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.
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
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
Taking sucralfate on an empty stomach at least 1 hour before meals is crucial for its effectiveness. Sucralfate works by forming a protective barrier over ulcers, and food can interfere with this process. Therefore, it is recommended to take sucralfate on an empty stomach to ensure maximum efficacy.
Choice B reason:
Administering an additional dose if a dose is missed is incorrect. If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule should be resumed. Doubling up on doses can lead to potential side effects and complications.
Choice C reason:
Scheduling doses with each meal and at bedtime is not appropriate for sucralfate. This medication should be taken on an empty stomach, not with meals. Taking it with food can reduce its effectiveness in treating peptic ulcers.
Choice D reason:
Continuing with the normal dose schedule after missing a dose is partially correct but lacks the specific instruction to skip the missed dose if it is almost time for the next one. The correct approach is to take the missed dose as soon as possible unless it is close to the next scheduled dose.
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.
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