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 A
Explanation
A. A reduced plasma albumin level can lead to increased free drug levels in the bloodstream, raising the risk of drug toxicity, particularly for highly protein-bound medications.
B. Decreased therapeutic effects are less likely because the decrease in albumin can lead to higher free drug concentrations, which may actually increase effects rather than decrease them.
C. Altered drug absorption is generally not directly influenced by plasma albumin levels; it relates more to gastrointestinal factors.
D. Increased drug metabolism is not a direct consequence of lower albumin levels; instead, the concern is primarily about increased free drug concentrations and potential toxicity.
Correct Answer is B
Explanation
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.