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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. This hospital might use a different manufacturer, but the medication is the same:
While it is possible that different manufacturers might produce pills of varying appearances, this response does not directly address the client's concern or involve them in verifying the medication. It's important for the nurse to first understand what the client is accustomed to before providing reassurance about the medication.
B. What does your usual pill look like?:
Asking the client to describe their usual pill is the best response. This approach allows the nurse to verify the medication in question by comparing it to the client’s known medication. It also reassures the client that their concerns are being taken seriously and provides an opportunity for the nurse to check if there has been an error or if the medication is indeed correct.
C. This is the medication prescribed by your provider:
While this statement is factual, it does not directly address the client’s concern about the appearance of the medication. It's important to involve the client in verifying the medication to ensure they are receiving the correct drug and to maintain their trust.
D. This pill is probably from a different lot number than yours at home:
This response assumes the issue is related to the lot number, which may not be the case. It does not involve the client in the verification process or address their specific concern about the appearance of the medication. Providing a more thorough and engaging response would be more appropriate.
Correct Answer is A
Explanation
A. Wait for at least another 30 minutes before calling to have the level drawn:
For oral medications, peak drug levels are typically drawn 1 to 2 hours after administration, depending on the medication's pharmacokinetics. Since the client took the medication only 30 minutes ago, it is premature to draw the level now. Waiting an additional 30 minutes would align with the typical peak times for oral medications, ensuring that the drug level reflects its peak concentration.
B. Schedule the level to be drawn in 8 hours:
Drawing the peak level 8 hours after administration would likely be too late, as most oral medications reach their peak concentration within 1 to 2 hours. Scheduling the level for 8 hours later may result in an inaccurate measurement of the peak drug level, leading to potentially misleading clinical information.
C. Call the lab to have the medication level drawn immediately:
Drawing the level immediately after 30 minutes may not provide an accurate representation of the peak drug level. Oral medications generally reach peak levels later, and an early draw could result in a falsely low measurement that does not reflect the drug's maximum concentration.
D. Arrange for the level to be drawn tomorrow since the peak time has passed:
The peak time has not passed, as the medication was only administered 30 minutes ago. Drawing the level tomorrow would be far too late to assess the peak concentration accurately, which is essential for evaluating the effectiveness and safety of the medication.
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