RN Nursing · Antepartum · Practice question
A 57-year-old client considering hormone replacement therapy (HRT) asks the nurse about potential risks. Which client factor would require further evaluation before prescribing estrogen therapy?
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The client experiences frequent mood swings.
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The client reports vaginal dryness and discomfort.
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✓
The client has a history of uncontrolled hypertension.
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The client has a family history of skin cancer.
Answer & explanation
Correct: The client has a history of uncontrolled hypertension.
Estrogen-containing hormone replacement therapy (HRT) is associated with several cardiovascular risks, including increased risk of hypertension, thromboembolic events, stroke, and myocardial infarction. A history of uncontrolled hypertension is a significant contraindication or at minimum a condition requiring careful evaluation before initiating estrogen therapy, because exogenous estrogen can further elevate blood pressure and increase cardiovascular morbidity. This factor must be assessed and managed before HRT can be safely prescribed. Frequent mood swings are actually one of the perimenopausal symptoms that estrogen therapy may help alleviate and do not represent a safety concern for prescribing HRT. Vaginal dryness and discomfort are among the most common indications for HRT or topical estrogen therapy, not a contraindication. A family history of skin cancer, while worth noting, is not a recognized contraindication to estrogen therapy; the concern with HRT is primarily breast cancer and endometrial cancer risk, not skin cancer. Therefore, uncontrolled hypertension is the client factor that demands further evaluation and potentially precludes or delays initiation of estrogen therapy.
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