A patient who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection.
During the patient’s history taking, the nurse finds out that the patient has been self-administering St. John’s Wort, an herbal preparation, on a friend’s advice.
What information is most significant about this finding?

St. John’s Wort can decrease plasma concentrations of cyclosporine.

Consumption of St. John’s Wort can reduce the patient’s sodium intake.

Adding the herb can decrease the need for corticosteroids.

The patient probably used this herb to treat depression.

Answer and Explanation

The Correct Answer is A

Choice A rationale

St. John’s Wort is known to interact with many prescription drugs, including cyclosporine, a medication often given to transplant patients to prevent organ rejection. St. John’s Wort can decrease plasma concentrations of cyclosporine, thus endangering the success of organ transplantations.

Choice B rationale

There is no evidence to suggest that consumption of St. John’s Wort can reduce the patient’s sodium intake.

Choice C rationale

Adding the herb does not decrease the need for corticosteroids. In fact, it can interact with many medications and cause serious complications.

Choice D rationale

While St. John’s Wort is often used to treat depression, in the context of a patient who has undergone a renal transplant, the most significant information is its potential to interact with cyclosporine and endanger the success of the transplant.

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Correct Answer is C

Explanation

Choice A rationale

Decreasing cigarette use to a pack per day is not enough. Smoking can increase stomach acid and reduce the ability of the stomach lining to resist acid, thus aggravating peptic ulcer disease. Therefore, the patient should be advised to quit smoking entirely.

Choice B rationale

Lethargy could be a side effect of cimetidine. It’s important for the patient to notify the healthcare provider if they experience this, as it could indicate a need to adjust the medication.

Choice C rationale

Cimetidine should be taken with or immediately following meals for best absorption. If antacids are used, they should be taken at least one hour apart from cimetidine. Therefore, taking the medication an hour after antacids is incorrect and indicates the need for further instruction.

Choice D rationale

Sexual dysfunction is a rare but possible side effect of cimetidine. Patients should be advised to monitor for this and report any issues to their healthcare provider.

A. Replace salt with a salt substitute. B. Cover your skin before going outside. C. Limit intake of high-potassium foods. D. Monitor skin for excessive bruising.

Correct Answer is C

Explanation

Choice A rationale

While reducing salt intake is generally beneficial for clients with heart failure, replacing salt with a salt substitute is not recommended for clients taking spironolactone. Many salt

substitutes contain potassium, and spironolactone can cause high potassium levels in the blood.

Choice B rationale

Covering the skin before going outside is a general recommendation for sun protection, but it is not specifically related to the use of spironolactone.

Choice C rationale

Spironolactone is a potassium-sparing diuretic, which means it can cause the body to retain potassium. Therefore, clients taking this medication should be advised to limit their intake of high-potassium foods to prevent hyperkalemia, a potentially serious condition characterized by high levels of potassium in the blood.

Choice D rationale

While it is always important to monitor for signs of bruising, this is not the most critical instruction for a client taking spironolactone. The risk of hyperkalemia is a more immediate concern.

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Naxlex Comprehensive Predictor Exams

A patient with peptic ulcer disease has been prescribed cimetidine.Which statement made by the patient indicates the need for further instruction by the nurse?

Correct Answer is C

Explanation

A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client’s plan of care?

Correct Answer is C

Explanation

The nurse is administering sodium polystyrene sulfonate to a client with acute kidney injury (AKI). Which laboratory finding indicates that the medication has been effective?

An elderly client with heart failure arrives at the emergency room due to nausea, vomiting, and anorexia.Based on the client’s signs and symptoms, which piece of data from the medical history is most significant when planning this client’s care?

The nurse is preparing a discharge teaching plan for a patient who is taking ciprofloxacin hydrochloride tablets due to suspected anthrax exposure. What instructions should be included in the teaching plan?

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A client is receiving intravenous vancomycin, and the nurse plans to draw blood for a peak and trough to determine the serum level of the drug. Which collection times would provide the best determination of these levels?

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An adult patient at an outpatient clinic has been prescribed the antibiotic tetracycline HCl. What instructions should the nurse include in the patient’s teaching plan?