A nurse is teaching a client who has heart failure about the use of digoxin as a conventional drug to improve his cardiac function. Which of the following statements by the client indicates a need for further teaching?

"I should avoid taking licorice as an herb because it may cause irregular heart rhythms."

"I should monitor my pulse rate and report any changes to my health care provider."

"I should take digoxin with food or milk to prevent stomach upset."

"I should check my weight daily and report any sudden increase to my health care provider."

Answer and Explanation

The Correct Answer is C

The correct answer is

C. "I should take digoxin with food or milk to prevent stomach upset."

Choice A reason: This statement is correct and does not indicate a need for further teaching. The client should avoid taking licorice as an herb because it may cause irregular heart rhythms. Licorice contains glycyrrhizin, which can lower the potassium level in the blood and increase the risk of digoxin toxicity. Licorice may also increase blood pressure and interfere with the effects of some blood pressure medications.

Choice B reason: This statement is also correct and does not indicate a need for further teaching. The client should monitor his pulse rate and report any changes to his healthcare provider. Digoxin can affect the heart rate and rhythm, and cause bradycardia (slow heart rate) or arrhythmias (irregular heartbeats)¹². The client should check his pulse before taking digoxin, and if it is below 60 beats per minute, he should skip the dose and call his healthcare provider. The client should also report any signs of digoxin toxicity, such as nausea, vomiting, loss of appetite, blurred vision, yellow or green halos around objects, confusion, or weakness.

Choice C reason: This statement is incorrect and indicates a need for further teaching. The client should not take digoxin with food or milk to prevent stomach upset. Food or milk may decrease the absorption of digoxin and reduce its effectiveness. Digoxin should be taken on an empty stomach, at least one hour before or two hours after a meal. If the client experiences stomach upset from digoxin, he should consult his healthcare provider for advice.

Choice D reason: This statement is also correct and does not indicate a need for further teaching. The client should check his weight daily and report any sudden increase to his healthcare provider. Digoxin is used to treat heart failure, a condition in which the heart cannot pump enough blood to meet the body's needs¹². One of the symptoms of heart failure is fluid retention, which can cause weight gain, swelling of the legs or ankles, shortness of breath, or difficulty breathing. A sudden increase in weight may indicate worsening of heart failure and require adjustment of the treatment plan.

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Correct Answer is D

Explanation

The correct answer is

D. All of the above.

Choice A reason: This statement is correct and reflects one of the possible adverse effects or interactions that may occur with biologically based therapies such as herbs and supplements. Allergic reactions or hypersensitivity can occur when the body's immune system reacts to a foreign substance, such as a plant extract or a dietary supplement, and produces antibodies and other chemicals that cause symptoms such as itching, rash, hives, swelling, or anaphylaxis (a severe and potentially life-threatening reaction). Some examples of herbs or supplements that may cause allergic reactions include echinacea, chamomile, garlic, ginkgo, and bee pollen.

Choice B reason: This statement is also correct and reflects another possible adverse effect or interaction that may occur with biologically based therapies such as herbs and supplements. Hepatic or renal toxicity or dysfunction can occur when the liver or the kidneys are damaged or impaired by a substance, such as a plant extract or a dietary supplement, that may be toxic or interfere with their normal function. Some examples of herbs or supplements that may cause hepatic or renal toxicity or dysfunction include kava, comfrey, chaparral, licorice, ephedra, and aristolochia.

Choice C reason: This statement is also correct and reflects another possible adverse effect or interaction that may occur with biologically based therapies such as herbs and supplements. Gastrointestinal distress or bleeding can occur when the stomach or the intestines are irritated or injured by a substance, such as a plant extract or a dietary supplement, that may cause inflammation, ulceration, perforation, or bleeding. Some examples of herbs or supplements that may cause gastrointestinal distress or bleeding include aloe vera, cascara sagrada, senna, ginger, ginseng, garlic, ginkgo, and feverfew.

Choice D reason: This statement is correct because it includes all of the above statements. Biologically based therapies such as herbs and supplements may cause various adverse effects or interactions depending on the type, dose, duration, quality, purity, and combination of these products. Therefore, choice D is the best answer for assessing the client for possible adverse effects or interactions that may occur with biologically based therapies.

A. Lisinopril, an ACE inhibitor for blood pressure B. Amoxicillin, a penicillin antibiotic for infection C. Prednisone, a corticosteroid for inflammation D. Metformin, a biguanide for diabetes mellitus E. Fluoxetine, an SSRI for depression

Correct Answer is ["C","E"]

Explanation

Choice A reason: This statement is incorrect and inappropriate for identifying the interaction between echinacea and lisinopril. Echinacea does not interact with lisinopril, an ACE inhibitor for blood pressure. There is no evidence that echinacea affects the blood pressure or the pharmacokinetics of lisinopril¹².

Choice B reason: This statement is incorrect and inappropriate for identifying the interaction between echinacea and amoxicillin. Echinacea does not interact with amoxicillin, a penicillin antibiotic for infection. There is no evidence that echinacea affects the antibacterial activity or the pharmacokinetics of amoxicillin¹².

Choice C reason: This statement is correct and appropriate for identifying the interaction between echinacea and prednisone. Echinacea may interact with prednisone, a corticosteroid for inflammation, by reducing its effectiveness or increasing its side effects. Echinacea has immunostimulatory properties that may counteract the immunosuppressive effects of prednisone¹². Echinacea may also induce the enzyme cytochrome P450 3A4, which is involved in the metabolism of prednisone, and decrease its blood level¹². Furthermore, echinacea may increase the risk of infection or bleeding in people who take prednisone¹².

Choice D reason: This statement is incorrect and inappropriate for identifying the interaction between echinacea and metformin. Echinacea does not interact with metformin, a biguanide for diabetes mellitus. There is no evidence that echinacea affects the blood glucose or the pharmacokinetics of metformin¹².

Choice E reason: This statement is correct and appropriate for identifying the interaction between echinacea and fluoxetine. Echinacea may interact with fluoxetine, an SSRI for depression, by increasing its side effects or toxicity. Echinacea may inhibit the enzyme cytochrome P450 2D6, which is involved in the metabolism of fluoxetine, and increase its blood level¹². Echinacea may also increase the risk of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin in the brain, in people who take fluoxetine¹²..

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A nurse is teaching a client who has heart failure about the use of digoxin as a conventional drug to improve his cardiac function. Which of the following statements by the client indicates a need for further teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is evaluating a client who has been using biologically based therapies such as herbs and supplements to treat his health conditions. The nurse should assess the client for which of the following adverse effects or interactions that may occur with biologically based therapies?

Correct Answer is D

Explanation

A nurse is reviewing the medication list of a client who uses echinacea as a CAM product to boost his immune system function. The nurse should identify that echinacea may interact with which of the following conventional drugs? (Select all that apply.)

Correct Answer is ["C","E"]

Explanation

A nurse is caring for a client who takes warfarin for atrial fibrillation and wants to use ginkgo biloba as a CAM product to improve his memory. The nurse should inform the client that ginkgo biloba may interact with warfarin in which of the following ways?

A nurse is counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. Which of the following statements by the nurse is appropriate?

A nurse is caring for a client who takes warfarin for atrial fibrillation and wants to use ginkgo biloba as a CAM product to improve his memory. The nurse should inform the client that ginkgo biloba may interact with warfarin in which of the following ways?

A nurse is reviewing the medication list of a client who uses echinacea as a CAM product to boost his immune system function. The nurse should identify that echinacea may interact with which of the following conventional drugs? (Select all that apply.)