A nurse is educating a client who wants to use acupuncture as an integrative medicine for her migraine headaches. The nurse should inform the client that acupuncture involves which of the following actions?

The correct answer is

A. Decrease in serum potassium level and increase in serum sodium level.

Choice A reason: A decrease in serum potassium level and an increase in serum sodium level is a possible effect of licorice on the client's laboratory results. This is because licorice contains glycyrrhizin, a compound that can inhibit the enzyme 11-beta-hydroxysteroid dehydrogenase, which converts cortisol to cortisone. This leads to increased cortisol levels, which can mimic the effects of aldosterone, a hormone that regulates sodium and potassium balance. As a result, licorice can cause sodium and water retention, hypertension, and hypokalemia (low potassium levels) in some people.

Choice B reason: An increase in serum potassium level and decrease in serum sodium level is not a likely effect of licorice on the client's laboratory results. This is because licorice tends to have the opposite effect, as explained above.

Choice C reason: A decrease in serum calcium level and an increase in serum magnesium level is not a consistent or conclusive effect of licorice on the client's laboratory results. This is because the evidence for the effects of licorice on calcium and magnesium metabolism is limited and conflicting. Some studies suggest that licorice may lower calcium levels by increasing urinary calcium excretion, while others suggest that licorice may increase calcium levels by enhancing intestinal calcium absorption. Similarly, some studies suggest that licorice may lower magnesium levels by increasing urinary magnesium excretion, while others suggest that licorice may increase magnesium levels by enhancing intestinal magnesium absorption.

Choice D reason: Increase in serum calcium level and decrease in serum magnesium level is not a common or expected effect of licorice on the client's laboratory results. This is because licorice does not have a clear or consistent impact on calcium and magnesium metabolism, as mentioned above.

The correct answer is

D. All of the above.

Choice A reason: This statement is correct and the nurse should inform the client that St. John's wort may interact with oral contraceptives. St. John's wort is an herbal supplement that has antidepressant and anti-inflammatory effects. However, it may also affect the metabolism and clearance of some drugs by inducing the activity of certain enzymes in the liver. One of these enzymes, called CYP3A4, is responsible for breaking down oral contraceptives, such as ethinyl estradiol and norethindrone. Taking St. John's wort with oral contraceptives may reduce their effectiveness and increase the risk of pregnancy or breakthrough bleeding. Therefore, the nurse should advise the client to use an alternative or additional method of birth control while taking St. John's wort.

Choice B reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with anticoagulants. Anticoagulants are drugs that prevent blood clots by inhibiting the activity of certain clotting factors in the blood. Some examples of anticoagulants are warfarin, heparin, and dabigatran. Taking St. John's wort with anticoagulants may decrease their effectiveness and increase the risk of thrombosis or embolism. This is because St. John's wort may induce the activity of CYP3A4 and CYP2C9, two enzymes that are involved in the metabolism and clearance of warfarin and dabigatran. Therefore, the nurse should advise the client to monitor his or her blood clotting tests, such as INR or PT, and to report any signs or symptoms of bleeding or clotting while taking St. John's wort.

Choice C reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with antiretrovirals. Antiretrovirals are drugs that inhibit the replication of human immunodeficiency virus (HIV) by targeting different stages of its life cycle. Some examples of antiretrovirals are protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors. Taking St. John's wort with antiretrovirals may decrease their effectiveness and increase the risk of HIV resistance or progression to acquired immunodeficiency syndrome (AIDS). This is because St. John's wort may induce the activity of CYP3A4 and P-glycoprotein, two proteins that are involved in the absorption, distribution, metabolism, and excretion of many antiretrovirals. Therefore, the nurse should advise the client to avoid taking St. John's wort with antiretrovirals and to consult his or her health care provider before starting or stopping any herbal supplements.

Choice D reason: This statement is correct because it includes all of the above statements. St. John's wort may interact with many conventional drugs by affecting their pharmacokinetics or pharmacodynamics. Some of these interactions may have serious consequences for the client's health and well-being. Therefore, choice D is the best answer for informing the client that St. John's wort may interact with oral contraceptives, anticoagulants, and antiretrovirals.