Pharm Ch 10 Review Questions

1. A nurse is discussing complementary and alternative medicine (CAM) with a client. Which major advantage of CAM should the nurse consider during the discussion? a. Lower cost of treatment b. Reducing the need for medications c. Greater accessibility of therapies d. Fewer side effects from medications

1. Answer: b. Reducing the need for medications Objective: Explain the role of complementary and alternative medicine in promoting client wellness. Rationale: From a pharmacology perspective, the major value of CAM therapy is the ability to reduce the need for medications. Reduction of drug dose, with or without use of CAM, leads to fewer adverse effects from medications. CAM may or may not have a lower cost of treatment, and will vary based on the type of treatment and need of the client. Accessibility is not the major advantage.

10. A client reports to the nurse that he is taking dietary and herbal supplements to help lower his cholesterol levels. Which supplements should the nurse expect the client to mention during health assessment? (Select all that apply.) a. Cranberry b. Echinacea c. Flaxseed oil d. Garlic e. Green tea

10. Answer: c. Flaxseed oil; d. Garlic; e. Green tea Objective: Identify common specialty supplements taken by patients. Rationale: Herbal supplements that may be used to reduce blood cholesterol levels include flaxseed oil, garlic, and green tea. Cranberry is used to prevent urinary tract infections. Echinacea is associated with enhancement of the immune system.

2. A client is discussing the use of an herbal product, which has a liquid formulation. Which preparations of the herbal supplement should the nurse expect the client to mention during this assessment? (Select all that apply.) a. Extract b. Salve c. Tincture d. Infusion e. Alcohol

2. Answer: a. Extract; c. Tincture; d. Infusion Objective: Identify the parts of an herb that might contain active ingredients, and the types of formulations made from these parts. Rationale: The two basic formulations of herbal products are solid and liquid. Liquid formulations are made by extracting the active chemicals from the plant using solvents such as water, alcohol, or glycerol. The liquids are then concentrated in various strengths and ingested as extracts, infusions, teas, or tinctures. Solid products include pills, tablets, and capsules made from the dried herbs. Other solid products are salves and ointments that are administered topically.

3. A client interested in using herbal therapy expresses concern about its safety. When reviewing the regulation by the Dietary Supplement Health and Education Act of 1994, what information should the nurse include? a. A requirement for herbal products to be tested before manufacturing b. A requirement that manufacturers prove the efficacy of each product c. The power of the FDA to remove a product from the market if it poses a threat to the public d. A requirement of the manufacturer to prove that the product is safe for the general public

3. Answer: c. The power of the FDA to remove a product from the market if it poses a threat to the public Objective: Analyze the strengths and weaknesses of legislation regulating herbal and dietary supplements. Rationale: The DSHEA gives the FDA the authority to remove from the market any product that poses a significant or unreasonable risk to the public. Dietary supplements do not have to be tested before marketing, and the manufacturer does not have to prove the efficacy of the product.

4. During the admission interview, the nurse obtains information that the client is taking herbal supplements. What implications does this information have for the client's treatment? a. This is not important, as herbal products are natural and pose no risk to the client. b. These products are a welcome adjunct to conventional treatment. c. The nurse must observe the client for allergic or adverse reactions. d. The herbal products could interact with prescribed medications and affect drug action.

4. Answer: d. The herbal products could interact with prescribed medications and affect drug action. Objective: Describe the role of the nurse in teaching patients about complementary and alternative therapies. Rationale: Some herbal products contain ingredients that can serve as agonists or antagonists to prescription drugs. Herbal supplements should not be taken without discussion with the healthcare provider. While herbal products come from natural sources, this does not preclude any risks.

5. When providing teaching for a client who is planning to use herbal products, the nurse should include which information? a. Take the smallest amount possible when starting herbal therapy. b. Do not take herbal products for more than 2-3 weeks. c. Research the clinical trials before using the products. d. Read the label to determine indications for treatment or cure.

5. Answer: a. Take the smallest amount possible when starting herbal therapy. Objective: Discuss the role of the nurse in teaching patients about complementary and alternative therapies. Rationale: Natural products contain many active ingredients, many of which have not been tested or identified. Since clinical trials are not conducted on herbal products, the client should take the smallest amount possible when starting herbal therapy to determine any allergies or adverse reaction to the product. Clients with known allergies to food products or medicines should seek medical advice before using herbal supplements. Some products can be taken for longer than 2-3 weeks. Herbal supplements cannot make claims to treat or cure a disease.

6. The client states using the herbal product saw palmetto. The nurse determines that the product is helpful when the client reports which effect? a. The ability to fall asleep quickly b. Less difficulty initiating urination c. A decrease in the frequency of headaches d. Less burning and pain with urination

6. Answer: b. Less difficulty initiating urination. Objective: Describe the pharmacologic actions and safety of herbal and dietary supplements. Rationale: Saw palmetto is used to relieve urinary problems related to prostate enlargement, such as urinary hesitancy, urgency, and a decrease in urinary stream. This herbal product does not affect sleep, cause headaches, or relieve symptoms of a urinary tract infection.

7. A client receiving warfarin (Coumadin) therapy reports use of the herb feverfew. The nurse should observe the client for evidence of which finding? a. Liver toxicity b. Increased diuretic effect c. Renal dysfunction d. Increased bleeding potential

7. Answer: d. Increased bleeding potential Objective: Describe the pharmacologic actions and safety of herbal and dietary supplements. Rationale: Feverfew can lead to a client's increased risk for bleeding when taken with drugs that affect coagulation, such as aspirin, heparin, NSAIDs, and warfarin. Liver toxicity, increased diuretic effect, and renal dysfunction would not be anticipated with the use of feverfew together with warfarin.

8. A client taking an antidepressant reports also taking the herbal supplement St. John's wort. What should the nurse assess in the client? a. Neurological status for signs of sedation b. Respiratory status for signs of distress c. Symptoms of headache and dizziness. d. Vital signs for hypotension and slow pulse

8. Answer: c. Symptoms of headache and dizziness Objective: Describe the pharmacologic actions and safety of herbal and dietary supplements. Rationale: St. John's wort can interact with antidepressants and can lead to serotonin syndrome. Signs and symptoms of serotonin syndrome include agitation, sweating, headache, and dizziness.

9. The nurse is providing staff education about the benefits of adding dietary supplements to the treatment plan for clients. Which information is accurate? (Select all that apply.) a. Amino acids can promote muscle strength and endurance. b. Dietary supplements are an inexpensive alternative to traditional medicines. c. Glucosamine can help preserve cartilage around the joints. d. Dietary supplements protect older adults from side effects of prescribed drugs. e. Supplements are used to target general health conditions.

9. Answer: a. Amino acids can promote muscle strength and endurance; c. Glucosamine can help preserve cartilage around the joints. Objective: Discuss the role of the nurse in teaching clients about complementary and alternative therapies. Rationale: Specialty supplements are non-herbal dietary products used to enhance a wide variety of body functions. They are more specific in their action than herbal products and are generally targeted for a small number of conditions. Glucosamine is a natural substance in the body necessary for cartilage growth and maintenance. Amino acids are natural building blocks of muscle protein, and can help promote muscle strength and endurance. As with herbal products, the nurse should advise clients to report use of supplements to help determine any potential drug interactions with prescribed medications.

The patient wants to know how herbal products are regulated and why a person needs to be cautious when taking them. What is the most appropriate response by the nurse?

Herbal products are regulated by the Dietary Supplement Health and Education Act of 1994 (DHSEA). Herbal products are classified as dietary supplements, and they do not have to be tested prior to marketing. The manufacturer does not have to prove the safety of the dietary supplement; however, if it is removed from the market by DHSEA, the government has to prove that the product is unsafe. DHSEA does not regulate the accuracy of the label. The product may or may not contain the products listed in the amounts provided on the label. Some herbal products have ingredients that can serve as agonists or antagonists to prescription drugs. This is why the patient needs to be cautious about taking herbals and to let the physician know what herbals the patient is taking.

Mr. Hsu reports that he is interested in using additional "specialty supplements" in his efforts to promote his health status. Discuss the implications of using "specialty supplements" with prescribed medications.

Specialty supplements are nonherbal products that are used to promote a wide variety of body functions. These supplements are derived from either plant or animal sources. Their actions are generally more specific than many other herbal products and are targeted for specific body functions. As with herbal products, the link between most specialty supplements and their claimed benefits is unclear. In most cases, a normal diet supplies sufficient quantity of needed substances, and taking additional amounts may provide no benefit. In other cases, the product is marketed for conditions in which the supplement has no proven effect. These substances are generally not harmful unless taken in large amounts. Unfortunately, patients can get false hopes of an easy cure for chronic conditions such as heart disease or arthritis pain. As with herbal products, the nurse should assess and monitor the patient taking supplements and prescribed medications for any adverse interaction.

Lee Hsu is a 63-year-old male client of Chinese descent. He was born in the United States. He has studied complementary and alternative medicine (CAM) from his mother. He practices meditation, acupuncture, and yoga. In addition, he uses herbal products such as ma huang (Ephedra), ginger, and gingko biloba. During his annual physical examination, Mr. Hsu is diagnosed with an enlarged prostate gland. The physician prescribes finasteride (Proscar) to manage the condition. He also has elevated blood pressure and is placed on an antihypertensive medication. The nurse prepares to educate Mr. Hsu about his prescriptions and to answer his questions. 1. When the nurse is trying to educate Mr. Hsu about his newly prescribed medications, what is the nurse's best response to the patient when he begins talking about using herbal products?

The nurse needs to be sensitive to the patient's need for alternative treatment and must strive to avoid being judgmental. The nurse needs to present both the advantages and limitations of herbal medications, so that the patient can make informed decisions about treatment. Importantly, the nurse needs to identify any herbal preparations that the patient is taking, so that the healthcare provider and pharmacist can determine any drug interactions with the herbal products and the prescribed medications.