A female client with mild depression reports to the nurse that she recently started taking St. John’s wort. Which information provided by the client requires further instruction?

Insomnia may occur while taking the medication.

Another form of contraception is not needed.

Sensitivity to the sun can develop.

Hard candy can be used for a dry mouth.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.

Choice B reason:

St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.

Choice C reason:

Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.

Choice D reason:

Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.

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Correct Answer is B

Explanation

Choice A reason:

A CT scan performed six months earlier does not typically require follow-up unless there were specific findings or complications from the previous scan. The timing of the previous scan is not a contraindication for a new CT scan with contrast. However, it is always good practice to review previous imaging results to compare and assess any changes.

Choice B reason:

Metformin hydrochloride is a medication used to manage type 2 diabetes mellitus. It is important to follow up on this information because metformin can interact with the contrast dye used in CT scans. The combination can increase the risk of lactic acidosis, a rare but serious complication. Therefore, it is crucial to assess kidney function and possibly withhold metformin before and after the procedure to reduce this risk.

Choice C reason:

A report of the client’s sobriety for the last five years is generally a positive aspect of their medical history and does not require follow-up in the context of a CT scan with contrast. Sobriety does not impact the safety or efficacy of the contrast dye used in the scan.

Choice D reason:

A metal hip prosthesis placed twenty years ago is relevant information but does not typically require follow-up before a CT scan. Unlike MRI, where metal implants can cause issues, CT scans are generally safe for patients with metal prostheses. However, the presence of metal can sometimes affect the quality of the images, so it is important for the radiologist to be aware of it.

A. Complete blood count. B. Serum electrolytes. C. Capillary blood glucose. D. Serum liver enzymes.

Correct Answer is D

Explanation

Choice A reason: A complete blood count (CBC) is not typically required before starting statin therapy. While a CBC can provide valuable information about a patient’s overall health, it does not specifically relate to the potential side effects or necessary monitoring for statin use. Statins primarily affect the liver, so monitoring liver function is more critical.

Choice B reason: Serum electrolytes are important for assessing overall metabolic and kidney function, but they are not directly related to the initiation of statin therapy. Statins do not typically affect electrolyte levels, so this test is not necessary before starting the medication.

Choice C reason: Capillary blood glucose levels are important for monitoring diabetes and blood sugar control. While statins can have an impact on blood glucose levels, this is not the primary concern when initiating therapy. Monitoring liver function is more directly related to the potential side effects of statins.

Choice D reason: Serum liver enzymes are crucial to review before starting statin therapy. Statins can cause liver enzyme elevations, indicating liver damage or dysfunction. Therefore, baseline liver enzyme levels should be obtained to monitor for any potential hepatotoxicity during treatment.

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A female client with mild depression reports to the nurse that she recently started taking St. John’s wort. Which information provided by the client requires further instruction?

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