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 C
Explanation
Choice A rationale
Tazarotene, a retinoid, increases photosensitivity by thinning the stratum corneum, the skin's outermost layer. This reduces the protective barrier against ultraviolet (UV) radiation, making the skin more susceptible to sunburn and UV-induced DNA damage. Patients must be educated to use sun protection, but it is not the most critical question.
Choice B rationale
While a history of skin cancer can influence dermatological treatment plans, it is not the primary contraindication for tazarotene. Tazarotene is an analog of vitamin A, and its mechanism involves regulating cell proliferation and differentiation, which is not directly related to a personal or family history of skin cancer.
Choice C rationale
Tazarotene is a potent teratogen, meaning it can cause severe congenital malformations if taken during pregnancy. This teratogenic risk necessitates that all female patients of child-bearing potential use reliable contraception to prevent pregnancy. A pregnancy test is also required before initiation of therapy.
Choice D rationale
While some medications interact with alcohol, tazarotene is a topical retinoid primarily metabolized in the liver to its active form, tazarotenic acid. There is no significant systemic absorption or direct interaction with alcohol consumption that would cause a major adverse effect, making it a less critical question than contraception.
Correct Answer is B
Explanation
Choice A rationale
Ambulating with assistance is not an immediate indicator of a positive outcome for a client with a DVT. Ambulation is often contraindicated in the initial stages of treatment to prevent a pulmonary embolism. Therefore, this assessment does not reflect a primary outcome of DVT management, which focuses on preventing complications and resolving the clot.
Choice B rationale
An oxygen saturation of 98% is a critical indicator that the client has not developed a pulmonary embolism, a serious and life-threatening complication of DVT. This outcome demonstrates that the thrombus has not dislodged and traveled to the lungs, obstructing gas exchange. Normal oxygen saturation levels range from 95% to 100%.
Choice C rationale
While pain reduction is an important aspect of care, a pain score of 2/10 after medication is a temporary relief measure and does not represent a definitive outcome for DVT. The primary goal is to prevent a pulmonary embolism and resolve the thrombus, and pain control is a supportive measure in achieving that goal.
Choice D rationale
Verbalizing risk factors indicates that the client has received education, which is an important intervention. However, it is an educational outcome, not a physiological one. It does not provide direct evidence that the DVT is resolving or that the client is free from the most serious complication of the disease, a pulmonary embolism.
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