Chapter 05: Complementary and Alternative Therapies McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition

Multiple Choice

1. A family member expresses concern that a patient is taking several herbal remedies and worries that they may be unsafe. The nurse will respond by saying that herbal products: a. are classified as medications by the Dietary Supplement Health and Education Act of 1994. b. are regulated by the government and are determined to be safe. c. aren’t usually effective but are generally harmless. d. should be discussed with the patient’s provider in conjunction with other medications.

ANS: D

Herbs are sometimes useful but can also be useless or dangerous. There are no agencies that regulate safety and efficacy. Patients should always tell providers if they are taking any herbal remedies since there are known drug–herbal interactions and side effects.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Ginger can cause fetal birth defects.” b. “Ginger is not safe during pregnancy.” c. “Ginger can cause abortion in low doses.” d. “Ginger may be taken for the short-term treatment of nausea associated with pregnancy.”

2. A pregnant woman tells the nurse that she is taking ginger to reduce morning sickness. What will the nurse tell this patient?

ANS: D

Ginger may be taken during pregnancy for morning sickness, but only on a short-term, low-dose basis. There is no indication that it causes fetal birth defects.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient asks the nurse about an herbal supplement and reports that it has a United States Pharmacopeia (USP) seal of approval. The nurse explains that this indicates: a. identity, potency, purity, and labeling accuracy. b. premarket testing for safety and efficacy. c. structure and function claims may be made. d. the supplement’s ability to prevent and treat disease.

ANS: A

The USP “seal of approval” indicates accuracy of the products identity, potency, purity, and labeling. It does not indicate premarket research on safety and accuracy, does not allow manufacturers to make claims about the function of the products, and does not indicate the substance’s ability to prevent and treat disease.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Ginseng will inhibit your immune system.” b. “Ginseng can increase risk of hypoglycemia if taken with diabetes medications.” c. “Side effects of ginseng are common.” d. “You may experience a decrease in blood pressure while taking ginseng.”

4. A woman reports using ginseng to treat menopausal symptoms. Which response by the nurse is correct?

ANS: B

People with diabetes taking ginseng should consult with their provider if used in conjunction with other herbs or drugs, because hypoglycemia may result. It may boost the immune system. Side effects are rare except with long-term use or in large doses. Ginseng can increase blood pressure.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Assessment/Nursing Intervention

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Hawthorn may be used long term in conjunction with nitrates.” b. “Hawthorn may contribute to hypertension.” c. “Hawthorn may interact with antihypertensive drugs.” d. “Hawthorn treats heart failure by lowering potassium levels.”

5. A woman who is experiencing symptoms of heart failure asks the nurse about using hawthorn. Which response by the nurse is correct?

ANS: C

Hawthorn may increase the action of antihypertensive medications. Its efficacy is not conclusive and it may interact with nitrates. It may decrease blood pressure. There is no evidence that hawthorn lowers potassium levels.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. “The root extract is proven to be effective in treating upper respiratory and urinary tract infections.” b. “Research regarding the benefits of Echinacea is inconclusive.” c. “Use it as needed when antibiotics fail to treat your infections.” d. “You may use it safely up to 8 weeks at a time as a preventive medication.”

6. A patient who has HIV asks the nurse about taking Echinacea to improve immune function. What will the nurse tell this patient?

ANS: B

Research regarding the benefits of Echinacea as treatment for cold and flu symptoms is inconclusive. The use of Echinacea to stimulate the immune system of patients with HIV is being investigated, but its use is currently not recommended.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I should experience immediate effects with this herb.” b. “Potential side effects include gas, bloating, and heartburn.” c. “I should take ginger with nonsteroidal anti-inflammatory drugs (NSAIDs) to enhance its effects.” d. “If I develop gastrointestinal (GI) upset, I should stop taking ginger immediately.”

7. The nurse is counseling a female patient who reports taking ginger to treat postoperative nausea. Which statement by the patient indicates understanding of the teaching?

ANS: B

Patients may not experience immediate beneficial effects. Patients should not take ginger with NSAIDs without consulting the provider. GI upset (gas, bloating, heartburn) are common side effects of the herb, but do not require immediate discontinuation.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Echinacea b. Ginkgo biloba c. Kava d. Sage

8. The nurse is providing preoperative education to a patient who will have surgery in several weeks. The patient denies taking anticoagulant medications but reports using herbal supplements. Which herb would cause the nurse to be concerned about increased bleeding risk when used with blood thinners?

ANS: B

Ginkgo can prolong bleeding time and therefore should be discontinued 2 weeks prior to surgery.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I may take licorice root with prednisone.” b. “I may develop hypotension while taking licorice root.” c. “I should avoid licorice root when pregnant.” d. “I should try licorice instead of coming back to see the provider.”

9. The nurse provides counseling to a patient who reports taking licorice root to treat a stomach ulcer. Which statement by the patient indicates understanding of the teaching?

ANS: C

In large amounts, licorice root has been associated with preterm labor and should be avoided in women who are pregnant. Licorice root when taken with corticosteroids can lead to life-threatening hypokalemia. In large amounts, it can elevate blood pressure. The benefits of licorice in the treatment of any condition have not been proven, and the client should see the provider rather than turn to the herbal medication.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Ginkgo biloba b. Kava c. Milk thistle d. Sage

10. Which herb listed below is used to treat cirrhosis and chronic hepatitis?

ANS: C

Milk thistle has been used widely to treat cirrhosis, chronic hepatitis, and gallbladder disorders.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Apply sunscreen while taking St. John’s wort.” b. “It is absolutely safe to take St. John’s wort with prescription antidepressants.” c. “St. John’s wort only interacts with antidepressant medications.” d. “You should take St. John’s wort as needed when symptoms occur.”

11. A patient reports taking St. John’s wort to treat symptoms of depression and asks the nurse how to use this product safely and effectively. Which response by the nurse is correct?

ANS: A St. John’s wort can cause photosensitivity, so patients should be counseled to use sunscreen. Combined use with prescription antidepressants has been associated with a potential increase in the risk of suicidal ideation, so use should be discussed with the healthcare provider. St. John’s wort interacts with a variety of other medications. Full effects do not occur for 4 to 8 weeks, so it cannot be taken as needed.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Consumers should research products and their manufacturers before taking.” b. “Manufacturers are required to list interactions of herbs with drugs and food.” c. “Products manufactured for drug and grocery store chains are safe.” d. “Toxicological analysis is required of all commercial herbal products.”

12. A patient asks the nurse about the safety of herbal products in general. Which response by the nurse is correct?

ANS: A

There are no comprehensive regulations of herbal supplements regarding safety and efficacy, so consumers should research herbs and product manufacturers. Companies manufacturing for drug and grocery stores are suspect and do not always list all ingredients on their labels.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Actions and uses b. Interactions and precautions c. Scientific name of the product d. Safety and efficacy study results

13. Which information can consumers expect to be included in labeling of herbal products?

ANS: C

Manufacturers should list the scientific name of the product and the parts of the plant used in preparation. They are not required to list actions, uses, interactions, precautions, and any results of safety or efficacy studies.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: N/A

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. Which herbal remedies are often used for GI disorders? (Select all that apply.)

a. Chamomile b. Cinnamon c. Echinacea d. Ginger e. Ginkgo Biloba f. Peppermint

ANS: A, B, D, F

Chamomile, cinnamon, ginger, and peppermint are often used to treat GI disorders.

DIF: Cognitive Level: Remembering (Knowledge)

TOP: Nursing Process: N/A

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies