A nurse is interested in providing community education and screening on hypertension.
In order to reach a priority population, to what target audience would the nurse provide this service?

Choice A rationale

While a cough is a known side effect of lisinopril due to bradykinin accumulation, a new-onset cough in a client with heart failure and hypertension could also signal worsening heart failure, particularly pulmonary edema. Assessing lung sounds for crackles and monitoring oxygenation is paramount to differentiate between these two distinct etiologies and guide appropriate intervention.

Choice B rationale

Changing antihypertensives is a medical decision made by the provider. The nurse's role is to assess the client's symptoms and provide objective data to the provider. Switching medications without a thorough assessment could be premature and might delay the diagnosis of a more serious condition like decompensated heart failure.

Choice C rationale

Obtaining vital signs is a fundamental nursing action, but it is not the most appropriate initial action in this specific clinical scenario. The report of a new cough in a client with heart failure necessitates a targeted assessment of the respiratory system, including auscultating lung sounds and evaluating for signs of hypoxemia, to rule out a life-threatening complication.

Choice D rationale

While a cough is a known side effect of lisinopril, dismissing the symptom could be dangerous. The cough may not be benign; it could be an early sign of pulmonary congestion from heart failure. The nurse must perform a comprehensive assessment to ensure the client's safety and to avoid misattributing a serious finding to a common medication side effect.

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.