A client with depression has been taking citalopram, an SSRI, for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
"Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous."
"It's very important that you not take the St. John's wort at the same time of day as your antidepressant."
"It's very important that you comply with your prescribed treatment."
The Correct Answer is A
A. "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." is correct; St. John's wort can reduce the effectiveness of SSRIs and may increase the risk of serotonin syndrome, making it vital for the nurse to address this safety concern.
B. "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." is a valid point, but it does not specifically address the interaction with the client’s current medication.
C. "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." is misleading; the concern is not just about timing but about taking both together at all.
D. "It's very important that you comply with your prescribed treatment." while true, this response does not directly address the specific risks associated with combining St. John's wort and citalopram.
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Correct Answer is D
Explanation
A. The patient’s statement about the peak of NPH insulin being 6-12 hours is correct; it is important to know when to monitor for hypoglycemia.
B. Taking NPH before breakfast is appropriate, as it is typically given in the morning to provide coverage for meals throughout the day.
C. The duration of NPH insulin lasting for 12-18 hours is accurate, which is crucial for understanding how long the patient can expect blood glucose control.
D. NPH insulin should not be taken right before meals as it does not act quickly enough to cover immediate carbohydrate intake. Rapid-acting insulin is typically used for that purpose, indicating a need for further teaching.
Correct Answer is A
Explanation
A. Hypocalcemia is correct because esomeprazole, a proton pump inhibitor, can lead to decreased calcium absorption, resulting in low calcium levels, which can cause muscle cramps.
B. Hyperkalemia is incorrect; while potassium levels can be affected by various medications, muscle cramps are not typically associated with high potassium levels.
C. Hypercalcemia is incorrect as it refers to elevated calcium levels, which would not cause muscle cramps and could actually lead to muscle weakness rather than cramping.
D. Hyponatremia is incorrect; low sodium levels may cause other symptoms but are not specifically linked to muscle cramps in the same way as low calcium levels are.