Scenario:

A nurse is caring for a 32-year-old female client who was recently diagnosed with endometriosis. The client is in the clinic for a follow-up visit after beginning nafarelin treatment.

Setting: Clinic

Exhibits

Which of the following manifestations reported by the client should the nurse identify as a therapeutic effect of the nafarelin? (Select all that apply.)

Choice A rationale: CNS manifestations such as headaches are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin, a gonadotropin-releasing hormone (GnRH) agonist, works by reducing the production of estrogen in the body. This can lead to a variety of side effects, including headaches. While these side effects can be bothersome, they do not indicate that the medication is effectively treating the endometriosis.

Choice B rationale: The reduction in pain level during sexual intercourse, or dyspareunia, is a therapeutic effect of nafarelin. Endometriosis can cause painful sexual intercourse, and one of the goals of treatment with nafarelin is to reduce this pain. The client’s report of decreased dyspareunia suggests that the nafarelin is effectively treating the endometriosis.

Choice C rationale: Changes in the nasal mucosa, such as irritation, are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin is administered intranasally, which can lead to irritation of the nasal mucosa. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.

Choice D rationale: Changes in breast size are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin can cause a variety of side effects, including changes in breast size. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.

Choice E rationale: The absence of menstruation, or amenorrhea, is a therapeutic effect of nafarelin. Nafarelin works by reducing the production of estrogen in the body, which can lead to a temporary halt in menstruation. This is a therapeutic effect as it can help to reduce the pain and other symptoms associated with endometriosis.

Choice F rationale: Dermatological manifestations such as increased acne are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin can cause a variety of side effects, including increased acne. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.

Choice A rationale

Acute laryngotracheobronchitis, also known as croup, is a common childhood condition that is usually caused by a viral infection. The main symptom is a distinctive barking cough. A cool mist tent can help to soothe the inflamed airways and reduce stridor, which is a high-pitched,

wheezing sound caused by disrupted airflow. Therefore, decreased stridor would indicate that the treatment has been effective.

Choice B rationale

While a decreased temperature might indicate a resolution of any underlying infection, it is not directly related to the effectiveness of a cool mist tent in treating acute laryngotracheobronchitis.

Choice C rationale

A barking cough is a symptom of acute laryngotracheobronchitis and does not indicate treatment effectiveness.

Choice D rationale

Improved hydration is important but is not a direct indicator of the effectiveness of the cool mist tent.