The nurse is providing discharge teaching to a client with angina pectoris who is prescribed metoprolol 50 mg PO daily. Which information should the nurse include in the teaching?

Choice A Reason:
St. John's Wort is a well-known herbal remedy that has been used for centuries to treat various ailments, including depression. It is believed to work by increasing the levels of neurotransmitters in the brain, such as serotonin, which can help improve mood and alleviate depressive symptoms. Clinical studies have shown that St. John's Wort can be effective for mild to moderate depression.

Choice B Reason:
Black Cohosh is primarily used to relieve symptoms associated with menopause, such as hot flashes and night sweats. While it may have some mood-stabilizing effects, there is insufficient evidence to support its use as a primary treatment for depression.

Choice C Reason:
Peppermint is commonly used for its soothing properties to aid digestion and reduce headaches. However, it is not typically used as a treatment for depression, and there is no substantial evidence to suggest it would be effective for this purpose.

Choice D Reason:
Echinacea is best known for its potential to boost the immune system and reduce symptoms of colds and other infections. It is not recognized as a treatment for depression, and there is no significant research to support its use in this context.

Choice A Reason
Ceftriaxone is an antibiotic that may be prescribed during COPD exacerbations to treat or prevent infection. A white blood cell count of 16,000 u/L indicates an elevated level, which could be a response to infection. Therefore, ceftriaxone would be appropriate, and there is no need to question this medication based on the white blood cell count.

Choice B Reason
Zafirlukast is a leukotriene receptor antagonist used for the prophylactic treatment of asthma, and it may be used off-label for COPD. AST and ALT levels are liver enzymes, and the values provided (AST of 30 units/L and ALT of 20 units/L) are within normal ranges. Thus, there is no immediate concern regarding liver function that would prompt the nurse to question the use of zafirlukast.

Choice C Reason
Theophylline is a bronchodilator used in the treatment of COPD. However, a theophylline level of 21 mg/dL is above the therapeutic range, which is generally considered to be 5-15 mg/dL. Levels above 20 mg/dL are associated with toxicity and can lead to serious side effects such as seizures or arrhythmias. Therefore, the nurse should question this medication due to the high theophylline level.

Choice D Reason
Prednisone is a corticosteroid that may be used to reduce inflammation during COPD exacerbations. A glucose level of 110 mg/dL is slightly elevated but may be expected as corticosteroids can increase blood sugar levels. This would not typically be a reason to question the use of prednisone unless the patient has poorly controlled diabetes or other specific contraindications.