The nurse is assigned a 49-year-old female client in the primary care office for a wellness visit. The nurse assesses the client, documents nurses notes, and reviews the medication administration record for potential interactions. The nurse should be most concern with the potential interaction between __________and _________.
Complete the sentence by choosing one answer from each option in the drop-down list below:
Medication Reconciliation:
St. John's wort 450 mg by mouth twice daily
Gabapentin 400 mg by mouth twice daily
Aspirin 81 mg by mouth daily
Atorvastatin 80 mg by mouth daily
Lisinopril 5 mg by mouth daily
Warfarin 5 mg by mouth daily
Ginger 5mg by mouth daily
Valerian 10mg by mouth daily
Correct Answer : A,F
A. St. John's wort 450 mg by mouth twice daily: St. John's wort is known to be a potent inducer of cytochrome P450 enzymes and can significantly reduce the effectiveness of warfarin by increasing its metabolism. This interaction can lead to subtherapeutic levels of warfarin and an increased risk of thromboembolic events.
B. Gabapentin 400 mg by mouth twice daily: While gabapentin can interact with other medications, its interactions with warfarin or St. John's wort are generally not as significant as those between warfarin and St. John's wort.
C. Aspirin 81 mg by mouth daily: Aspirin has anticoagulant properties and can have interactions with warfarin. However, the interaction with St. John's wort is less pronounced compared to the interaction between warfarin and St. John's wort.
D. Atorvastatin 80 mg by mouth daily: Atorvastatin primarily affects lipid levels and has different metabolic pathways compared to warfarin. It does not have a strong interaction with St. John's wort.
E. Lisinopril 5 mg by mouth daily: Lisinopril is an ACE inhibitor and does not have significant interactions with St. John's wort or warfarin.
F. Warfarin 5 mg by mouth daily. Warfarin is an anticoagulant that requires careful monitoring due to its interactions with various substances that can either increase the risk of bleeding or decrease its effectiveness.
G. Ginger 5 mg by mouth daily: Ginger can affect platelet function but is not as significant in interaction with warfarin as St. John's wort.
H. Valerian 10 mg by mouth daily: Valerian may have mild interactions with central nervous system depressants but does not have significant interactions with warfarin or St. John's wort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Wait for at least another 30 minutes before calling to have the level drawn:
For oral medications, peak drug levels are typically drawn 1 to 2 hours after administration, depending on the medication's pharmacokinetics. Since the client took the medication only 30 minutes ago, it is premature to draw the level now. Waiting an additional 30 minutes would align with the typical peak times for oral medications, ensuring that the drug level reflects its peak concentration.
B. Schedule the level to be drawn in 8 hours:
Drawing the peak level 8 hours after administration would likely be too late, as most oral medications reach their peak concentration within 1 to 2 hours. Scheduling the level for 8 hours later may result in an inaccurate measurement of the peak drug level, leading to potentially misleading clinical information.
C. Call the lab to have the medication level drawn immediately:
Drawing the level immediately after 30 minutes may not provide an accurate representation of the peak drug level. Oral medications generally reach peak levels later, and an early draw could result in a falsely low measurement that does not reflect the drug's maximum concentration.
D. Arrange for the level to be drawn tomorrow since the peak time has passed:
The peak time has not passed, as the medication was only administered 30 minutes ago. Drawing the level tomorrow would be far too late to assess the peak concentration accurately, which is essential for evaluating the effectiveness and safety of the medication.
Correct Answer is D
Explanation
A) Report the incident immediately to your supervisor upon noticing: Reporting the incident is an important step, but it should come after assessing the client's condition. Immediate assessment of the client's vital signs and overall status takes precedence to address any potential immediate health impacts due to the medication error.
B) Gather reversal agents to administer to the client: Gathering reversal agents is a critical step if the medication administered poses an immediate risk and reversal is necessary. However, this action should follow an initial assessment of the client's condition to determine if reversal is needed.
C) Notify the client's provider immediately while present with the client: Notifying the provider is essential to receive guidance on how to manage the medication error. Nonetheless, the first priority should be to assess the client's condition to provide accurate information to the provider.
D) Assess the client's vital signs: The initial action should be to assess the client’s vital signs and overall condition to determine any immediate effects of the incorrect medication. This assessment helps in identifying if the client is experiencing any adverse reactions or complications, which will guide subsequent actions such as notifying the provider and administering reversal agents if needed.
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