go to school, because he gets teased.
 
  The nurse learns that the boy's father did not begin puberty until age 16 years. Laboratory tests on this child do not reveal true hypogonadism. What will the nurse tell these parents when they ask what can be done for their son?
  a. A limited course of androgen therapy may be prescribed, but it is not necessary.
  b. He will eventually begin puberty, so this is nothing to worry about.
  c. He will probably have to receive injections of androgens for 3 to 4 years.
  d. The risk of accelerated growth plate closure is too great to warrant androgen therapy.

Question 2

A postpartum patient is receiving ergonovine maleate (Ergotrate) to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg.
 
  The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do?
  a. Continue to monitor and tell the patient to report increased cramping.
  b. Notify the provider of possible uterine hypertonicity.
  c. Notify the provider of the patient's blood pressure.
  d. Request an order to administer the Ergotrate intravenously.

[lkanara2]

Answer to Question 1

ANS: A
Although treatment is not required in this patient, the psychologic effects of delayed puberty indicate a limited course of androgen therapy. Telling the parents not to worry does not address their concerns. This patient will not be a candidate for long-term androgen replacement therapy. Limited treatment can minimize the risk of epiphyseal closure, especially with close monitoring and radiographs.

Answer to Question 2

ANS: A
This patient is showing signs of a desired response to the drug, so the nurse should continue to monitor. Increased cramping may be a sign of overdose, so the patient should know to notify the nurse if this occurs. A firm uterus with minimal bleeding is the desired effect. The blood pressure is within normal limits. There is no indication for giving this drug intravenously, because that method poses significant risks and is indicated only with severe hemorrhage.

[joe]

Excellent

[marict]

TYSM