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Endocrine System

Hormone Replacement Therapy Practice Questions

18 free Hormone Replacement Therapy practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 18 Medium

Why is progestogen included in combined estrogen and progestogen therapy for a post-menopausal woman with an intact uterus?

  1. A Reduce hot flashes more effectively than estrogen given alone
  2. B Protect the endometrium from hyperplasia
  3. C Enhance bone mineral density beyond estrogen-only therapy
  4. D Increase the long-term risk of invasive breast cancer

Correct answer: Protect the endometrium from hyperplasia

When a woman with an intact uterus receives estrogen replacement, adding progestogen protects the endometrium from hyperplasia and possible malignancy.

Question 2 of 18 Medium

What is the most accurate statement regarding the timing of starting menopausal hormone therapy (MHT)?

  1. A It is only considered safe when initiated after a woman reaches age 65
  2. B The benefit-to-risk ratio is most favourable within 10 years of menopause
  3. C It reliably prevents cardiovascular disease in essentially all treated women
  4. D It is absolutely contraindicated whenever vasomotor symptoms are present

Correct answer: The benefit-to-risk ratio is most favourable within 10 years of menopause

Guidelines indicate that initiating hormone therapy in women under ~60 years or within 10 years of menopause tends to yield more favourable benefits versus risks.

Question 3 of 18 Medium

What is not expected to be assessed by the provider prior to initiating hormone replacement therapy?

  1. A Personal and family history of breast cancer and cardiovascular disease
  2. B Screening for contraindications such as thromboembolism
  3. C Baseline bone-density scan in all cases before starting
  4. D Patient’s menopausal symptom severity and preferences

Correct answer: Baseline bone-density scan in all cases before starting

While bone density may be considered, universal baseline DEXA for MHT initiation is not required. The key pre-therapy assessments include risks, symptom severity, and contraindications.

Question 4 of 18 Easy

What hormone replacement regimen does a woman with a hysterectomy only need if symptomatic for menopause?

  1. A Estrogen plus progestogen
  2. B Estrogen-only therapy
  3. C Progestogen-only therapy
  4. D No hormone therapy is indicated

Correct answer: Estrogen-only therapy

In women without a uterus, estrogen alone can be used since progestogen protection of the endometrium is not required.

Question 5 of 18 Medium

Which route of estrogen administration is preferred for a woman with increased risk of venous thromboembolism?

  1. A Oral estrogen
  2. B Transdermal (patch/gel) estrogen
  3. C Intramuscular estrogen injection
  4. D Vaginal estrogen only

Correct answer: Transdermal (patch/gel) estrogen

Transdermal estrogen bypasses first-pass liver metabolism and may carry lower risk of VTE compared to oral administration.

Question 6 of 18 Medium

What is the next best action if a 52-year-old woman on hormone replacement reports new-onset irregular vaginal bleeding?

  1. A Reassure her, since bleeding is an expected effect of long-term HRT
  2. B Evaluate promptly for endometrial pathology
  3. C Empirically increase the estrogen dose to suppress the bleeding
  4. D Switch her immediately to progestogen-only therapy instead

Correct answer: Evaluate promptly for endometrial pathology

Unscheduled uterine bleeding in a woman on MHT signals need for further evaluation (e.g., endometrial assessment) rather than being automatically benign.

Question 7 of 18 Medium

What do current guidelines recommend regarding hormone therapy for a woman seeking it primarily for osteoporosis prevention?

  1. A Offer hormone therapy to all postmenopausal women solely for bone protection
  2. B Offer it only if symptomatic, after individualised risk-benefit discussion
  3. C Offer universal hormone therapy regardless of symptoms or personal risk
  4. D Offer hormone therapy chiefly to prevent dementia in every aging woman

Correct answer: Offer it only if symptomatic, after individualised risk-benefit discussion

Hormone therapy is best considered for symptomatic relief; its use solely for chronic disease prevention (e.g., osteoporosis, dementia) is not routinely recommended without symptoms.

Question 8 of 18 Hard

What is the recommended approach for treating central hypothyroidism (due to pituitary deficiency)?

  1. A Titrate the levothyroxine dose to a strictly normal serum TSH level
  2. B Target free thyroxine (FT4) in the upper half of its reference range
  3. C Withhold thyroid hormone replacement and monitor clinically instead
  4. D Use the serum TSH measurement alone to guide all dose adjustments

Correct answer: Target free thyroxine (FT4) in the upper half of its reference range

In central (secondary) hypothyroidism, TSH may not be reliable, so levothyroxine dosing is guided to raise free T4 into upper half of normal rather than focusing on TSH.

Question 9 of 18 Medium

What options are available if a patient has contraindications to hormone replacement therapy and does not want to proceed with it?

  1. A No, only systemic hormones can relieve menopausal vasomotor symptoms
  2. B Yes; SSRIs/SNRIs, gabapentin, or lifestyle measures are alternatives
  3. C No, hormone therapy must be used in every case regardless of the risks
  4. D Non-hormonal options work equally well for preventing osteoporosis

Correct answer: Yes; SSRIs/SNRIs, gabapentin, or lifestyle measures are alternatives

If hormone therapy is contraindicated or declined, non-hormonal medications (e.g., SSRIs/SNRIs, gabapentin) and lifestyle interventions are valid alternatives for vasomotor symptoms.

Question 10 of 18 Medium

What is the correct guidance regarding the duration of hormone therapy use for a woman on estrogen therapy?

  1. A Hormone therapy may safely be continued indefinitely in essentially all women
  2. B Use the lowest effective dose for the shortest appropriate duration
  3. C Treatment duration is irrelevant as long as menopausal symptoms persist
  4. D Progressively higher doses become necessary with each year of treatment

Correct answer: Use the lowest effective dose for the shortest appropriate duration

Guidelines recommend hormone therapy be used at the lowest effective dose for the shortest duration that meets treatment objectives, with periodic reassessment.

Question 11 of 18 Medium

What is the most appropriate laboratory monitoring for a woman on systemic hormone replacement therapy?

  1. A No laboratory or clinical monitoring is required while she is symptom-free
  2. B Periodic blood pressure, lipids, and breast assessment rather than hormone levels
  3. C Weekly measurement of serum estradiol to titrate the prescribed dose
  4. D A routine monthly steroid hormone panel drawn at the same clinic visit

Correct answer: Periodic blood pressure, lipids, and breast assessment rather than hormone levels

Monitoring for hormone therapy involves assessing risk factors (blood pressure, lipids, breast health) and screening rather than frequent hormone levels.

Question 12 of 18 Medium

In a woman on estrogen replacement who reports headache, visual changes, and elevated blood pressure, what does this indicate?

  1. A A routine, expected side effect that needs no change in therapy
  2. B A possible contraindication to continued therapy (stroke risk)
  3. C A migraine guaranteed to arise from the menopause transition itself
  4. D A clear indication to double her current estrogen replacement dose

Correct answer: A possible contraindication to continued therapy (stroke risk)

Elevated BP and neurological symptoms may indicate increased risk for stroke or vascular event; HT in such context must be re-evaluated.

Question 13 of 18 Medium

What is an accurate statement regarding vaginal estrogen for genitourinary syndrome of menopause?

  1. A Vaginal estrogen is systemic and carries the same risks as oral therapy
  2. B Low-dose vaginal estrogen acts locally and may be safer for these symptoms
  3. C Vaginal estrogen is ineffective for any genitourinary urinary symptoms
  4. D Vaginal estrogen must be avoided whenever any urogenital symptom is present

Correct answer: Low-dose vaginal estrogen acts locally and may be safer for these symptoms

Low-dose vaginal estrogen is effective locally for urogenital symptoms and may have lower systemic risks in women without estrogen-dependent cancer history.

Question 14 of 18 Easy

What would be a contraindication to systemic hormone replacement therapy?

  1. A A recent severe venous thromboembolism
  2. B Mild, intermittent vasomotor symptoms only
  3. C Current age of less than 55 years at presentation
  4. D No personal history of cardiovascular disease

Correct answer: A recent severe venous thromboembolism

Recent VTE is a contraindication to systemic HT due to increased risk of thromboembolic events from hormone therapy.

Question 15 of 18 Medium

How does smoking affect the risk of hormone therapy in women?

  1. A Smoking has no meaningful influence on hormone therapy risk
  2. B Smoking raises thromboembolic and cardiovascular risk with HT
  3. C Smoking entirely abolishes the efficacy of hormone therapy
  4. D Smoking matters only once the woman is older than age 70

Correct answer: Smoking raises thromboembolic and cardiovascular risk with HT

Smoking increases risk of VTE, cardiovascular disease and stroke; hence combined with hormone therapy it raises these risks and should be addressed.

Question 16 of 18 Medium

In a woman on hormone replacement reporting thigh pain and swelling, what could this indicate?

  1. A A normal post-menopausal symptom needing no further action
  2. B Possible deep-vein thrombosis requiring urgent evaluation
  3. C A simple muscle strain caused by recent physical exercise
  4. D A guaranteed and expected side-effect of all hormone therapies

Correct answer: Possible deep-vein thrombosis requiring urgent evaluation

Leg swelling and pain in a patient on HT may signal DVT—a known risk of estrogen therapy—and requires prompt assessment.

Question 17 of 18 Medium

For a woman continuing hormone therapy at age 65 with persistent moderate symptoms, what is the appropriate action?

  1. A Always unsafe to continue regardless of treatment duration
  2. B Acceptable if benefits outweigh risks with periodic reassessment
  3. C Virtually guaranteed to cause breast cancer at this age
  4. D Automatically mandated to be continued for the rest of her life

Correct answer: Acceptable if benefits outweigh risks with periodic reassessment

Extension of HT beyond age 60 may be appropriate if individualised assessment finds benefits outweigh risks, but requires regular reassessment.

Question 18 of 18 Medium

What monitoring is emphasized in hormone replacement therapy for transgender care?

  1. A No ongoing monitoring is necessary once the regimen is stable
  2. B Periodic hormone, bone density, metabolic and cancer surveillance
  3. C Monitoring confined to only the first month of starting therapy
  4. D Monitoring of the patient's mental health status and nothing else

Correct answer: Periodic hormone, bone density, metabolic and cancer surveillance

Hormone regimens in transgender care require ongoing monitoring of hormone levels, bone health, metabolic parameters and cancer risk due to long-term endocrine changes.

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