RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021
Medical & Surgical Nursing
Easy
Absolute contraindication of hormone replacement therapy is?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021
Explanation
- Hormone Replacement Therapy (HRT) is absolutely contraindicated in individuals with a history of thrombosis, such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
- The estrogen component of HRT has a pro-coagulant effect, meaning it increases the risk of blood clot formation.
- This occurs because estrogen increases the synthesis of clotting factors (like fibrinogen, factor VII, and factor X) and decreases the levels of natural anticoagulants like antithrombin.
- Therefore, administering HRT to a patient with a history of thrombosis poses a significant and unacceptable risk of a new or recurrent thromboembolic event.
Why Other Options Were Wrong
- Option B: This term is too broad. While undiagnosed abnormal uterine bleeding is an absolute contraindication, hemorrhage from other known causes is not necessarily a contraindication.
- Option C: A fibroadenoma is a benign (non-cancerous) breast tumor. It is not considered an absolute contraindication for HRT.
- Option D: Metrorrhagia (irregular uterine bleeding) is a contraindication only when it is undiagnosed. The cause must be investigated to exclude underlying pathology like endometrial cancer before starting HRT.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Absolute contraindications for Hormone Replacement Therapy (HRT) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Nurses must conduct a thorough patient history assessment before the initiation of HRT, specifically screening for any personal or family history of thromboembolic events, cancers, or liver disease.
- Patient education is a critical nursing role. Nurses should teach patients on HRT to recognize the signs and symptoms of DVT (leg pain, swelling, redness) and PE (sudden chest pain, shortness of breath) and to seek immediate medical attention if they occur.
- What if? If a patient has severe menopausal symptoms but also has a history of DVT, the approach changes. Non-hormonal treatments (like SSRIs, gabapentin) become the first-line choice. In some cases, a specialist may consider transdermal estrogen, which has a lower thrombotic risk than oral estrogen, after a thorough risk-benefit analysis.
How to Approach the Question
- First, identify the key terms in the question: 'Absolute contraindication' and 'hormone replacement therapy (HRT)'. 'Absolute' means the therapy must be avoided under all circumstances.
- Next, evaluate each option based on your knowledge of HRT's risks.
- Recall that estrogen, a key component of HRT, is known to increase the risk of blood clots. This makes 'Thrombosis' a very strong candidate for an absolute contraindication.
- Consider the other options. 'Haemorrhage' and 'Metrorrhagia' relate to bleeding. Remember that it is specifically undiagnosed abnormal vaginal bleeding that is a contraindication, to rule out cancer. These options are not as universally absolute.
- Evaluate 'Fibroadenoma'. This is a benign condition and is unlikely to be an absolute contraindication for a major therapy like HRT.
- By comparing the options, you can conclude that a history of thrombosis is the most definitive and universally accepted absolute contraindication among the choices provided.
Concept Tested & Keywords
- Concept Tested: Absolute contraindications for Hormone Replacement Therapy (HRT)
- Stem keywords: Absolute contraindication, hormone replacement therapy, HRT
- Lead-in keywords: is
- Negative lead-in flag: false
Question ID
QHuSfb53fH83f57uOTM9OD
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 11109-11111
E6 Medicine Harrison 22e Part 2 p. 1053-1055
E6 Pharmacology Nursing Lilley 11e Part 2 p. 244-246
Practise the full RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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