Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client’s history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation on the advice of a friend.
Which information is most significant about this finding?
A. The client probably used this herb to treat depression.
B. Wort can decrease plasma concentrations of the cyclosporine.
Cyclosporine is an immunosuppressive medication commonly used to prevent graft rejection after organ transplantation. St. John's Wort is known to induce cytochrome P450 enzymes, which can increase the metabolism and decrease the effectiveness of many medications, including cyclosporine. This interaction can lead to decreased plasma concentrations of cyclosporine, which can increase the risk of graft rejection. Therefore, it is important to advise the client to discontinue the use of St. John's Wort and inform their healthcare provider about any herbal or supplement use to prevent potential interactions with prescribed medications. Options a, c, and d are not directly related to the client's current condition and are not as significant as option b.
C. Ingestion of wort can reduce the client’s intake of sodium.
D. Adding the herb can decrease the need for corticosteroids.
E. Adding the herb can decrease the need for corticosteroids.
This question is an excerpt from Nurse Dive's nursing test bank - HESI Pharmacology Proctored Exam. Take the full exam now
Full Explanation
Cyclosporine is an immunosuppressive medication commonly used to prevent graft rejection after organ transplantation. St. John's Wort is known to induce cytochrome P450 enzymes, which can increase the metabolism and decrease the effectiveness of many medications, including cyclosporine. This interaction can lead to decreased plasma concentrations of cyclosporine, which can increase the risk of graft rejection. Therefore, it is important to advise the client to discontinue the use of St. John's Wort and inform their healthcare provider about any herbal or supplement use to prevent potential interactions with prescribed medications. Options a, c, and d are not directly related to the client's current condition and are not as significant as option b.
Similar Questions
A female client starts a new prescription, oxybutynin, for symptoms of an overactive bladder. The client tells the nurse that she is training to run in a marathon. Which instruction should the nurse emphasize?
A. Avoid crowds to help prevent acquiring infections.
B. Wear protective padding to protect from bruising if a fall occurs.
C. Take measures to avoid dehydration and over-heating.
Oxybutynin is a medicine used to treat symptoms of an overactive bladder. One of the side effects of oxybutynin is that it can cause dry mouth, constipation, and dry skin21. These side effects can increase the risk of dehydration. Additionally, oxybutynin can cause flushing and heat stroke. Therefore, it is important for the client to take measures to avoid dehydration and over-heating while training for a marathon.
D. Keep skin and eyes covered to protect from sun injury.
Full Explanation
Oxybutynin is a medicine used to treat symptoms of an overactive bladder. One of the side effects of oxybutynin is that it can cause dry mouth, constipation, and dry skin21. These side effects can increase the risk of dehydration. Additionally, oxybutynin can cause flushing and heat stroke. Therefore, it is important for the client to take measures to avoid dehydration and over-heating while training for a marathon.
A client with anemia secondary to chronic kidney disease started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?
A. Reports on increased energy levels and decreased fatigue.
Reports of increased energy levels and decreased fatigue can be subjective and influenced by many factors.
B. Takes concurrent iron therapy without adverse effects.
Taking concurrent iron therapy without adverse effects is important to support the production of red blood cells but does not confirm the effectiveness of epoetin alfa.
C. The hemoglobin level increased to 12 grams/dL (120mmol/L).
Epoetin alfa is a medication that stimulates the production of red blood cells and is commonly used to treat anemia in patients with chronic kidney disease. Hemoglobin level is the most important parameter to monitor the effectiveness of epoetin alfa therapy. An increase in hemoglobin level indicates an improvement in the patient's anemia and suggests that the medication is effective. While options a, b, and d are also important considerations in the management of anemia, they do not provide a definitive indication of the effectiveness of epoetin alfa therapy.
D. Food diary shows increased consumption of iron rich foods.
Increased consumption of iron-rich foods can be helpful in managing anemia, but it does not provide a direct indication of the effectiveness of epoetin alfa therapy.
Full Explanation
Epoetin alfa is a medication that stimulates the production of red blood cells and is commonly used to treat anemia in patients with chronic kidney disease. Hemoglobin level is the most important parameter to monitor the effectiveness of epoetin alfa therapy. An increase in hemoglobin level indicates an improvement in the patient's anemia and suggests that the medication is effective.
While options a, b, and d are also important considerations in the management of anemia, they do not provide a definitive indication of the effectiveness of epoetin alfa therapy. Reports of increased energy levels and decreased fatigue can be subjective and influenced by many factors. Taking concurrent iron therapy without adverse effects is important to support the production of red blood cells but does not confirm the effectiveness of epoetin alfa. Increased consumption of iron-rich foods can be helpful in managing anemia, but it does not provide a direct indication of the effectiveness of epoetin alfa therapy.
When caring for a client with diabetes insipidus who is receiving antidiuretic hormone intranasally, which serum lab test is most important for the nurse to monitor?
A. Platelets
B. Glucose
C. Osmolality
Diabetes insipidus is a condition in which the kidneys are unable to conserve water, leading to excessive thirst and urination. It is treated with antidiuretic hormone (ADH), which helps the kidneys retain water and reduce urine output. When caring for a client with diabetes insipidus who is receiving ADH intranasally, it is important for the nurse to monitor the client’s serum osmolality. Osmolality is a measure of the concentration of particles in a solution and can provide information about the client’s hydration status. Monitoring serum osmolality can help determine if the ADH therapy is effective in managing the client’s diabetes insipidus.
D. Calcium
Full Explanation
Diabetes insipidus is a condition in which the kidneys are unable to conserve water, leading to excessive thirst and urination. It is treated with antidiuretic hormone (ADH), which helps the kidneys retain water and reduce urine output. When caring for a client with diabetes insipidus who is receiving ADH intranasally, it is important for the nurse to monitor the client’s serum osmolality.
Osmolality is a measure of the concentration of particles in a solution and can provide information about the client’s hydration status.
Monitoring serum osmolality can help determine if the ADH therapy is effective in managing the client’s diabetes insipidus.
