Mens / Womens Exam 2
1203) Which supplement would the nurse instruct a client taking oral contraceptives to increase? Calcium Vitamin C Vitamin E Potassium
Vitamin C Rationale: Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required. It is unnecessary to increase the intake of calcium when one is taking oral contraceptives. There is no clinical evidence linking oral contraceptives with a deficiency of vitamin E. There is no interrelationship between oral contraceptives and dietary intake of potassium.
1200) A client asks the nurse what she should do if she forgets to take her contraceptive pill 1 day. Which response by the nurse is appropriate? 'Take your pills as instructed.' 'Call your primary health care provider immediately.' 'Continue as usual, and there shouldn't be a problem.' 'On the next day take 1 pill in the morning and 1 pill before bedtime.'
'On the next day take 1 pill in the morning and 1 pill before bedtime.' Rationale: The client should make up for the missed pill by taking 2 pills the next day; taking 1 pill in the morning and 1 pill in the evening decreases the chance of the client becoming nauseated. Telling the client to take her pills as instructed does not explain what is to be done if a pill is missed; missing 1 pill can alter hormone levels and predispose the client to becoming pregnant. It is unnecessary to call the primary health care provider unless other problems are identified. Telling the client that there should be no problem if she continues as usual is incorrect advice; again, missing 1 pill can alter hormone levels and predispose a woman to pregnancy.
18 The nurse is caring for a client with osteoporosis who has been prescribed alendronate. When providing care, which intervention would be a priority? AAdminister the alendronate 30 to 60 minutes before the client eats. BNotify the health care provider if the client reports jaw pain. CEncourage the client to increase their intake of vitamin D. DMonitor the client's serum calcium levels.
BNotify the health care provider if the client reports jaw pain. Rationale: Alendronate is a bisphosphonate that helps slow down bone resorption, decreasing osteoporosis. Osteonecrosis of the jaw is a rare, adverse reaction to alendronate, and jaw pain can be a symptom of this. Therefore, notifying the health care provider of the jaw pain is the priority. The other interventions are also correct for a client with osteoporosis, but are not as important as reporting the potential adverse drug effect.
14 A client is prescribed alendronate. Which instruction should the nurse emphasize when teaching about this medication? A"Take the medication with a full glass of milk two hours after meals." B"It is recommended that you take this medication with calcium and a glass of juice." C"Be sure to take this medication on an empty stomach." D"You may take this medication after any meal, at the same time every day."
C"Be sure to take this medication on an empty stomach." Rationale: Alendronate (Fosamax) is used to treat and prevent osteoporosis. It should be taken first thing in the morning with 6 to 8 ounces of plain water at least 30 minutes before other medication or food. Food and fluids (other than water) greatly decrease the absorption of this medication. The client must also be instructed to remain in the upright position for 30 minutes following the dose to facilitate passage into the stomach and minimize irritation of the esophagus.
8 The nurse is administering an osmotic diuretic to a client with a traumatic brain injury. Which finding best indicates that the medication was effective? A250 mL clear, yellow urine output over four hours BClear bilateral lung sounds to posterior auscultation CIntracranial pressure reading of 14 mmHg DBilateral ovoid pupils that are slow to constrict
CIntracranial pressure reading of 14 mmHg Rationale: Osmotic diuretics, such as mannitol, are used to reduce intracranial or intraocular pressure. Intracranial pressure (ICP) for a client with a head injury should be less than 20 mmHg and the osmotic diuretic may be administered to reduce a high ICP. The osmotic diuretic will reduce the amount of water normally reabsorbed by the renal tubules and loop of Henle, so urinary output is increased, which is an expected occurrence, but does not indicate effectiveness of the medication. Ovoid pupils may indicate the presence of cerebral hypertension. An osmotic diuretic is not intended to reduce pulmonary edema, thus clear lung sounds are not an indicator for effectiveness of the diuretic for this particular client.
13 The nurse is caring for a female client who is requesting hormonal contraceptives. Which of the following questions should the nurse ask to assess for contraindications? AHave you ever had a blood clot? BHow many children do you have? CDo you drink alcohol? DDid you experience acne in adolescence?
AHave you ever had a blood clot? Rationale: A history of thromboembolic disorders is a contraindication to hormonal contraceptives; therefore, any history of thrombus should be assessed. The number of children/pregnancies and use of alcohol are probable history questions but are not contraindications to this method. Acne is a side effect of oral contraceptives but not a contraindication.
1376) A biphasic antiovulatory medication of combined progestin and estrogen is prescribed for a client. Which instruction would the nurse include when teaching about this oral contraceptive? 'Report irregular vaginal bleeding.' 'Restrict sexual activity temporarily.' 'Have regular bimonthly Pap smears.' 'Increase dietary intake of calcium.'
'Report irregular vaginal bleeding.' Rationale: Antiovulatory medications suppress menstruation. Breakthrough bleeding is not expected with biphasic medications. The medication is given for 21 days, and menstrual flow does not occur during this time. Sexual activity is not restricted when one is taking oral contraceptives. There is no indication for increased frequency of Pap smears; one a year is sufficient. Increased calcium intake is not relevant to the administration of oral contraceptives.
16 A nurse is preparing to administer intravenous mannitol to a client with increased intracranial pressure. Which action will the nurse perform prior to administering the medication? AConnect an in-line filter to the infusion tubing BDilute the medication with lactated ringers CPrepare an infusion warmer DEnsure the client has a patent central line
A Connect an in-line filter to the infusion tubing Rationale: The nurse should connect a filter to the infusion tubing prior to administering mannitol. Mannitol is an osmotic diuretic that may contain crystals within the solution. The in-line filter prevents the administration of particulates into the bloodstream. Mannitol should be administered undiluted. An infusion warmer is not required for the administration of mannitol. Mannitol can be administered through a peripheral line.
1435) A woman questions the nurse about the effectiveness of oral contraceptives. Which important factor about the effectiveness of oral contraceptives would the nurse include in the response? User motivation Simplicity of use Reliability record Identified risk factors
User motivation Rationale: Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method.
633) Which B vitamin deficiency will result in Wernicke encephalopathy? B 3 (niacin) B 1 (thiamine) B 2 (riboflavin) B 6 (pyridoxine)
B 1 (thiamine) Rationale: Severe deficiency of thiamine will result in Wernicke encephalopathy. Niacin deficiency causes pellagra. Riboflavin deficiency can result in cutaneous, oral, and corneal changes. Pyridoxine deficiency can progress to sideroblastic anemia, neurological disturbances, and xanthurenic aciduria, among other problems.
125) Which topic will the nurse include in the discharge teaching of a client who has had a total gastrectomy? Daily use of a stool softener Injections of vitamin B 12 for life Monthly injections of iron dextran Replacement of pancreatic enzymes
Injections of vitamin B 12 for life Rationale: Intrinsic factor is lost with removal of the stomach, and vitamin B 12 is needed to maintain the hemoglobin level and prevent pernicious anemia. Adequate diet, fluid intake, and exercise should prevent constipation. Iron deficiency anemia is not expected. Secretion of pancreatic enzymes should not be affected because this surgery does not alter this function.
420) Which prescription would the nurse anticipate for the client who takes a medication that interferes with fat absorption? High-fat diet Supplemental cod liver oil Total parenteral nutrition (TPN) Water-miscible forms of vitamins A and E
Water-miscible forms of vitamins A and E Rationale: Vitamins A, D, E, and K are known as fat-soluble vitamins because bile salts and other fat-related compounds aid their absorption. A high-fat diet will not achieve the uptake of fat-soluble vitamins in this client. Supplemental cod liver oil will not achieve the uptake of fat-soluble vitamins in this client. TPN is unnecessary; a well-balanced diet is preferred. Water-miscible forms of vitamins A and E can be absorbed with water-soluble nutrients.
221) Which therapeutic effect would the nurse expect to identify when mannitol is administered to a client? Improved renal blood flow Decreased intracranial pressure Maintenance of circulatory volume Prevention of the development of thrombi
Decreased intracranial pressure Rationale: As an osmotic diuretic, mannitol helps reduce cerebral edema. Although there may be a transient increase in blood volume as a result of an increased osmotic pressure, which increases renal perfusion, this is not the therapeutic effect. Prevention of the development of thrombi is not the reason for giving this medication.
575) The nurse is caring for a 6-year-old child who has undergone craniotomy. The parents ask what effect mannitol has. Which response by the nurse is most appropriate? 'It relieves cerebral pressure.' 'It increases the bladder's filtration rate.' 'It reduces glucose excretion in the urine.' 'It decreases the peripheral retention of fluid.'
'It relieves cerebral pressure.' Rationale: Mannitol is an osmotic diuretic used to relieve cerebral edema. The bladder is a storage basin and is not involved with filtration; mannitol acts in the kidneys. Mannitol is an osmotic diuretic that affects neither the body's excretion of glucose nor peripheral edema.
1061) Which physiological function is the last function lost during anesthesia induction? Gag reflex Eyelid reflexes Voluntary control Respiratory movement
Respiratory movement Rationale: There is no respiratory movement in stage 4 of anesthesia; before this stage, respirations are depressed but present. The gag reflex is lost in stage 3 of anesthesia. Eyelid reflexes are lost in stage 2 of anesthesia. Voluntary control is lost in stage 2 of anesthesia.
363) Which assessment would the nurse perform specific to the safe administration of intravenous mannitol? Body weight daily Urine output hourly Vital signs every 2 hours Level of consciousness every 8 hours
Urine output hourly Rationale: Mannitol, an osmotic diuretic, increases the intravascular volume that must be excreted by the kidneys. The client's urine output should be monitored hourly to determine the client's response to therapy. Although mannitol results in an increase in urinary excretion that is reflected in a decrease in body weight (1 L of fluid is equal to 2.2 pounds [1 kg]), a daily assessment of the client's weight is too infrequent to assess the client's response to therapy. Urine output can be monitored hourly and is a more frequent, accurate, and efficient assessment than is a daily weight. Vital signs should be monitored every hour considering the severity of the client's injury and the administration of mannitol. Although the level of consciousness should be monitored with a head injury, conducting assessments every 8 hours is too infrequent to monitor the client's response to therapy.
1199) A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin would the nurse recommend? Vitamin E Vitamin B Vitamin D Vitamin C
Vitamin D Rationale: All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C helps maintain cartilage and connective tissue integrity but does not help prevent osteoporosis. Vitamins E and B do not help prevent osteoporosis.
1420) The nurse provides client teaching on the use of oral contraceptives. Which statement made by the client indicates to the nurse that teaching was effective? 'I will take my pill at the same time every day.' 'I can stop the pill and try to get pregnant right away.' 'I may miss two periods and not worry about being pregnant.' 'I am so glad we won't have to use condoms even if I miss just one pill during the month.'
'I will take my pill at the same time every day.' Rationale: Taking the pill at the same time every day makes it more effective, and the client should be instructed to do so. A woman should wait 2 to 3 months after stopping the oral contraceptive pill before attempting to become pregnant. If two consecutive menstrual cycles are missed, the client should stop the contraceptive pill and perform a pregnancy test. The client should use a barrier method of contraception for the first month of pill use and when a pill is missed to help prevent conception.
1155) A client is prepared for a supratentorial craniotomy with burr holes, and an intravenous infusion of mannitol is instituted. The nurse concludes that this medication is primarily given for which purpose? Lower blood pressure Prevent hypoglycemia Increase cardiac output Decrease fluid in the brain
Decrease fluid in the brain Rationale: Osmotic diuretics remove excessive cerebrospinal fluid (CSF), reducing intracranial pressure. Osmotic diuretics increase, not decrease, the blood pressure by increasing the fluid in the intravascular compartment. Osmotic diuretics do not directly influence blood glucose levels. Although there is an increase in cardiac output when the vascular bed expands as CSF is removed, it is not the primary purpose of administering the medication.
1453) Which birth control agent requires administration once every 3 months? Progestin-only pills Intramuscular progestin Combination biphasic forms Combination monophasic forms
Intramuscular progestin Rationale: Intramuscular progestin requires the administration of a single injection every 3 months. Progestin-only oral contraceptive pills should be taken on a daily basis because of a higher incidence of ovulatory cycles. Combination biphasic and monophasic forms are administered as either a 21- or 28-day course.
1433) The nurse teaches a client about side effects that necessitate discontinuation of oral contraceptives. Which statement made by the client indicates that the teaching was effective? 'I'll stop taking the pills if I have chest pain.' 'I'll stop taking the pills if I start to retain fluid.' 'I'll stop taking the pills if I have white discharge from the vagina.' 'I'll stop taking the pills if I have pain during the middle of my cycle.'
'I'll stop taking the pills if I have chest pain.' Rationale: Oral contraceptives should be discontinued with any symptom that may be related to a pulmonary embolus. Fluid retention is a common side effect of increased estrogen and progestin; discontinuation of the contraceptive is unnecessary. Leukorrhea may be a sign of infection, not a side effect of oral contraceptives. Abdominal pain in the middle of the menstrual cycle is not expected while an oral contraceptive is being taken. Abdominal pain in the area of an ovary that occurs midway during the menstrual cycle (mittelschmerz) usually indicates ovulation.
1372) A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate as a form of birth control. Which important information would the nurse include when teaching the client about this medication? 'Medroxyprogesterone offers protection against the herpes simplex virus.' 'You will need a repeat injection every 6 months.' 'Increase your intake of iron-rich foods to prevent anemia from increased blood loss during menstruation.' 'Increase your calcium intake and exercise because loss of bone mineral density may occur.'
'Increase your calcium intake and exercise because loss of bone mineral density may occur.' Rationale: Loss of bone mineral density is a significant side effect of depot medroxyprogesterone acetate, and increased calcium intake and exercise should be encouraged. Medroxyprogesterone should be administered every 11 to 13 weeks; 6 months is too long before the next dose. Menstrual periods usually lighten or disappear over time. Medroxyprogesterone confers no protection against herpes simplex virus.
1202) A 28-year-old woman who is a smoker seeks advice about oral contraceptives. Which response by the nurse is appropriate? 'Oral contraceptives can cause thrombophlebitis.' 'Oral contraceptives must be used with other methods.' 'Some oral contraceptives can be used without concern.' 'Some oral contraceptives are safe, but others are not safe.'
'Oral contraceptives can cause thrombophlebitis.' Rationale: Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis. Using oral contraceptives with other methods of contraception is not necessary if there are no contraindications; oral contraceptives are effective used alone. There is no 'safe' oral contraceptive for all women or one that may be used without concern; any client at risk should be informed of the potential consequences of taking an oral contraceptive.
1380) A client comes in for a pregnancy test. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. Which response by the nurse is appropriate? 'That's the trouble with using contraceptive pills. People frequently forget to take them.' 'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.' 'Let's find out whether you really are pregnant. If you are, you may want to consider having an abortion.' 'Contraceptive pills are unpredictable. You could have become pregnant even if you had taken them regularly.'
'You may be correct. The effect of contraceptive pills depends on them being taken on a regular schedule.' Rationale: An oral contraceptive program requires the client to take one tablet daily from the fifth day of the cycle and continue taking tablets for 20 or 21 days. Interrupting the monthly dosage program may permit release of luteinizing hormone, resulting in ovulation and possibly pregnancy. Stating that people often forget to take oral contraceptive pills is judgmental; contraceptive practice is the client's choice. It is premature to discuss abortion. Oral contraceptives that are taken on an exact schedule have a very high rate of success.
62 A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A. Take medication, go for a 30 minute morning walk, then eat breakfast. B. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C. Take medication with breakfast, then take a 30 minute morning walk. D. Go for a 30 minute morning walk, eat breakfast, then take medication.
A. Take medication, go for a 30 minute morning walk, then eat breakfast. Rationale: Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.
1205) Oral contraceptives are prescribed for a client who smokes heavily. Which side effect would the nurse warn the client might occur? Blood clots Cervical cancer Ovarian cancer Risk of coronary heart disease later in life
Blood clots Rationale: Heavy smoking is a major risk factor for an increased risk of thrombosis or blood clots. Cervical cancer is associated with human papillomavirus infection, not oral contraceptive use. Oral contraceptives have a protective effect against ovarian cancer. Although there is an increased risk of coronary heart disease while taking an oral contraceptive, this risk abates when it is no longer taken and does not carry over into later life.
1375) A 31-year-old client is seeking contraceptive information. While obtaining the client's history, which factor indicates to the nurse that oral contraceptives are contraindicated? Older than 30 years Current hypothyroidism Two multiple pregnancies Blood pressure 162/110
Blood pressure 162/110 Rationale: Oral contraceptives may cause or exacerbate hypertension; even borderline hypertension places the client at risk for a brain attack. Oral contraceptives are not contraindicated for women older than 30 years of age if there are no known risk factors. There is no relationship between oral contraceptives and multiple births. Contraceptives are not contraindicated in clients who have hypothyroidism.
1425) A client is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect? Cervicitis Ovarian cysts Fibrocystic breasts Breakthrough bleeding
Breakthrough bleeding Rationale: Breakthrough bleeding, or midcycle bleeding, commonly occurs when women start using oral contraceptives. If it persists, the dosage should be changed. There is no evidence that cervicitis, ovarian cysts, or fibrocystic breasts are related to the use of oral contraceptives.
324) Which vitamin would the nurse anticipate may become deficient in a client prescribed cholestyramine for the treatment of type II hyperlipoproteinemia? Niacin (vitamin B 3) Calciferol (vitamin D) Ascorbic acid (vitamin C) Cyanocobalamin (vitamin B 12)
Calciferol (vitamin D) Rationale: Bile acid sequestrants (also known as bile acid-binding resins) bind with bile acids to form an insoluble compound that is then excreted in the feces. These medications decrease the absorption of fat-soluble vitamins (A, D, E, K). Vitamins B 3, C, and B 12 are water-soluble vitamins and are not affected by the administration of this medication.
813) A health care provider prescribes mannitol for a client with a head injury. Which mechanism of action is responsible for therapeutic effects of this medication? Decreasing the production of cerebrospinal fluid Limiting the metabolic requirements of the brain Drawing fluid from brain cells into the bloodstream Preventing uncontrolled electrical discharges in the brain
Drawing fluid from brain cells into the bloodstream Rationale: Mannitol, an osmotic diuretic, pulls fluid from the brain to relieve cerebral edema. Mannitol's diuretic action does not decrease the production of cerebrospinal fluid. Mannitol does not affect brain metabolism; rest and lowered body temperature reduce brain metabolism. Preventing uncontrolled electrical discharges in the brain is the action of phenytoin sodium, not mannitol.
1398) The nurse is counseling a 34-year-old client who has requested a prescription for oral contraceptives. Which condition would warrant additional discussion? Anemia Depression Hypertension Dysmenorrhea
Hypertension Rationale: One of the side effects of oral contraceptives is hypertension; therefore they are contraindicated for any woman who already has hypertension, particularly at the client's age or older. Anemia is not a contraindication for women who want to take oral contraceptives because oral contraceptives may help this condition by decreasing bleeding. Depression is not a contraindication for women who want to take oral contraceptives. Oral contraceptives may be prescribed for women with menstrual difficulties such as dysmenorrhea.
1220) The nurse is caring for a client who has just received epidural anesthesia. The nurse would monitor for which adverse effects? Uterine atony Hypotension Decreased urine production Precipitous second stage of labor
Hypotension Rationale: Regional anesthesia lowers the blood pressure, which puts both mother and fetus in jeopardy. The client may not have the sensation to void, but the amount of urine manufactured does not decrease because a regional block does not affect the kidneys. Epidural anesthesia does not shorten the second stage of labor and does not cause uterine atony.
530) A 6-year-old child is receiving an intravenous solution of 10% glucose and mannitol to reduce cerebral edema. Which complication would the nurse monitor the child for? Overhydration Seizure activity Acute heart failure Hypovolemic shock
Hypovolemic shock Rationale: Both hypertonic glucose and mannitol cause diuresis; the child should be monitored for excessive fluid loss. Hypertonic glucose and mannitol will cause fluid loss, not gain. Seizure activity is not anticipated as a result of this infusion. An increased fluid volume can lead to heart failure; however, hypertonic glucose and mannitol cause fluid loss, not gain.
1215) A client who is a smoker expresses a desire to postpone her first pregnancy for at least 5 years and declines to use a barrier method. Which method would the nurse anticipate providing education for? A birth control patch A vaginal ring Medroxyprogesterone Combined oral contraceptive pills
Medroxyprogesterone Rationale: Medroxyprogesterone is a long-acting progestin-only contraceptive that is less likely to cause cardiovascular problems in women who smoke than contraceptives containing estrogen might. Vaginal rings, combined oral contraceptive pills, and the birth control patch all contain estrogen and are not recommended for women who smoke.
135) Which body function maintained by thiamine (vitamin B 1) and niacin (vitamin B 3) will the nurse monitor when prescribed for a client with alcoholism? Neuronal activity Bowel elimination Efficient circulation Prothrombin development
Neuronal activity Rationale: Thiamine and niacin help convert glucose for energy and influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacturing of prothrombin.
1381) A client taking oral contraceptives for 3 months tells the nurse she has breakthrough bleeding between menstrual cycles. For which causative factor would the nurse first assess in the client? Illness Anorexia nervosa Ectopic pregnancy Nonadherence to protocol
Nonadherence to protocol Rationale: Nonadherence to the instructions for taking the oral contraceptive can alter hormone levels, and breakthrough bleeding may occur as a result. Illness and anorexia nervosa are more likely to cause amenorrhea, not breakthrough bleeding. If nonadherence is determined not to be a concern, then the nurse would assess for far less likely causes such as ectopic pregnancy.
532) A child is prescribed intravenous mannitol. The nurse understands mannitol belongs to which classification of diuretics? Loop Osmotic Potassium sparing Carbonic anhydrase inhibitor
Osmotic Rationale: Osmotic diuretics, such as mannitol, increase the osmotic pressure of glomerular filtrate and thus decrease absorption of sodium; they are used to treat cerebral edema and increased intraocular pressure. Loop diuretics, such as furosemide, inhibit resorption of sodium and potassium in the loop of Henle; they are used for heart failure and pulmonary edema. Potassium-sparing diuretics, such as spironolactone, interfere with sodium resorption in the distal tubules, thus decreasing potassium excretion; they are used to treat cirrhotic ascites and pulmonary edema. Carbonic anhydrase inhibitors, such as acetazolamide, increase sodium excretion by decreasing sodium-hydrogen ion exchange. They are used to treat seizure disorders and open-angle glaucoma.
894) A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. Which type of toxicity would the nurse suspect? Retinol (vitamin A) Thiamine (vitamin B 1) Pyridoxine (vitamin B 6) Ascorbic acid (vitamin C)
Retinol (vitamin A) Rationale: Retinol is lipid soluble and eliminated by the liver. Joint pain, hair loss, jaundice, anemia, irritability, pruritus, and enlarged liver and spleen are signs of vitamin A toxicity. Thiamine, pyridoxine, and ascorbic acid are water soluble, so they are typically excreted in the urine before toxic blood levels can be achieved. However, excess thiamine may elicit an allergic reaction in some individuals, excess vitamin C (ascorbic acid) may cause diarrhea or renal calculi, and ultrahigh doses (about 800 times the normal dose) of pyridoxine (vitamin B 6) can promote neuropathy. Remember that lipid-soluble vitamins normally take longer to eliminate and accumulate faster than water-soluble vitamins.