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The nurse is assigned a 49-year-old female client in the primary care office for a wellness visit. The nurse assesses the client, documents nurses notes, and reviews the medication administration record for potential interactions. The nurse should be most concern with the potential interaction between __and _.
Complete the sentence by choosing one answer from each option in the drop-down list below:
Medication Reconciliation:

St. John's wort 450 mg by mouth twice daily

Gabapentin 400 mg by mouth twice daily

Aspirin 81 mg by mouth daily

Atorvastatin 80 mg by mouth daily

Lisinopril 5 mg by mouth daily

Warfarin 5 mg by mouth daily

Ginger 5mg by mouth daily

Valerian 10mg by mouth daily

Answer and Explanation

Correct Answer : A,F

A. St. John's wort 450 mg by mouth twice daily: St. John's wort is known to be a potent inducer of cytochrome P450 enzymes and can significantly reduce the effectiveness of warfarin by increasing its metabolism. This interaction can lead to subtherapeutic levels of warfarin and an increased risk of thromboembolic events.

B. Gabapentin 400 mg by mouth twice daily: While gabapentin can interact with other medications, its interactions with warfarin or St. John's wort are generally not as significant as those between warfarin and St. John's wort.

C. Aspirin 81 mg by mouth daily: Aspirin has anticoagulant properties and can have interactions with warfarin. However, the interaction with St. John's wort is less pronounced compared to the interaction between warfarin and St. John's wort.

D. Atorvastatin 80 mg by mouth daily: Atorvastatin primarily affects lipid levels and has different metabolic pathways compared to warfarin. It does not have a strong interaction with St. John's wort.

E. Lisinopril 5 mg by mouth daily: Lisinopril is an ACE inhibitor and does not have significant interactions with St. John's wort or warfarin.

F. Warfarin 5 mg by mouth daily. Warfarin is an anticoagulant that requires careful monitoring due to its interactions with various substances that can either increase the risk of bleeding or decrease its effectiveness.

G. Ginger 5 mg by mouth daily: Ginger can affect platelet function but is not as significant in interaction with warfarin as St. John's wort.

H. Valerian 10 mg by mouth daily: Valerian may have mild interactions with central nervous system depressants but does not have significant interactions with warfarin or St. John's wort.

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Free Nursing Study Resources

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"D"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

Naloxone is an opioid antagonist and is used to reverse opioid overdoses.

Flumazenil is a benzodiazepine antagonist and can reverse the effects of benzodiazepines.

Glucagon can be used to treat beta-blocker overdose by increasing heart rate and blood pressure.

Acetylcysteine acts as an antidote for acetaminophen toxicity by replenishing glutathione levels to enhance non-toxic metabolism of acetaminophen.

A. Transdermal patch B. Topical ointment C. Suspended-release D. Sublingual

Correct Answer is D

Explanation

A. Transdermal patch:
A transdermal patch provides a slow, continuous release of medication over a period of time. While it is useful for long-term management of conditions, it does not provide the rapid onset needed for acute situations. The medication gradually enters the bloodstream through the skin, making it less effective for immediate relief.

B. Topical ointment:
Topical ointments are applied to the skin and are absorbed locally at the site of application. They are not designed for rapid systemic absorption and typically have a slower onset compared to other routes like sublingual or intravenous.

C. Suspended-release:
Suspended-release formulations are designed for controlled, extended-release of medication over time. These are not intended for rapid onset but rather for maintaining therapeutic levels of the medication over an extended period. They are suitable for long-term treatment rather than immediate relief.

D. Sublingual:
Sublingual administration (under the tongue) provides the most rapid onset for nitroglycerin. This route allows the medication to be absorbed directly into the bloodstream through the mucous membranes in the mouth, bypassing the gastrointestinal tract and first-pass metabolism in the liver. This results in a quick therapeutic effect, which is crucial for managing acute angina attacks.

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Naxlex Comprehensive Predictor Exams

A charge nurse is teaching a group of nurses about the antagonist action of reversal medications. For each medication listed below, click to specify the expected reversal agent

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"D"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

A nurse is teaching with a group of nurses about the administration of nitroglycerin. Which of the following routes of administration provides the most rapid onset for the client?

Correct Answer is D

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