Chapter 108: Complementary & Alternative Therapy (Evolve)

A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement? A. Ginger root (Zingiber officinale) B. Garlic (Allium sativum) C. Coenzyme Q-10 (CoQ-10) D. Feverfew (Tanacetum parthenium)

A. Ginger root (Zingiber officinale) Ginger root is used to suppress nausea and vomiting caused by motion sickness and morning sickness and also for postoperative nausea and vomiting. It may be involved in the blockade of serotonin receptors located in the chemoreceptor trigger zone of the brain. Garlic, coenzyme Q-10, and feverfew are not used to suppress nausea and vomiting.

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? A. Ma huang (Ephedra) B. Valerian (Valeriana officinalis) C. St. John's wort (Hypericum perforatum) D. Saw palmetto (Serenoa repens)

A. Ma huang (Ephedra) Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death. The ban was challenged in 2007, but a rehearing petition was denied. Valerian, St. John's wort, and saw palmetto are currently available for sale in the United States.

It is most important for the nurse to inform which patient NOT to use ginkgo biloba? A. A patient with Alzheimer's disease and hypertension B. A patient with atrial fibrillation taking warfarin [Coumadin] C. A patient taking sildenafil [Viagra] for erectile dysfunction D.A patient prescribed fluoxetine [Prozac] for depression

Answer: B Rationale: Gingko biloba suppresses coagulation and should be used with caution in patients taking antiplatelet drugs, anticoagulants (such as warfarin), and heparin.

A patient plans to take saw palmetto. Which statement should the nurse include when teaching the patient about this supplement? A. Saw palmetto has numerous serious adverse effects. B. Saw palmetto should be used with caution in patients taking antiplatelet drugs. C. Saw palmetto is used to treat hot flashes associated with menopause. D. Beneficial effects of saw palmetto usually occur within 1 week.

Answer: B Rationale: Saw palmetto should be used with caution in patients taking antiplatelet drugs (such as aspirin) or anticoagulants (eg, warfarin or heparin). Saw palmetto is very well tolerated. In rare cases, saw palmetto causes nausea or headache. Although antiandrogenic effects (eg, gynecomastia) have not been reported, it may be wise to monitor for them. Saw palmetto may have antiplatelet actions, but increased bleeding has not been reported. Saw palmetto (Serenoa repens, Sabal serrulata) is taken to relieve urinary symptoms associated with benign prostatic hypertrophy (BPH). Benefits of saw palmetto take at least 1 or 2 months to develop.

A patient with diabetes mellitus type 2 is taking an oral hypoglycemic agent. The patient tells the nurse that he wants to start taking garlic supplements. It is most important for the nurse to do what? A. Inform the patient that garlic may interfere with absorption of the oral hypoglycemic agent. B. Caution the patient against taking any herbal supplement. C. Warn the patient that garlic can potentiate the effects of the oral hypoglycemic agent. D. Teach the patient that ingestion of garlic with oral hypoglycemic agents can cause hyperglycemia.

Answer: C Rationale: Garlic can increase insulin levels and thus potentiate the hypoglycemic effects of drugs for diabetes.

Which statement about St. John's wort does the nurse identify as true?A. St. John's wort is often used in combination with other antidepressants for a more rapid response to treatment. B. Use of St. John's wort in patients taking digoxin results in increased digoxin levels. C. St. John's wort has been found to be effective in the treatment of severe depression. D. Serotonin syndrome is a potential adverse effect of therapy with St. John's wort.

Answer: D Rationale: Combining St. John's wort with certain drugs can intensify serotonergic sufficient to cause potentially fatal serotonin syndrome. Also, because St. John's wort has a variety of known adverse interactions and is likely to have more that are as yet unknown, caution is clearly advised. St. John's wort is not recommended for treating depression in patients taking other medications. St. John's wort greatly reduces levels of digoxin, a drug for heart failure. For patients with mild to moderate major depression, St. John's wort appears superior to placebo and equal to tricyclic antidepressants. For patients with severe depression, there is no convincing proof of efficacy.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with coumadin therapy. What herbs should the nurse include in the teaching? (Select all that apply.) A. Echinacea B. Garlic C. Ginger root D. Gingko biloba E. Valerian

B. Garlic C. Ginger root D. Gingko biloba Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatoxicity C. Suicidal behavior D. Acute renal failure

B. Hepatoxicity In the United States, kava is promoted as a natural alternative to benodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatoxicity, which lead the FDA to issue a public warning in March 2002. Also, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatoxicity.

A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication? A. Docusate sodium [Colace] B. Insulin C. Furosemide [Lasix] D. Aspirin

B. Insulin Black cohosh may potentiate the hypoglycemic effect of insulin and oral hypoglycemics. In addition, adverse hypotensive effects have been associated with antihypertensive medications. No interactive effects have been reported with docusate sodium, aspirin, or furosemide.

The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient? A. Increase consumption of foods high in vitamin K. B. Do not take any dietary or herbal supplements. C. Notify the healthcare provider immediately if you experience any signs of bleeding. D. Research studies have shown there is no benefit in using herbs to treat medical conditions.

C. Notify the healthcare provider immediately if you experience any signs of bleeding. Glucosamine may increase the risk of bleeding in patients taking anticoagulants such as coumadin. The nurse should educate the patient about the signs of bleeding. Glucosamine is widely used to treat osteoarthritis of the knee, hip, and wrist. Increasing vitamin K intake may decrease the effect of Coumadin.

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)? A. Lowers cholesterol B. Relieves menopausal hot flashes C. Supports the immune system D. Reduces pain of arthritis

C. Supports the immune system The DSHEA restricts the wording of labels on product packaging. A label cannot claim to diagnose, treat, cure, or prevent disease. However, the label is allowed to state the product's ability to favorably influence body function or structure. Statements on a label such as "reduces the pain of arthritis," "lowers cholesterol," and "relieves menopausal hot flashes" would not be in compliance with DSHEA regulations.

The nurse recognizes that the supplement echinacea (Echinacea angustifolia) should not be taken as prolonged therapy for patients with which condition? A. Peptic ulcer disease B. Diabetes C. Glaucoma D. Tuberculosis

D. Tuberculosis When taken on a short-term basis to suppress inflammation and stimulate the immune system, echinacea has few adverse effects. However, if taken as long-term therapy, it can suppress immune function. It should be avoided in patients with chronic infections, such as tuberculosis, that require optimal immune function. Patients with diabetes, peptic ulcer disease, or glaucoma need not avoid taking echinacea.