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.

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Correct Answer is A

Explanation

Choice A reason:

Administering iodine one hour before PTU is recommended because iodine can help reduce the thyroid hormone levels more effectively when given before PTU. This sequence ensures that the iodine is absorbed and utilized by the thyroid gland before PTU inhibits the synthesis of new thyroid hormones.

Choice B reason:

Scheduling both medications at bedtime is not appropriate. PTU and iodine solutions should be administered at specific times to maximize their effectiveness. PTU is typically given in divided doses throughout the day, while iodine solutions are often given before meals.

Choice C reason:

Administering both drugs together with a meal is incorrect. PTU should be taken on an empty stomach to ensure proper absorption, and iodine solutions are usually given before meals.

Choice D reason:

Giving a parenteral dose once every 24 hours is not applicable for these medications. PTU is administered orally in divided doses, and iodine solutions are also given orally.

A. Bronchitis. B. Diarrhea. C. Hypertension. D. Edema.

Correct Answer is C

Explanation

Choice A Reason:

Bronchitis is a condition that affects the respiratory system, and while it is important to monitor, it is not a primary concern when administering phenylephrine. Phenylephrine is a decongestant that works by narrowing the blood vessels in the nasal passages, which can help relieve congestion but does not directly impact bronchitis.

Choice B Reason:

Diarrhea is a gastrointestinal condition that, while uncomfortable, does not significantly interact with phenylephrine. It is important to manage and monitor, but it does not pose a direct risk when taking phenylephrine.

Choice C Reason:

Hypertension is a significant concern when administering phenylephrine. Phenylephrine can increase blood pressure by causing vasoconstriction. For clients with hypertension, this can exacerbate their condition and lead to serious cardiovascular complications. Therefore, it is crucial to report this condition to the healthcare provider before administering the medication.

Choice D Reason:

Edema, or swelling, can be a symptom of various underlying conditions, including heart failure or kidney issues. While it is important to monitor, it is not as directly impacted by phenylephrine as hypertension. However, any underlying condition causing edema should be considered when administering medications.

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Naxlex Comprehensive Predictor Exams

The healthcare provider prescribes propylthiouracil (PTU) and Lugol’s solution, a strong iodine solution, for a client with hyperthyroidism. How should the nurse schedule the administration of these medications?

Correct Answer is A

Explanation

A client with nasal congestion receives a prescription for phenylephrine 10 mg PO every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication?

Correct Answer is C

Explanation

A client with a fungal infection of the toenail reports to the nurse that the client has been applying an over-the-counter (OTC) triple antibiotic ointment to the infection daily for two weeks without any improvement. Which action should the nurse take?

A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?

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?

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?Reference Range:• Hemoglobin (Hgb): 14 to 18 g/dL (8.7 to 11.2 mmol/L)

A client who is taking furosemide reports experiencing leg cramps, a cough, feeling tired, and palpitations. Which action should the nurse take first?

A male client receives a scopolamine transdermal patch 2 hours before surgery. Four hours after surgery, the client tells the nurse that he is experiencing pain and asks why the patch is not working. Which action should the nurse take?

Patient Data Exhibits The nurse is preparing the client’s plan of care. Select 4 findings that would indicate to the nurse that the administration of the vancomycin antibiotic would be safe to administer.

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?