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 D

Explanation

Choice A reason: Zolpidem is primarily prescribed for the short-term treatment of insomnia. It works by enhancing the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, which helps to induce sleep. While improved sleep can indirectly affect other conditions, such as incontinence, decreased episodes of incontinence are not a direct outcome of zolpidem administration.

Choice B reason: Improved ability to concentrate is not a primary outcome of zolpidem treatment. Zolpidem is a sedative-hypnotic medication used to treat insomnia by helping patients fall asleep faster and stay asleep longer. While better sleep can improve overall cognitive function, the primary goal of zolpidem is to improve sleep quality, not directly enhance concentration.

Choice C reason: Exhibiting fewer emotional outbursts is not a direct effect of zolpidem. The medication is designed to treat insomnia and does not have a significant impact on emotional regulation. Emotional outbursts may be related to other underlying conditions that zolpidem does not address.

Choice D reason: The primary desired outcome of zolpidem administration is to help the patient sleep soundly through the night. Zolpidem is effective in reducing sleep latency and increasing the duration of sleep, which is particularly beneficial for older adults who may have difficulty maintaining sleep. Achieving a full night’s rest is the main indicator that zolpidem is working as intended.

A. Withhold the scheduled dose and notify the healthcare provider. B. Administer the dose and monitor the client’s blood pressure regularly. C. Assess for orthostatic hypotension before administering the dose. D. Apply a telemetry monitor before administering the dose.

Correct Answer is A

Explanation

Choice A reason: Withholding the scheduled dose and notifying the healthcare provider is the correct action because the client’s heart rate is significantly low at 48 beats per minute. Labetalol, a beta-blocker, can further reduce the heart rate, potentially leading to bradycardia or other cardiac complications. It is crucial to inform the healthcare provider to reassess the medication regimen and ensure the client’s safety.

Choice B reason: Administering the dose and monitoring the client’s blood pressure regularly is not advisable in this scenario. Although monitoring blood pressure is important, the primary concern here is the client’s low heart rate. Administering labetalol could exacerbate bradycardia, leading to severe complications.

Choice C reason: Assessing for orthostatic hypotension before administering the dose is a good practice but not the most critical action in this situation. The client’s low heart rate poses a more immediate risk than orthostatic hypotension. Therefore, withholding the medication and notifying the healthcare provider is a higher priority.

Choice D reason: Applying a telemetry monitor before administering the dose is useful for continuous cardiac monitoring, but it does not address the immediate concern of the client’s low heart rate. The priority should be to withhold the medication and consult the healthcare provider to prevent potential bradycardia.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When administering zolpidem to an older client, which computer documentation indicates that the desired outcome has been achieved?

Correct Answer is D

Explanation

Administer a scheduled dose of labetalol PO to a client with hypertension. The client’s temperature is 99°F (37.2°C), a heart rate of 48 beats per minute, respirations of 16 breaths per minute, and a blood pressure of 150/90 mm Hg. Which action should the nurse take?

Correct Answer is A

Explanation

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