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?

St. John’s Wort can decrease plasma concentrations of cyclosporine.

The client probably used this herb to treat depression.

Ingestion of St. John’s 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 A

Choice A Reason:

St. John’s Wort is known to significantly decrease the blood concentrations of cyclosporine, a critical immunosuppressant used to prevent organ rejection in transplant patients. This herb induces the activity of cytochrome P450 enzymes, particularly CYP3A4, which increases the metabolism of cyclosporine, leading to lower plasma levels and a higher risk of graft rejection. This interaction is highly significant and requires immediate attention to adjust the client’s medication regimen and prevent further complications.

Choice B Reason:

While it is true that St. John’s Wort is commonly used to treat depression, this information is not as significant in the context of graft rejection. The primary concern is the herb’s interaction with cyclosporine, which directly impacts the effectiveness of the immunosuppressive therapy. Understanding the reason for using the herb is important, but it does not address the immediate risk of graft rejection.

Choice C Reason:

There is no substantial evidence to suggest that ingestion of St. John’s Wort reduces sodium intake. This statement does not relate to the herb’s interaction with cyclosporine or its impact on graft rejection. Therefore, it is not a significant concern in this scenario.

Choice D Reason:

Adding St. John’s Wort does not decrease the need for corticosteroids. In fact, the herb’s interaction with cyclosporine can lead to inadequate immunosuppression, potentially increasing the need for additional medications to manage graft rejection. This statement is incorrect and does not address the critical issue of cyclosporine metabolism.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A Reason:

Determining the presence of abdominal pain is crucial because long-term use of ibuprofen can lead to gastrointestinal issues, including ulcers and bleeding. Abdominal pain can be an early sign of these complications, and prompt identification is essential to prevent more severe outcomes. Monitoring for gastrointestinal symptoms is a key aspect of managing patients on chronic NSAID therapy.

Choice B Reason:

While palpating the volume of pedal pulses is important for assessing peripheral circulation, it is not directly related to the potential side effects of long-term ibuprofen use. This assessment is more relevant for conditions affecting blood flow, such as peripheral artery disease, rather than for monitoring ibuprofen-related complications.

Choice C Reason:

Evaluating ongoing sleep patterns can provide valuable information about the client’s overall well-being and pain management. However, it is not the most critical assessment in the context of long-term ibuprofen use. Sleep disturbances may be related to chronic pain but are not directly indicative of ibuprofen’s adverse effects.

Choice D Reason:

Assessing back pain using a numeric scale is essential for evaluating the effectiveness of pain management strategies. However, it does not address the potential adverse effects of long-term ibuprofen use. While pain assessment is important, monitoring for signs of gastrointestinal complications takes precedence in this scenario.

A. Rinsing the mouth with water should be done after each use. B. To mask the taste of the medication, the inhaler can be used during meals. C. Caffeinated beverages should be limited to two cups per day. D. The inhaler will be used before bed at night.

Correct Answer is A

Explanation

Choice A reason:

Rinsing the mouth with water after using an inhaler, especially one containing corticosteroids, is crucial to prevent oral thrush (a fungal infection) and reduce irritation in the mouth and throat. This practice helps maintain oral hygiene and ensures the medication does not linger in the mouth, which can cause side effects.

Choice B reason:

Using the inhaler during meals to mask the taste of the medication is not recommended. Inhalers should be used as prescribed, and the technique should not be altered to mask the taste. Proper inhaler technique is essential for the medication to reach the lungs effectively.

Choice C reason:

Limiting caffeinated beverages to two cups per day is generally good advice for overall health, but it is not directly related to the use of an inhaler. Caffeine can sometimes exacerbate symptoms of asthma or other respiratory conditions, but this is not a primary instruction for inhaler use.

Choice D reason:

Using the inhaler before bed at night may be part of a prescribed regimen, but it is not a general instruction that indicates understanding of inhaler use. The timing of inhaler use should follow the healthcare provider’s instructions, which may vary depending on the medication and the individual’s condition.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with chronic lower back pain has been taking ibuprofen PO twice a day for several months. Which assessment is most important for the nurse to complete?

Correct Answer is A

Explanation

The nurse is teaching a client how to use an inhaler device. Which client statement indicates to the nurse that the client understands the instructions?

Correct Answer is A

Explanation

A client has a new prescription for diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). Which information in the client’s history is of greatest concern to the nurse in monitoring the client’s response to this medication?

The nurse is caring for a client receiving a prescription for sucralfate to treat a peptic ulcer. Which instruction should the nurse provide during discharge education?

A client receives a prescription for allopurinol. Which information provided by the client requires additional instruction by the nurse?

The nurse notifies the healthcare provider (HCP) that the client is having trouble remembering to take his second dose of captopril. What angiotensin-converting enzyme (ACE) inhibitors can be given only once per day? Select all that apply.

A client receives a prescription for penicillin 1.2 million units IM. The available vial is labeled, “600,000 units/mL.” How many mL should the nurse administer? (Enter numeric value only.)

A client who is newly diagnosed with diabetes insipidus (DI) is receiving synthetic vasopressin intravenously. Which side effect of vasopressin reported by the client should the nurse report to the healthcare provider?

The nurse is providing discharge instructions to a client who has been prescribed gabapentin 300 mg by mouth (PO) three times a day for postherpetic neuralgia. Which symptom should the nurse tell the client to report to the healthcare provider?

The healthcare provider prescribes magnesium sulfate 300 mg/hour IV. The IV bag contains magnesium sulfate 4 grams in dextrose 5% in water (D5W) 500 mL. How many mL/hour should the nurse set the infusion pump? (Enter numerical value only. If rounding is required, round to the nearest tenth.)