Chapter 10: The Use of Herbs and Supplements

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. The nurse preparing an educational program focused on herbal supplement targets as a likely interested group: a. Inner-city females who live below the poverty level b. White females who own their own successful businesses c. Male Hispanic Americans who are single, divorced, or widowed d. Men and women from small rural communities who are self-employed farmers

ANS: B

Non-Hispanic, white, older, normal-to-underweight women with more education were found to use dietary supplements more than any other racial, ethnic, age, or gender group.

DIF: Cognitive Level: Applying REF: p. 115

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

2. During an admission interview, a patient tells the nurse about taking Ginkgo biloba daily. The nurse responds to this information by inquiring whether the client: a. has ever been screened for depression. b. experiences gastrointestinal (GI) upset. c. has concerns regarding impotence. d. has reoccurring bouts of bronchitis.

ANS: B

Side effects of Ginkgo biloba include GI upset and should be assessed for by the nurse. Neither depression, nor impotence, nor chronic bronchitis conditions are generally self-treated with Gingko biloba. These conditions are not considered typical side effects of Gingko biloba either.

DIF: Cognitive Level: Applying REF: p. 118

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

3. An older adult client is being seen for the first time at the outpatient geriatric clinic. As a component of the nursing admission history, the nurse inquires about the use of herbs and other supplements. The basis for this inquiry is that such herbal therapy: a. may interact with prescription medications. b. is hazardous when used by older adults. c. replaces the need for prescription medications. d. causes excessive sedation in older adults.

ANS: A

The gerontological nurse has the obligation to ask questions and obtain specific information about the use of herbs and supplements because they may interact with prescription medications. When used cautiously and with knowledge of potential interactions with other medications, herbs and supplements are not hazardous. They do not replace the need for prescription medications. Not all herbs and supplements cause excessive sedation.

DIF: Cognitive Level: Applying REF: p. 124

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

4. The nurse is conducting a presurgical interview when it is noted that the older adult patient’s medication list includes Tylenol 650 mg four times a day for arthritic pain, gingko 80 mg twice a day, and glucosamine chondroitin 500 mg three times per day. The nurse proceeds to share with the client that in order to minimize the risk for postsurgical complications, there is the need to refrain from taking: a. glucosamine chondroitin for 1-2 weeks due to a potential for excess anesthetic sedation. b. ginkgo for 2 weeks due to the potential for increased bleeding. c. Tylenol for 24-48 hours due to the potential for increased bleeding. d. gingko for 1 week due to the potential for an allergic reaction during surgery.

ANS: B

It is recommended that ginkgo be discontinued for 2 weeks preoperatively due to the potential for increased bleeding. There is no evidence that ginkgo is associated with allergic reactions during surgery. There are no recommendations for discontinuation of glucosamine chondroitin, and glucosamine is not associated with a potential for increased sedation from anesthetics. Tylenol is not associated with a potential for increased bleeding.

DIF: Cognitive Level: Analyzing REF: p. 123, Table 10-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

5. When a nursing interview identifies that a client is daily taking doses of herbal supplements, the nurse’s priority is to: a. evaluate the effectiveness of the herbal supplement self-treatment. b. determine why the client feels the need to take the herbal supplements. c. identify when the herbal supplementation began. d. discuss the client’s knowledge regarding the herbal supplements’ side effects.

ANS: D

The conversation about the client’s use of herbal supplements should focus first on the client’s understanding of the herbs’ uses, side effects, dosage, and safety concerns. Once the therapeutic communication has established a nonjudgmental nature, the nurse can go on to if the client feels the supplements are effective, why the client feels the need to take the supplements, and when the supplements were started.

DIF: Cognitive Level: Analyzing REF: pp. 123–124

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

6. The nurse admitting a client to a same day surgery unit makes the decision to notify the surgical team to cancel the procedure based on the client’s statement that: a. “Will I start taking my St. John’s wort as soon as I can eat again?” b. “I’ve haven’t taken my ginkgo for exactly 10 days.” c. “I didn’t want to risk catching a cold so I took my echinacea with just a sip of water.” d. “It seemed strange not taking my garlic pill this morning.”

ANS: D

Herbs that can affect bleeding and clotting time, such as garlic, ginger, ginkgo, and ginseng, should be especially noted and reported to the surgical team. There is no known surgery-related risk involved with the regular self-medication of St. John’s Wort or echinacea. Ginkgo should be stopped at least 7 days prior to surgery.

DIF: Cognitive Level: Analyzing REF: p. 123

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

7. When a client who routinely takes the herb St. John’s Wort (SJW) shares that his or her “hay fever is really bad right now,” the nurse initially: a. notifies the primary care provider that the client has been self-medicating for hay fever. b. compares the client’s current blood pressure to his/her baseline blood pressure. c. stresses the need to avoid over-the-counter (OTC) medications containing monoamines. d. suggests that the client stop taking the herb until the hay fever has improved.

ANS: B

When taking SJW, people should be warned not to take medications containing monoamines, such as medications for nasal decongestants, hay fever, and asthma, because this combination may cause hypertension. The primary care provider should not be notified until the BP monitoring is known. Avoiding specific OTC medications and stopping the herb is information the client should have been given prior.

DIF: Cognitive Level: Analyzing REF: p. 123

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

8. The major focus regarding nursing education for the older adult regarding the use of herbal supplements is the: a. high risk of herbal overdose since the manufacturing process lacks effective controls. b. likelihood that the client will substitute herbals for more expensive prescribed medications. c. expense of the herbal supplements since they are seldom covered by insurance. d. possibility of dangerous interactions between herbals and the client’s prescription medications.

ANS: D

A major issue in the use of herb and other supplements is the risk for interactions. This is especially a concern due to the number of medications already taken by elders. While the remaining options are all legitimate concerns, they are not unique to the older adult consumer.

DIF: Cognitive Level: Applying REF: p. 122

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

9. The nurse is confident that the client who chooses to take red rice yeast daily for dyslipidemia has an understanding of its possible side effects when the client: a. has regular laboratory work to monitor cholesterol levels. b. shows caution by slowly rising from the chair. c. states, “If I start noticing muscle pain, I’ll stop taking the pills.” d. schedules regular, yearly glaucoma screenings.

ANS: C

Persons need to know the potential side effects of red yeast rice, similar to those of lovastatin, such as muscle pain. Regular cholesterol monitoring will not aid in the identification or management of possible side effects. The need to rise slowly from a chair is not directly related to the side effect of muscle pain. There is no current research to support the need for regular glaucoma screens as a precaution when taking red rice yeast.

DIF: Cognitive Level: Analyzing REF: p. 120

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies

Multiple Response

1. The nurse is confident that the client who takes glucosamine sulfate daily is conscientious of the safety issues involved when hearing the client state: (Select all that apply.)

a. “I’m always careful to buy the same brand of glucosamine sulfate.” b. “If glucosamine sulfate wasn’t safe the drug store wouldn’t sell it.” c. “My pharmacist is so helpful when I have questions about the herbals I take.” d. “The liquid form of glucosamine sulfate is what I consistently take.” e. “I made sure my physician knew that I was allergic to strawberries.”

ANS: A, C, D, E

Regarding product safety, there is no standardization among manufacturers, so the amount of active ingredients per dose among brands is inconsistent; herbs and supplements should be purchased from reputable sources; herbs are available in different forms, making accurate dosing difficult; and persons who have allergies to certain plants may have allergies to herbs in the same plant family. There is insufficient research data to confidently make a statement about the safety of such herbal therapy.

DIF: Cognitive Level: Applying REF: p. 124

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies a. in the natural state melatonin is produced by the pineal gland and regulates the sleep-wake cycle. b. melatonin is available in both immediate and extended release forms; however, only the immediate form is effective. c. there are no significant adverse effects to melatonin. d. it must be used with caution in a patient that is taking other medications that have central nervous system depressant effects. e. evidence shows that it is effective at decreasing sleep onset latency, improving quality of sleep, and improving morning wakefulness.

2. An older adult is having difficulty sleeping and asks a nurse, “My neighbor told me that I should take melatonin to help me sleep. What do you think about this?” The nurse responds to the individual’s question using the knowledge that: (Select all that apply.)

ANS: A, D, E

In the natural state, melatonin is endogenously produced by the pineal gland and is an important signal in regulating the sleep-wake cycle. Melatonin must be used with caution in patients who are taking other medications that cause drowsiness or have central nervous system depressant effects. Studies have demonstrated that melatonin is effective at decreasing sleep onset latency, improving quality of sleep, and improving morning wakefulness. Melatonin is available in both an immediate and extended release form, and both forms are effective. There are adverse effects to melatonin, which include dizziness, nausea, and drowsiness.

DIF: Cognitive Level: Applying REF: p. 120

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Pharmacological and Parenteral Therapies