A patient receives an injection of human chorionic gonadotropin ...

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A patient receives an injection of human chorionic gonadotropin after follicular maturation has been induced with another agent. The patient comes to the clinic 2 days later complaining of headache, irritability, and fatigue. What will the nurse do?
 
  a. Perform a urine pregnancy test.
  b. Reassure the patient that these are known adverse effects.
  c. Request an order for a serum estrogen level.
  d. Review the patient's abdominal ultrasound.

Question 2

A patient receiving menotropin (Repronex) for infertility comes to the clinic for evaluation on the ninth day of treatment. Her serum estrogen level is 200 pg/mL per maturing follicle. An ultrasound reveals that follicles have enlarged to 22 mm.
 
  The patient complains of left lower abdominal pain. What will the nurse do?
  a. Administer human chorionic gonadotropin, because the ovary has ripened.
  b. Assess for abdominal fullness and distension and auscultate lung sounds.
  c. Inform the patient that the pain is associated with ovulation.
  d. Recommend ibuprofen for pain and administer the next dose of menotropin.

[al]

Answer to Question 1

ANS: B
Headache, irritability, and fatigue are known adverse effects of hCG. A urine pregnancy test is not indicated, because it is too soon for the patient to be pregnant. A serum estrogen level and an abdominal ultrasound are not indicated.

Answer to Question 2

ANS: B
Menotropins can cause ovarian hyperstimulation syndrome, which can cause sudden enlargement of the ovaries. When it occurs rapidly and is accompanied by ascites, pleural effusion, and pain, the patient should be hospitalized and the menotropin should be withdrawn. Although the follicular size and estrogen level indicate a ripened ovary, the first priority is to assess for ovarian hyperstimulation syndrome, because this patient reports pain. Ovulation will not occur until hCG is given, so this pain is not associated with ovulation. Until ovarian hyperstimulation syndrome has been ruled out, it is not appropriate to administer the next dose of menotropins.

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TYSM

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