A client is taking warfarin and asks the nurse if taking St. John's wort is acceptable.
What response by the nurse is best?
"No, it may interfere with the warfarin.”.
"There isn't any information about that.”.
"Why would you want to take that?".
"Yes, it is a good supplement for you.”
The Correct Answer is A
St. John's wort (Hypericum perforatum) is a potent inducer of the cytochrome P450 enzyme system, specifically CYP3A4, in the liver. Warfarin is metabolized by the same enzyme system, primarily by CYP2C9. However, St. John's wort also induces other CYP enzymes that may indirectly affect warfarin metabolism. This enzyme induction accelerates the metabolism of warfarin, leading to subtherapeutic plasma concentrations. This reduces the anticoagulant effect of warfarin, increasing the risk of thrombus formation and thromboembolic events in the client.
Choice B rationale
This statement is factually incorrect. There is extensive scientific literature and numerous studies documenting the significant and clinically relevant drug interaction between St. John's wort and warfarin. The interaction is well-established, with multiple case reports and randomized controlled trials demonstrating that St. John's wort reduces the international normalized ratio (INR) in clients on warfarin therapy.
Choice C rationale
This response is non-therapeutic and dismissive of the client's question. It fails to provide the necessary health and safety information regarding a potentially dangerous drug interaction. A therapeutic communication approach requires the nurse to provide accurate, evidence-based information to empower the client to make informed health decisions.
Choice D rationale
This statement is factually incorrect and potentially life-threatening. St. John's wort can cause a dangerous drug-drug interaction with warfarin by reducing its therapeutic effect. Recommending this supplement to a client on warfarin could lead to a stroke, pulmonary embolism, or other life-threatening thromboembolic events due to the loss of adequate anticoagulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["300"]
Explanation
Step 1 is 300 mL ÷ 60 minutes = 5 mL/min.
Step 2 is 5 mL/min × 60 min/hr = 300 mL/hr. The final answer is 300 mL/hr.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
An elevated low-density lipoprotein (LDL-C) level is a significant risk factor for atherosclerosis because LDL-C is the primary carrier of cholesterol to the tissues. High levels lead to the deposition of cholesterol within the arterial walls, forming atherosclerotic plaques. These plaques narrow arteries, impede blood flow, and can rupture, leading to thrombosis and acute cardiovascular events. A normal LDL-C level is typically less than 100 mg/dL.
Choice B rationale
Decreased levels of high-density lipoprotein cholesterol (HDL-C) are concerning because HDL-C plays a protective role in the cardiovascular system. HDL-C is responsible for reverse cholesterol transport, a process where it removes excess cholesterol from the arterial walls and transports it back to the liver for excretion. Low levels impair this protective mechanism, allowing cholesterol accumulation and plaque formation. A normal HDL-C level is typically above 40 mg/dL for men and 50 mg/dL for women.
Choice C rationale
Asian ethnicity is not considered an independent risk factor for atherosclerosis. While certain populations may have varying risk profiles due to genetic and lifestyle factors, ethnicity alone does not directly predispose an individual to the condition in the same manner as modifiable factors like dyslipidemia or smoking. A comprehensive risk assessment relies on established clinical and lifestyle factors, not solely on a person’s racial background.
Choice D rationale
A history of smoking is a major, modifiable risk factor for atherosclerosis. The chemicals in cigarette smoke damage the endothelium, the inner lining of blood vessels, making it more permeable to cholesterol. Smoking also increases inflammation, promotes platelet aggregation, and lowers HDL-C levels. These combined effects accelerate the formation and progression of atherosclerotic plaques, significantly increasing the risk of cardiovascular events like myocardial infarction and stroke.
Choice E rationale
A single blood pressure reading of 142/92 mm Hg, while elevated, is not sufficient for a diagnosis of hypertension or to be considered a definitive risk factor. Hypertension is diagnosed based on multiple elevated readings over time. While this reading is concerning, a single measurement can be influenced by various factors. The finding warrants further monitoring, but it does not represent a chronic risk factor until a pattern of sustained high blood pressure is established
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