A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client’s history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation on the advice of a friend.

Which information is most significant about this finding?

The client probably used this herb to treat depression.

Wort can decrease plasma concentrations of the cyclosporine.

Ingestion of wort can reduce the client’s intake of sodium.

Adding the herb can decrease the need for corticosteroids.

Answer and Explanation

The Correct Answer is B

Cyclosporine is an immunosuppressive medication commonly used to prevent graft rejection after organ transplantation. St. John's Wort is known to induce cytochrome P450 enzymes, which can increase the metabolism and decrease the eﬀectiveness of many medications, including cyclosporine. This interaction can lead to decreased plasma concentrations of cyclosporine, which can increase the risk of graft rejection. Therefore, it is important to advise the client to discontinue the use of St. John's Wort and inform their healthcare provider about any herbal or supplement use to prevent potential interactions with prescribed medications. Options a, c, and d are not directly related to the client's current condition and are not as significant as option b.

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Correct Answer is C

Explanation

Ipratropium is a medication used to treat chronic obstructive pulmonary disease (COPD)1. When using an ipratropium inhaler for the first time or if it has not been used for a while, it is important to prime the inhaler by spraying it into the air away from your face1. However, the inhaler only needs to be primed with 2 sprays, not 71. If the client primes the inhaler with 7 pumps, it indicates that additional teaching is needed.

A. Replace salt with a salt substitute. B. Limits intake of high-potassium foods. C. Cover your skin before going outside. D. Monitor skin for excessive bruising.

Correct Answer is B

Explanation

Spironolactone is a potassium-sparing diuretic that works by blocking the actions of aldosterone, a hormone that can lead to potassium loss in the urine. However, in some cases, spironolactone can cause hyperkalemia (high levels of potassium in the blood), which can be dangerous for patients with heart failure. Therefore, it is important to instruct the patient to limit their intake of high-potassium foods such as bananas, oranges, tomatoes, spinach, and salt substitutes containing potassium.

Option a (Replace salt with a salt substitute) is incorrect because salt substitutes often contain potassium, which can further increase the risk of hyperkalemia.

Option c (Cover your skin before going outside) is unrelated to the use of spironolactone and hyperkalemia.

Option d (Monitor skin for excessive bruising) is not directly related to the use of spironolactone and hyperkalemia, although it is a potential side eﬀect of other medications used to treat heart failure.

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Naxlex Comprehensive Predictor Exams

A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

Correct Answer is C

Explanation

A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this patient’s plan of care?

Correct Answer is B

Explanation

The nurse is planning to administer the antiulcer GI agent sucralfate to a client with a peptic ulcer disease. Which action should the nurse include in this client’s plan of care?

The nurse assesses a client with intermittent claudication who is receiving pentoxifylline. Which assessment should the nurse perform to determine the eﬀectiveness of the medication?

A female client starts a new prescription, oxybutynin, for symptoms of an overactive bladder. The client tells the nurse that she is training to run in a marathon. Which instruction should the nurse emphasize?

The nurse administers risedronate to a client with osteoporosis at 07:00. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

An older adult client with restless legs syndrome begins taking melatonin at bedtime. When evaluating the eﬀectiveness of the herb which client assessment should the nurse complete?

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

The nurse is planning care for a patient with major depression who is receiving a new prescription for duloxetine. Which information is most important for the nurse to obtain?