A female client with mild depression reports to the nurse that she recently started taking St. John’s wort. Which information provided by the client requires further instruction?
Insomnia may occur while taking the medication.
Another form of contraception is not needed.
Sensitivity to the sun can develop.
Hard candy can be used for a dry mouth.
The Correct Answer is B
Choice A reason:
Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.
Choice B reason:
St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.
Choice C reason:
Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.
Choice D reason:
Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Calcium acetate is not used to lower potassium levels. Potassium levels in the blood are typically managed through dietary restrictions, medications like potassium binders, and dialysis in patients with CKD. The normal range for blood potassium levels is 3.5 to 5.2 mEq/L for adults.
Choice B reason:
Calcium acetate can increase calcium levels in the blood, not decrease them. It is important to monitor calcium levels to avoid hypercalcemia, which can lead to complications such as vascular calcification and cardiac issues. The normal range for blood calcium levels is 8.6 to 10.2 mg/dL.
Choice C reason:
Calcium acetate is used to lower phosphate levels in patients with CKD. It works by binding to dietary phosphate in the intestines, forming insoluble calcium phosphate that is excreted in the stool. This helps prevent hyperphosphatemia, a common issue in CKD patients. The normal range for blood phosphate levels is 2.5 to 4.5 mg/dL.
Choice D reason:
Calcium acetate does not directly affect blood pH levels. Blood pH is regulated by the kidneys and lungs, and the normal range is 7.35 to 7.45. While CKD can affect acid-base balance, calcium acetate’s primary role is to manage phosphate levels.
Correct Answer is D
Explanation
Choice A reason:
Resuming a diet that consists of milk, cream, and bland foods is not the most critical instruction for a client taking esomeprazole. While bland foods can help reduce gastric irritation, they do not address the primary concern of monitoring for serious side effects. Esomeprazole is a proton pump inhibitor (PPI) that reduces stomach acid, and dietary changes alone are not sufficient to manage potential complications.
Choice B reason:
Calling the clinic if diarrhea or headache occurs when taking esomeprazole is important, but it is not the most critical instruction. Diarrhea and headache are common side effects of esomeprazole, but they are usually not severe. The client should be aware of these potential side effects, but the primary concern is monitoring for signs of gastrointestinal bleeding.
Choice C reason:
Once pain subsides, NSAID therapy should not be resumed without consulting the healthcare provider. NSAIDs can cause significant gastrointestinal issues, including ulcers and bleeding. The client should be advised to avoid NSAIDs unless specifically directed by their healthcare provider.
Choice D reason:
Notifying the healthcare provider of the passage of black stools is the most critical instruction. Black stools can indicate gastrointestinal bleeding, which is a serious side effect of both NSAIDs and esomeprazole. Immediate medical attention is necessary if this occurs to prevent further complications.
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