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","B","C"]
Explanation
A. Auscultating bowel sounds is important because anticholinergic agents can decrease gastrointestinal motility, leading to reduced bowel sounds and potential constipation.
B. Monitoring urine output is crucial as anticholinergics can cause urinary retention, and assessing output helps identify any adverse effects on bladder function.
C. Monitoring heart rate is necessary since anticholinergic agents can cause tachycardia as a side effect, making it important to assess the client’s cardiovascular status.
D. Administering an antidiarrheal agent is not typically indicated, as anticholinergic agents often cause constipation rather than diarrhea.
E. Assessing deep tendon reflexes is not directly relevant to the effects of anticholinergic medications and is not typically prioritized in this context.
Correct Answer is B
Explanation
A. Using combination therapy may be beneficial in some cases but is not the first step in ensuring the most appropriate drug is chosen for a specific pathogen.
B. Obtaining sensitivity testing is essential to determine the specific antibiotic to which the pathogen is susceptible, ensuring effective treatment.
C. Checking client allergies is important to prevent adverse reactions but does not directly address whether the chosen drug is appropriate for the pathogen.
D. Evaluating the bactericidal effects is part of assessing the treatment's effectiveness, but it should follow sensitivity testing to determine the correct medication.