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"]
Explanation
A. The client's skin and eyes are visibly jaundiced is correct because jaundice indicates a buildup of bilirubin in the blood, which is a sign of liver dysfunction.
B. The client's AST and ALT levels are elevated is correct because elevated levels of these liver enzymes indicate hepatocellular injury, which is consistent with liver damage due to acetaminophen overdose.
C. The client's temperature is 102.5° F (39.2° C) is incorrect; while a fever can occur in various conditions, it is not specific for liver damage in this context.
D. The client has an elevated red blood cell count is incorrect; elevated red blood cell counts are not indicative of liver damage and may be related to other factors.
E. The client's eyes are sensitive to light is incorrect; photophobia is not a direct indicator of liver damage and is more related to other conditions.
Correct Answer is C
Explanation
A. Hypertension can affect drug distribution to some extent due to altered perfusion but is not the most significant factor impacting distribution, especially for a local condition like cellulitis.
B. Liver dysfunction primarily affects the metabolism and clearance of drugs rather than their distribution, although it may indirectly influence distribution by altering protein binding.
C. Peripheral vascular disease significantly impacts blood flow to the extremities, which can hinder the distribution of the antibiotic to the affected area (the left leg) where the cellulitis is present, leading to reduced drug efficacy.
D. Diverticulitis disease primarily affects the gastrointestinal system and would not directly influence the distribution of an antibiotic used to treat cellulitis in the leg.