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 A

Explanation

The correct answer is A:

Choice A reason: Notifying the healthcare provider is crucial because the patient’s carbamazepine level is significantly above the therapeutic range, which is 4-12 mcg/mL. A level of 84 mcg/mL indicates a high risk of toxicity, and the healthcare provider must be informed to take appropriate action, which may include adjusting the dose or discontinuing the medication.

Choice B reason: Administering the carbamazepine as prescribed would not be safe without addressing the elevated drug level. Continuing to administer the medication could increase the risk of severe side effects and toxicity due to the already high serum level.

Choice C reason: Withholding the dose may be a necessary immediate action, but it does not address the need for medical intervention to manage the patient’s elevated drug level. Therefore, while withholding the dose might be part of the response, it should follow notifying the healthcare provider.

Choice D reason: Assessing the patient for side effects is important, but it is not the most immediate action required. The priority is to notify the healthcare provider because of the potential for serious toxicity given the high carbamazepine level.

A. Administer sucralfate once daily, preferably at bedtime. B. Give sucralfate on an empty stomach. C. Monitor for a secondary Candida infection. D. Monitor for electrolyte imbalances.

Correct Answer is B

Explanation

Choice A rationale

Sucralfate is not typically administered once daily, preferably at bedtime. It is usually given multiple times a day.

Choice B rationale

Sucralfate should be given on an empty stomach, at least one hour before meals and at bedtime. This is because the absorption of sucralfate can be affected by the presence of food in the stomach.

Choice C rationale

While it’s important to monitor for infections when administering any medication, there’s no specific association between sucralfate and secondary Candida infections.

Choice D rationale

Sucralfate does not typically cause electrolyte imbalances. Its main function is to form a protective barrier over the ulcer, preventing further damage from acid and pepsin.

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Naxlex Comprehensive Predictor Exams

Before administering the evening dose of carbamazepine, the nurse notes that the patient’s morning carbamazepine level was 84 mcg/mL. What action should the nurse take?

Correct Answer is A

Explanation

The nurse is preparing to administer the anti-ulcer gastrointestinal agent sucralfate to a patient with peptic ulcer disease.What should be included in this patient’s care plan?

Correct Answer is B

Explanation

A client taking atorvastatin has an increased serum creatine phosphokinase (CK) level. What should the nurse assess the client for?

A patient is receiving a secondary infusion of azithromycin 500 mg in 500 mL of normal saline (NS) to be infused over 2 hours. The intravenous (IV) administration set delivers 10 gtt/mL. How many gtt/min should the nurse regulate the infusion?

A patient with osteoporosis is administered risedronate at 0700 and requests a glass of milk to take with the medication.What should the nurse’s response be?

The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication.What action should the nurse take?

While evaluating a patient who has been taking acetaminophen for chronic pain, the nurse notices that the patient’s skin appears yellow.What action should the nurse take in response to this observation?

An older adult with iron deficiency anemia is being discharged with a prescription for ferrous sulfate enteric-coated tablets.To promote the best absorption of the medication, what information should the nurse include in the discharge instructions?

A patient has received a new prescription for levothyroxine.Which statement made by the patient indicates that the education was effective?

A client has a new prescription for zolpidem, a hypnotic.The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home.Which action should the nurse take?