A nurse is reviewing the laboratory results of a client who uses licorice as a CAM product to treat his cough and sore throat. The nurse should expect that licorice may have which of the following effects on his laboratory results?

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.

The correct answer is

A. Inserting thin needles into specific points on the body to restore energy balance.

Choice A reason: Inserting thin needles into specific points on the body to restore energy balance is the correct action for acupuncture. This is because acupuncture is based on the traditional Chinese medicine theory that health depends on the balance and flow of vital energy, called qi, through pathways called meridians. Acupuncture aims to stimulate specific points along these meridians, called acupoints, to correct any imbalances or blockages of qi and to promote healing and well-being.

Choice B reason: Applying pressure or massage to specific points on the body to relieve pain or stress is not a valid action for acupuncture. This is because this action describes another CAM practice called acupressure, which is similar to acupuncture but does not use needles. Acupressure also follows the traditional Chinese medicine theory of meridians and acupoints, but uses manual pressure, such as finger pressure, to stimulate the acupoints.

Choice C reason: Exposing specific points on the body to light, heat, or electricity to stimulate healing is not a valid action for acupuncture. This is because this action describes another CAM practice called electroacupuncture, which is a variation of acupuncture that uses electrical currents to stimulate the acupoints. Electroacupuncture may be used as an adjunct to acupuncture or as a standalone therapy.

Choice D reason: Placing cups on specific points on the body to create suction and increase blood flow is not a valid action for acupuncture. This is because this action describes another CAM practice called cupping, which is a form of therapy that uses cups made of glass, bamboo, or plastic to create a vacuum on the skin. Cupping may be used to treat pain, inflammation, blood circulation, and relaxation.