menopause

Question 1

44. The average onset of perimenopause in North
American women is between the ages of:
A. 35 to 40 years.
B. 40 to 45 years.
C. 45 to 50 years.
D. 50 to 55 years.

Answer 1

B. 40 to 45 years.

Question 2

45. Which of the following statements regarding
    perimenopause is false?
    A. Menstruation ceases during perimenopause.
    B. Hot flashes and flushes are common during the
    week before menses.
    C. Pregnancy is still possible during perimenopause.
    D. Ovulation becomes more erratic during
    perimenopause.

Answer 2

A. Menstruation ceases during perimenopause.

Question 3

46. In advising a woman about menopause, the NP
    considers that:
    A. the average age at last menstrual period for a North
    American woman is 47 to 48 years.
    B. hot flashes and night sweats occur in about 60% to
    90% of women.
    C. women with surgical menopause usually have
    milder symptoms.
    D. follicle-stimulating hormone (FSH) and luteinizing
    hormone (LH) levels are suppressed.

Answer 3

B. hot flashes and night sweats occur in about 60% to

90% of women.

Question 4

47. Findings in estrogen deficiency (atrophic) vaginitis
    include:
    A. a malodorous vaginal discharge.
    B. an increased number of lactobacilli.
    C. a reduced number of white blood cells.
    D. a pH greater than 5.0.

Answer 4

D. a pH greater than 5.0.

Question 5

48. A 53-year-old woman who is taking hormone therapy (HT) with conjugated estrogen, 0.45 mg/day, with medroxyprogesterone acetate (MPA), 1.5 mg, has
    bothersome atrophic vaginitis symptoms. You
    advise that:
    A. her oral estrogen dose should be increased.
    B. the addition of a topical estrogen can be helpful.
    C. the MPA component should be discontinued.
    D. baking soda douche should be tried.

Answer 5

B. the addition of a topical estrogen can be helpful.

Question 6

49. For a woman with bothersome hot flashes who cannot take HT, alternative options with demonstrated efficacy and limited adverse effects include the use of all of the following except:
A. venlafaxine.
B. sertraline.
C. gabapentin.
D. clonidine.

Answer 6

D. clonidine.

Question 7

50. Absolute contraindications to postmenopausal HT
include:
A. unexplained vaginal bleeding.
B. seizure disorder.
C. dyslipidemia.
D. migraine headache.

Answer 7

A. unexplained vaginal bleeding.

Question 8

51. In advising a perimenopausal woman about HT, you
    consider that it can:
    A. reduce the risk of venous thrombotic events.
    B. significantly reduce serum triglyceride levels.
    C. worsen hypertension in most women.
    D. help preserve bone density.

Answer 8

D. help preserve bone density.

Question 9

52. Postmenopausal HT use usually results in:
    A. a reduction in the rate of cardiovascular disease.
    B. an increase in the rate of rheumatoid arthritis.
    C. a reduction in the frequency and severity of
    vasomotor symptoms.
    D. a disturbance in sleep patterns.

Answer 9

C. a reduction in the frequency and severity of

vasomotor symptoms.

Question 10

53. The progestin component of HT is given to:
    A. counteract the negative lipid effects of estrogen.
    B. minimize endometrial hyperplasia.
    C. help with vaginal atrophy symptoms.
    D. prolong ovarian activity.

Answer 10

B. minimize endometrial hyperplasia.

Question 11

54. Concerning selective estrogen receptor modulator
    therapy such as raloxifene (Evista®), which of the
    following statements is correct?
    A. Concurrent progestin opposition is needed.
    B. Hot flashes are reduced in frequency and severity.
    C. Use is contraindicated when a woman has a history
    of breast cancer.
    D. Osteoporosis risk is reduced with use.

Answer 11

D. Osteoporosis risk is reduced with use.

Question 12

55. During perimenopause, which of the following is likely to be noted?
    A. The length of the menstrual cycle and duration of
    menstrual flow are often unpredictable.
    B. The length of the perimenopausal period is predictable.
    C. Symptoms are less severe in women who smoke.
    D. Hot flashes are uncommon.

Answer 12

A. The length of the menstrual cycle and duration of

menstrual flow are often unpredictable.

Question 13

56. A 48-year-old woman complains of increased frequency and severity of hot flashes. Her last menses occurred 6 months ago. You would expect all of the following laboratory findings except:
A. increased levels of LH.
B. elevated levels of testosterone.
C. reduced levels of estradiol.
D. reduced levels of progesterone.

Answer 13

B. elevated levels of testosterone.

Question 14

57. Which of the following is likely to be noted with
    short-term (less than 1 to 2 years) HT use in a
    postmenopausal woman?
    A. reduction in dementia risk
    B. significant increase in breast cancer risk
    C. minimized hot flashes
    D. increase in cardiovascular risk

Answer 14

C. minimized hot flashes

Question 15

58. Which body area has the greatest concentration of
estrogen receptors?
A. vulva
B. vascular bed
C. heart
D. brain

Answer 15

A. vulva

Question 16

59. When counseling a 46-year-old woman who is experiencing debilitating hot flashes, you advise all of the following regarding higher- and lower-dose hormone replacement therapy except:
    A. current clinical guidelines recommend using the
    lowest effective dose possible.
    B. higher-dose HT will relieve hot flashes faster than
    lower-dose regimens.
    C. lower-dose HT is better tolerated than higherdose
    HT.
    D. the duration of lower-dose HT is usually shorter
    than that of higher-dose regimens.

Answer 16

D. the duration of lower-dose HT is usually shorter

than that of higher-dose regimens.

Question 17

60. You see a 51-year-old woman who is considering
    HT. She has a family history of endometrial cancer,
    hyperlipidemia, and VTE. You advise her on all of the
    following except:
    A. the use of progestin can minimize the risk of
    endometrial cancer for a woman on HT and who
    has not had a hysterectomy.
    B. supplemental estrogen should be avoided in women who are at high risk of breast cancer or uterine
    cancer.
    C. supplemental estrogen should be avoided in women who are at high risk of cardiovascular disease.
    D. short-term studies demonstrate that oral HT is
    associated with lower thromboembolic risk than
    transdermal forms of HT.

Answer 17

D. short-term studies demonstrate that oral HT is
associated with lower thromboembolic risk than
transdermal forms of HT.

Question 18

61. Examples of phytoestrogens include all of the following except:
A. red clover.
B. ginseng.
C. vitamin E.
D. soy products.

Answer 18

C. vitamin E.

Question 19

62. The typical HT regimen contains \_\_\_\_ or less of the estrogen dose of COC.
A. one-eighth
B. one-fourth
C. one-half
D. three-fourths

Answer 19

B. one-fourth

Question 20

63. For the woman with a history of DVT who is having
significant vasomotor symptoms, which of the
following can be can be used for symptom
management?
A. 17β-estradiol patch
B. drospirenone
C. estrone.
D. paroxetine.

Answer 20

D. paroxetine.

Question 21

64. Long-term calcium supplementation is recommended in postmenopausal women as its use reduces the risk of fracture by approximately:
A. 25%.
B. 50%.
C. 65%.
D. 80%.

Answer 21

B. 50%.

Question 22

65. In postmenopausal women, a major benefit from the use of topical or local estrogen is:
A. decreased rate of breast cancer.
B. reduced risk of recurrent UTIs.
C. reduced risk of type 2 diabetes.
D. increased levels of androgens.

Answer 22

B. reduced risk of recurrent UTIs.

Question 23

66. When reviewing the use of nutritional supplements for the management of menopausal symptoms, the NP
    considers that:
    A. few high-quality studies support the use of these
    products.
    B. the use of these products is consistently reported
    to be helpful.
    C. the products can be safely used as long as blood
    hormone levels are carefully evaluated.
    D. the use of these products is associated with a greater reduction in menopausal symptoms than with
    prescription HT.

Answer 23

A. few high-quality studies support the use of these

products.

Question 24

67. A 51-year-old woman is using a vaginal estrogen
    preparation with effect to manage localized menopause symptoms. Anticipated effects of this therapy include a potential for:
    A. lower rate of urinary tract infection.
    B. endometrial atrophy.
    C. fewer vasomotor symptoms.
    D. resumption of menses.

Answer 24

A. lower rate of urinary tract infection.

Question 25

68. Which of the following statements is true? A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use. B. All progesterones are easily absorbed via the skin. C. Alfalfa is an example of a phytoprogesterone. D. Progesterones, whether synthetic or plant-based, should not be used by a woman who has undergone a hysterectomy.

Answer 25

A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use.