A nurse is completing an admission assessment for a client who has been taking St. John’s wort. The nurse should identify that which of the following medications can interact with St. John’s wort?

Choice A rationale
Hypercalcemia is not typically a risk in the emergency department unless the patient has a specific condition that causes elevated calcium levels.
Choice B rationale
Hypotension can occur in the emergency department, especially in cases of shock or severe dehydration, but it is not the most common risk.
Choice C rationale
Hypokalemia can occur, particularly in patients with certain medical conditions or those taking diuretics, but it is not the most common risk.
Choice D rationale
Hypernatremia can occur, especially in patients with dehydration or certain medical conditions, but it is not the most common risk.
Choice E rationale
Hypoglycemia is a common risk in the emergency department, especially in patients with diabetes or those who have not eaten for an extended period.

Choice A rationale
Mannitol is an osmotic diuretic used primarily to reduce intracranial pressure (ICP) and treat cerebral edema. It does not affect thyroxine levels, which are related to thyroid function. Thyroxine levels are regulated by the thyroid gland and are not influenced by mannitol administration.
Choice B rationale
Mannitol is not used to correct atrial flutter. Atrial flutter is a type of arrhythmia that requires specific antiarrhythmic medications or procedures such as cardioversion. Mannitol’s primary action is to increase osmotic pressure in the kidneys, leading to diuresis and reduction of fluid in tissues, including the brain.
Choice C rationale
Mannitol is effective in reducing intracranial pressure by creating an osmotic gradient that draws fluid from the brain tissue into the bloodstream, which is then excreted by the kidneys. This reduction in intracranial pressure is a desired therapeutic outcome when treating conditions like cerebral edema.
Choice D rationale
Mannitol does not increase hemoglobin levels. Hemoglobin levels are influenced by factors such as red blood cell production and destruction, iron levels, and overall health status. Mannitol’s mechanism of action is related to fluid balance and diuresis, not hematopoiesis.