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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?
- A. St. John’s Wort can decrease plasma concentrations of cyclosporine.
- B. Consumption of St. John’s Wort can reduce the patient’s sodium intake.
- C. Adding the herb can decrease the need for corticosteroids.
- D. The patient probably used this herb to treat depression.
Correct Answer: A
Rationale: St. John’s Wort induces CYP3A4, reducing cyclosporine levels (A), risking transplant rejection. It doesn’t affect sodium (B) or reduce corticosteroid needs (C). Depression treatment (D) is secondary to the transplant risk.
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A patient with open-angle glaucoma asks the nurse about the duration of use for the prescribed eye drops. What is the nurse’s accurate response?
- A. For long-term control of pain and swelling.
- B. Until a smaller angle can be restored.
- C. Until the excess pressure is reduced.
- D. For long-term control of normal eye pressure.
Correct Answer: D
Rationale: Open-angle glaucoma requires lifelong eye drops to maintain normal intraocular pressure (D). They don’t control pain/swelling (A) or restore angles (B). Pressure reduction (C) is ongoing, not temporary.
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?
- A. Notify the healthcare provider of the carbamazepine level.
- B. Administer the carbamazepine as prescribed.
- C. Withhold this dose of the carbamazepine.
- D. Assess the patient for side effects of carbamazepine.
Correct Answer: A
Rationale: Carbamazepine’s therapeutic range is 4-12 mcg/mL; 84 mcg/mL (A) indicates toxicity risk, requiring provider notification. Administering (B) or withholding (C) without consultation is unsafe. Assessing side effects (D) is secondary to reporting.
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?
- A. Instruct the client that it is necessary to take nothing but water with the medication.
- B. Withhold the medication until the client’s breakfast tray is available on the unit.
- C. Consult with a pharmacist about scheduling the dose one hour after the client eats.
- D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low-fat milk.
Correct Answer: A
Rationale: Risedronate, a bisphosphonate, must be taken with plain water on an empty stomach, 30 minutes before food or other beverages, to ensure optimal absorption. Milk (B) contains calcium, reducing absorption. Delaying until breakfast (C) violates timing requirements. Consulting a pharmacist (D) is unnecessary, as administration guidelines are clear.
A patient with nasal congestion has been prescribed phenylephrine 10 mg by mouth every 4 hours. What patient condition should the nurse report to the healthcare provider before administering the medication?
- A. Hypertension.
- B. Bronchitis.
- C. Diarrhea.
- D. Edema.
Correct Answer: A
Rationale: Phenylephrine, a decongestant, can raise blood pressure, making hypertension (A) a contraindication requiring provider consultation. Bronchitis (B), diarrhea (C), and edema (D) are not directly affected by phenylephrine.
A patient is currently on an oral contraceptive and has been prescribed erythromycin. What advice should the nurse provide to the patient?
- A. Utilize an additional form of contraception.
- B. Immediately discontinue the oral contraceptive.
- C. Ensure a 12-hour gap between taking the medications.
- D. Avoid prolonged exposure to direct sunlight.
Correct Answer: A
Rationale: Erythromycin may reduce oral contraceptive efficacy by inducing hepatic metabolism. Using an additional contraceptive method (A) prevents unintended pregnancy. Discontinuing the contraceptive (B) is unnecessary. Timing gaps (C) don’t mitigate the interaction. Sunlight avoidance (D) relates to other antibiotics like tetracycline.