Week 4 assessment
A patient is drinking at least 1 L of cranberry juice daily for the prevention of urinary tract infection. Which statement would cause the nurse to instruct the patient to use caution? "I eat red meat once a week." "My joints hurt all of the time." "I've had kidney stones in the past." "I have to urinate every couple of hours."
"I've had kidney stones in the past." Rationale Drinking more than 1 L/day may increase the risk of gastrointestinal upset and formation of uric acid kidney stones. Using the restroom every couple of hours is not an issue. The patient's weekly consumption of red meat should not alarm the nurse. Joint pain is unrelated. p. 1333
The nurse is teaching a patient about the benefits of soy. Which patient statement confirms that the patient understands the benefits of soy? "I can take soy with my tamoxifen." "Soy might help me with hot flashes." "I shouldn't eat meat if I'm taking soy." "Soy can help me with my depression."
"Soy might help me with hot flashes." ationale Soy protein and soy isoflavones have several uses, including prevention of breast cancer and, in postmenopausal women, treatment of hot flashes and prevention of osteoporosis. St. John's wort is used to treat mild depression. There are no contraindications to eating meat and taking soy. Soy should not be combined with tamoxifen and other drugs that can block estrogen receptors
In reviewing the home medications of a patient who has been given a new prescription for orlistat, the nurse notes that the patient takes levothyroxine. The nurse should provide which instruction? "Take the orlistat and the levothyroxine at least 4 hours apart." "Take the orlistat 30 minutes to 1 hour after the levothyroxine." "Take the levothyroxine on a full stomach right before bedtime." "Take the orlistat and the levothyroxine 1 hour after your multivitamin."
"Take the orlistat and the levothyroxine at least 4 hours apart."
The nurse is interviewing a patient who has chronic obstructive pulmonary disease (COPD). The patient wants to use herbal medications rather than conventional medications to treat a cold. Which statement made by the nurse is appropriate? "Herbal supplements have more side effects than conventional medications." "Many herbal medications are very expensive compared to conventional medications." "You should discuss any plans to take herbal medications with your primary healthcare provider." "You will need a prescription from your primary healthcare provider for herbal medications."
"You should discuss any plans to take herbal medications with your primary healthcare provider." Rationale Herbal drugs, as conventional drugs, may interact with drugs being taken for a number of conditions and/or may worsen those conditions, so decisions should be made in consultation with the primary care provider. Most herbal medications are available at a lower cost because of the low cost of production. Overall, herbal medications tend to be less expensive than conventional medications. Herbal supplements are made from natural substances, so they have fewer side effects compared to conventional medications. Herbal medications are supplied without a prescription.
The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time?
30m page 1003
A nurse is reviewing the medication records for vitamin K. The nurse will hold vitamin K and call the provider regarding which patient? A newborn infant A patient taking warfarin A patient with celiac disease A patient with megaloblastic anemia
A patient taking warfarin Rationale Vitamin K is not given to a patient taking warfarin, as this will interfere with the action of the warfarin. There is no contraindication to administering vitamin K for the other patients. p. 1001
Which factor in a patient's history is most likely related to the development of thiamine (vitamin B 1) deficiency? Exposure to asbestos Chronic alcohol abuse Gastric resection surgery Having a heart transplant
Chronic alcohol abuse That's right! Rationale Thiamine deficiency is common in individuals who abuse alcohol. Thiamine requirements are related to caloric intake, and principal dietary sources are enriched, fortified, or whole-grain products, such as breads and cereals. Exposure to asbestos, heart transplantation, and gastric resection surgery are situations unrelated to thiamine deficiency.
The nurse is reviewing the chart of a patient with human immunodeficiency virus infection. Which piece of data would alert the nurse to follow up? Orange juice Acetaminophen Fiber supplement Echinacea supplement
Echinacea supplement Rationale The information indicates that the patient is immunocompromised. Because echinacea acts by suppressing the immune system, it should not be given to this patient. Orange juice, acetaminophen, and fiber supplementation are not contraindicated for patients with human immunodeficiency virus. p. 1333
The patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement? Garlic (Allium sativum) Coenzyme Q-10 (CoQ-10) Ginger root (Zingiber officinale) Feverfew (T anacetum p arthenium)
Ginger root (Zingiber officinale)
A patient questions the nurse about herbal treatments for arthritic pain. What is the nurse's best response? "Glucosamine has shown promise. Consult your healthcare provider." " Ginkgo biloba has proven to be very useful as an antiinflammatory agent." "There are no safe herbal treatments for pain; take your prescription medications." "High doses of vitamins have been used for many years to help maintain joint health."
Glucosamine has shown promise. Consult your healthcare provider."
A patient receiving vitamin K most likely has demonstrated what? Diarrhea Confusion Seizure activity Hypoprothrombinemia
Hypoprothrombinemia Rationale Vitamin K is an essential nutrient for the synthesis of clotting factors. It is also the antidote for warfarin, an oral anticoagulant. The administration of vitamin K enhances the coagulation process, thus minimizing a patient's risk for excessive bleeding. Vitamin K is not used for the treatment of diarrhea, confusion, or seizures. p. 1002
In assessing a patient with a vitamin A deficiency, the nurse should determine if the patient has which manifestation? Excessive sweating Impaired night vision Tender, bleeding gums Disturbed sleep patterns
Impaired night vision Rationale Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency. Vitamin A is used primarily for the prevention or correction of vitamin A deficiency. Tender, bleeding gums, disturbed sleep patterns, and excessive sweating are not related to manifestations of vitamin A deficiency.
Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death? Ma huang (ephedra) Valerian (Valeriana officinalis) Saw palmetto (Serenoa repens) St. John's wort (Hypericum perforatum)
Ma huang (ephedra)
The patient takes feverfew daily. The nurse recalls that feverfew is commonly used to prevent what condition? Constipation Viral infections Migraine headaches Urinary tract infection
Migraine headaches
A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? Delayed healing Bone and joint pain Nausea and diarrhea Loosening of the teeth
Nausea and diarrhea Rationale Large doses of vitamin C can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain, and loosening of the teeth are unrelated to the side effects of vitamin C; they actually are symptoms of scurvy, a deficiency of vitamin C.
Which statement is found in the Dietary Supplement Health and Education Act (DSHEA) of 1994? No proof of efficacy is required for legend drugs. No proof of efficacy is required for dietary supplements. No proof of efficacy is required for over-the-counter drugs. Dietary supplements have to be supplied upon prescription.
No proof of efficacy is required for dietary supplements. Rationale According to the DSHEA of 1994, no proof of efficacy is required for dietary supplements because they are considered to be safe. In contrast to this, proof of efficacy is required for legend drugs and over-the-counter drugs. These drugs have a narrow therapeutic index when compared to dietary supplements. Prescription is not required for selling and supplying dietary requirements to patients because they have a greater margin of safety.
A patient is taking lorcaserin for weight loss and takes dextromethorphan over the counter for a cough. What will the nurse monitor for in this patient? Kidney stones Acute pancreatitis Nothing, this is safe Serotonin syndrome
Serotonin syndrome Rationale When serotonergic drugs such as lorcaserin are given with other serotonergic drugs (like dextromethorphan or bupropion), the risk for serotonin syndrome increases. Kidney stones and acute pancreatitis are associated with orlistat. It is not safe to give these types of drugs together.
The provider writes a prescription for lorcaserin. Which medication on the patient's current medication list would prompt the nurse to provide further teaching to the patient? Vitamin D Meloxicam Sertraline Omeprazole
Sertraline Rationale Serotonin syndrome is a risk associated with serotonergic drugs. When serotonergic drugs such as lorcaserin are given with other serotonergic drugs, this risk increases. Caution and close monitoring are advised when administering this drug along with selective serotonin reuptake inhibitors such as sertraline. Patients should be taught to monitor for symptoms of serotonin syndrome. Vitamin D, meloxicam, and omeprazole do not pose the same concerns. p. 1010
A patient who has depression is admitted to the emergency department with serotonin syndrome. The nurse learns that the patient is taking an herbal medication and citalopram. Which herbal medication is the patient most likely taking? Valerian Cranberry Saw palmetto St. John's wort
St. John's wort
Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)? Lowers cholesterol Reduces pain of arthritis Supports the immune system Relieves menopausal hot flashes
Supports the immune system
The nurse is reviewing the chart of a female patient who is scheduled for a hip replacement. Based on the chart information, what information about black cohosh will the nurse share with the patient? Increasing black cohosh will help normalize blood pressure. Drinking orange juice with black cohosh can cause toxic effects. Taking antihypertensives and black cohosh can cause hypotension. Black cohosh interacts with central nervous system (CNS) depressants.
Taking antihypertensives and black cohosh can cause hypotension.
A patient's body mass index (BMI) is 35. How should the nurse interpret this finding? The patient is obese. The patient is overweight. The patient is underweight. The patient is of normal weight.
The patient is obese.
A patient is admitted with multiple bruises over the arms and legs. What should be the nurse's first action? To call the healthcare provider To draw blood for coagulation studies To notify the police about possible abuse To ask the patient for a list of medications and herbal supplements
To ask the patient for a list of medications and herbal supplements Rationale The nurse should first assess before acting. Medications as well as supplements can cause a patient to be susceptible to bruising. The other actions would occur after assessment.
A patient who has inflammation of the liver has tenderness in the upper right abdomen and yellowish discoloration of the skin and sclera. After checking the patient's history, the nurse finds that the patient has been taking kava, an herbal drug, for a long time. What should the nurse teach the patient? To stop using kava To use acetaminophen To use dextromethorphan To use other herbal products
To stop using kava Rationale The patient has inflammation of the liver due to the use of kava. Prolonged use of kava may lead to liver toxicity; therefore, its use should be prevented. The use of acetaminophen should also be discontinued because it can cause liver toxicity. Dextromethorphan is used as a cough suppressant. Other herbal drugs may have side effects and should not be used unless cleared by the primary healthcare provider. p. 1341
The nurse is assessing a patient who has been taking warfarin phytonadione. The lab reports reveal that the patient has developed venous thromboembolism. What vitamin ingestion may be the reason for this finding? Vitamin A Vitamin D Vitamin E Vitamin K
Vitamin K
While performing an admission interview, which question would be the most appropriate for the nurse to ask the patient concerning the use of herbal supplements? "What is your opinion about herbal supplements?" "What supplements do you take, and how often do you take them?" "Is your healthcare provider aware of the herbal supplements you take?" "Are you aware that you must stop all herbal supplements before being admitted?"
What supplements do you take, and how often do you take them?" Rationale A goal of the admission interview is to determine what medications, including herbs, the patient takes, as this may affect the patient's treatment or interfere with medications. The patient does not need to stop herbal supplements before being admitted to the hospital. The nurse does not have to ask the patient's opinion about herbal supplements. Rather than asking if the healthcare provider is aware, the nurse should specifically ask what herbal supplements the patient uses.
