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This statement is correct and the nurse should inform the client that St. John's wort may interact with oral contraceptives. St. John's wort is an herbal supplement that has antidepressant and anti-inflammatory effects¹². However, it may also affect the metabolism and clearance of some drugs by inducing the activity of certain enzymes in the liver¹². One of these enzymes, called CYP3A4, is responsible for breaking down oral contraceptives, such as ethinyl estradiol and norethindrone¹². Taking St. John's wort with oral contraceptives may reduce their effectiveness and increase the risk of pregnancy or breakthrough bleeding¹². Therefore, the nurse should advise the client to use an alternative or additional method of birth control while taking St. John's wort¹².

This statement is also correct and the nurse should inform the client that St. John's wort may interact with anticoagulants. Anticoagulants are drugs that prevent blood clots by inhibiting the activity of certain clotting factors in the blood¹². Some examples of anticoagulants are warfarin, heparin, and dabigatran¹². Taking St. John's wort with anticoagulants may decrease their effectiveness and increase the risk of thrombosis or embolism¹². This is because St. John's wort may induce the activity of CYP3A4 and CYP2C9, two enzymes that are involved in the metabolism and clearance of warfarin and dabigatran¹². Therefore, the nurse should advise the client to monitor his or her blood clotting tests, such as INR or PT, and to report any signs or symptoms of bleeding or clotting while taking St. John's wort¹².

This statement is also correct and the nurse should inform the client that St. John's wort may interact with antiretrovirals. Antiretrovirals are drugs that inhibit the replication of human immunodeficiency virus (HIV) by targeting different stages of its life cycle¹². Some examples of antiretrovirals are protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors¹². Taking St. John's wort with antiretrovirals may decrease their effectiveness and increase the risk of HIV resistance or progression to acquired immunodeficiency syndrome (AIDS)¹². This is because St. John's wort may induce the activity of CYP3A4 and P-glycoprotein, two proteins that are involved in the absorption, distribution, metabolism, and excretion of many antiretrovirals¹². Therefore, the nurse should advise the client to avoid taking St. John's wort with antiretrovirals and to consult his or her health care provider before starting or stopping any herbal supplements¹².

This statement is correct and the nurse should ask the client about headache as a possible adverse effect that may occur after chiropractic manipulation. Chiropractic manipulation is a manual therapy that involves applying controlled, sudden force to specific joints of the spine or other parts of the body to improve mobility and function¹². However, it may also cause some mild and transient side effects, such as headache, in 33-60% of patients¹². The mechanism of headache after chiropractic manipulation is not fully understood, but it may be related to changes in blood flow, muscle tension, or nerve irritation in the cervical region¹². Therefore, the nurse should assess the client for headache, its severity, duration, location, and associated symptoms, and advise the client to report any persistent or severe headache to his or her health care provider¹².

This statement is also correct and the nurse should ask the client about dizziness as a possible adverse effect that may occur after chiropractic manipulation. Dizziness is a common side effect of chiropractic manipulation, especially of the cervical spine¹². It may manifest as vertigo (a sensation of spinning or moving), disequilibrium (a sensation of imbalance or unsteadiness), or presyncope (a sensation of faintness or lightheadedness)¹². The mechanism of dizziness after chiropractic manipulation is not fully understood, but it may be related to changes in blood pressure, vestibular function, or proprioception in the cervical region¹². Therefore, the nurse should assess the client for dizziness, its type, severity, duration, triggers, and associated symptoms, and advise the client to report any persistent or severe dizziness to his or her health care provider¹².

This statement is also correct and the nurse should ask the client about nausea as a possible adverse effect that may occur after chiropractic manipulation. Nausea is a less common but possible side effect of chiropractic manipulation¹². It may be related to dizziness, anxiety, or visceral stimulation caused by spinal manipulation¹². Therefore, the nurse should assess the client for nausea, its severity, frequency, triggers, and associated symptoms, and advise the client to report any persistent or severe nausea to his or her health care provider¹².

This statement is incorrect and does not reflect what acupuncture involves. Applying pressure or massage to specific points on the body to relieve pain or stress is not acupuncture, but acupressure. Acupressure is another form of traditional Chinese medicine that is similar to acupuncture in terms of the theory and principles of qi, meridians, and acupoints¹². However, acupressure does not use needles, but uses fingers, hands, elbows, or other devices to apply pressure or massage to the acupoints¹². Acupressure may also have some benefits for relieving pain, reducing stress, improving blood circulation, and enhancing well-being¹².

This statement is incorrect and does not reflect what acupuncture involves. Exposing specific points on the body to light, heat, or electricity to stimulate healing is not acupuncture, but phototherapy, thermotherapy, or electrotherapy. These are different forms of physical therapy that use different modalities to deliver energy to the body tissues to promote healing¹². Phototherapy uses light of different wavelengths and intensities to stimulate cellular activity and tissue repair¹². Thermotherapy uses heat or cold to increase or decrease blood flow and reduce inflammation and pain¹². Electrotherapy uses electrical currents or impulses to stimulate nerves, muscles, or cells¹². These therapies may have some benefits for various conditions such as wounds, infections, arthritis, muscle spasms, nerve damage, etc.¹².

This statement is incorrect and does not reflect what acupuncture involves. Placing cups on specific points on the body to create suction and increase blood flow is not acupuncture, but cupping. Cupping is another form of traditional Chinese medicine that is based on the theory and principles of qi, meridians, and acupoints¹ [^2^. Cupping involves placing cups made of glass metal bamboo or silicone on the skin and creating a vacuum inside them by heating or pumping out air 1 2 This creates suction and pulls the skin muscle and blood vessels into the cup 1 2 Cupping may have some benefits for relieving pain reducing inflammation improving blood circulation and enhancing well-being 1 2.

Using positive affirmations and suggestions to change behavior is not a valid action for hypnosis. This is because hypnosis is not a form of self-help or motivational technique, but a state of altered consciousness that requires the guidance of a trained therapist⁴.

Using biofeedback devices to monitor and control physiological responses is not a valid action for hypnosis. This is because biofeedback is a different form of therapy that uses electronic sensors to measure and display information about the body's functions, such as heart rate, blood pressure, muscle tension, etc. Biofeedback aims to teach the client how to regulate these functions voluntarily, while hypnosis aims to influence the client's subconscious mind.

Using music or art forms to express emotions and thoughts is not a valid action for hypnosis. This is because music or art therapy is a different form of therapy that uses creative expression as a way of coping with stress, trauma, or psychological issues. Music or art therapy does not involve inducing a trance-like state or using suggestions or directions from a therapist.

Increase in fecal pH and decrease in fecal short-chain fatty acids is not a likely effect of probiotics on the client's laboratory results. This is because probiotics, especially those containing LAB, tend to have the opposite effect, as explained above.

Decrease in serum cholesterol and triglyceride levels is not a consistent or conclusive effect of probiotics on the client's laboratory results. This is because the evidence for the lipid-lowering effects of probiotics is mixed and depends on various factors, such as the type, dose, duration, and formulation of probiotics, as well as the baseline lipid levels, diet, and lifestyle of the client³⁴.

Increase in serum cholesterol and triglyceride levels is not a common or expected effect of probiotics on the client's laboratory results. This is because most probiotics do not have adverse effects on lipid metabolism and may even have beneficial effects in some cases, as mentioned above..

Simvastatin, a statin for hyperlipidemia, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of simvastatin or other statins³⁴. However, some studies suggest that garlic may have additive lipid-lowering effects when combined with statins⁵⁶.

Metoprolol, a beta blocker for hypertension, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of metoprolol or other beta blockers³⁴. However, some studies suggest that garlic may have additive blood pressure-lowering effects when combined with beta blockers .

All of the above is not a correct answer because only aspirin may interact with garlic in a clinically relevant way. Simvastatin and metoprolol may not have significant interactions with garlic, although they may have additive effects on lipid levels and blood pressure, respectively..

Increase in serum potassium level and decrease in serum sodium level is not a likely effect of licorice on the client's laboratory results. This is because licorice tends to have the opposite effect, as explained above.

Decrease in serum calcium level and increase in serum magnesium level is not a consistent or conclusive effect of licorice on the client's laboratory results. This is because the evidence for the effects of licorice on calcium and magnesium metabolism is limited and conflicting. Some studies suggest that licorice may lower calcium levels by increasing urinary calcium excretion³, while others suggest that licorice may increase calcium levels by enhancing intestinal calcium absorption⁴. Similarly, some studies suggest that licorice may lower magnesium levels by increasing urinary magnesium excretion, while others suggest that licorice may increase magnesium levels by enhancing intestinal magnesium absorption.

Increase in serum calcium level and decrease in serum magnesium level is not a common or expected effect of licorice on the client's laboratory results. This is because licorice does not have a clear or consistent impact on calcium and magnesium metabolism, as mentioned above.

Applying pressure or massage to specific points on the body to relieve pain or stress is not a valid action for acupuncture. This is because this action describes another CAM practice called acupressure, which is similar to acupuncture but does not use needles. Acupressure also follows the traditional Chinese medicine theory of meridians and acupoints, but uses manual pressure, such as finger pressure, to stimulate the acupoints.

Exposing specific points on the body to light, heat, or electricity to stimulate healing is not a valid action for acupuncture. This is because this action describes another CAM practice called electroacupuncture, which is a variation of acupuncture that uses electrical currents to stimulate the acupoints. Electroacupuncture may be used as an adjunct to acupuncture or as a standalone therapy.

Placing cups on specific points on the body to create suction and increase blood flow is not a valid action for acupuncture. This is because this action describes another CAM practice called cupping, which is a form of therapy that uses cups made of glass, bamboo, or plastic to create a vacuum on the skin. Cupping may be used to treat pain, inflammation, blood circulation, and relaxation.