Question 1

The nurse is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse?

Accepted Answer

St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450, accelerates the metabolism of many drugs, causing loss of therapeutic effects. St. John's wort reduces the effects of digoxin, because P-glycoprotein transports drugs out of tubular cells of the kidney and into the urine, greatly reducing digoxin levels. St. John's wort does not counteract the beneficial effects of CNS depressants; it can actually intensify the effects of serotonin. St. John's wort is not known to increase the risk of bleeding.

Question 2

A nurse is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the nurse will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement?

Accepted Answer

Ginkgo biloba can suppress platelet aggregation and will increase the risk of bleeding in patients taking antiplatelet medications and anticoagulants. Coenzyme Q-10, Ma Huang, and St. John's wort do not have antiplatelet actions.

Question 3

Which claim may be made by manufacturers of dietary supplements? (Select all that apply.)

Accepted Answer

Claims cannot be made that address a specific disease or condition. Manufacturers can say that their product energizes and rejuvenates (not "treats insomnia"), promotes pulmonary health (not "clears secretions"), and reduces stress (not "treats anxiety"). Claims of reducing symptoms associated with conditions cannot be made, such as pain from arthritis or hot flashes from menopause.

Question 4

A patient will begin taking immunosuppressant drugs for rheumatoid arthritis. The nurse will caution this patient to avoid which dietary supplement?

Accepted Answer

Echinacea stimulates the immune system so it should not be used in patients with autoimmune disease such as RA; it also compromises the effectiveness of immunosuppressive drugs. Black cohosh, feverfew, and glucosamine are not contraindicated in patients with RA.

Question 5

A patient admitted to the emergency department with abdominal pain tells the nurse he has been taking kava. Which action is the nurse's priority at this time?

Accepted Answer

Kava can cause severe liver injury and, in some cases, require liver transplantation. This patient has abdominal pain, which can be the result of liver damage, so liver function tests should be reviewed. Kava does not affect the respiratory system, the cardiovascular system, or the blood-forming organs.

Question 6

A nurse discusses ginger root with a pregnant patient who asks about the risks and benefits of using ginger root to treat morning sickness during pregnancy. Which statement by the patient indicates a need for further teaching?

Accepted Answer

Ginger root can increase the risk of bleeding in patients taking other anticoagulant or antiplatelet drugs. In high doses, it can cause GI disturbances. It has been shown to be effective in treating morning sickness. It may affect fetal sex hormones.

Question 7

A nursing student asks a nurse what the NMBER system that rates dietary supplements means. The nurse responds that the NMBER system:

Accepted Answer

The Natural Medicines Brand Evidence-Based Rating (NMBER) system offers evidence-based ratings for over 60,000 supplement products based on scientific evidence of safety and efficacy. Information from this system does not describe the chemistry, toxicology, pharmacology, and uses of the products or describe data from clinical trials. The system does not fund research on these products.

Question 8

A patient in her twenties has frequent urinary tract infections, and her prescriber suggests drinking cranberry juice. She asks the nurse how drinking this can help. The nurse will tell her that cranberry juice:

Accepted Answer

Cranberry juice helps prevent UTIs by preventing bacteria from adhering to the urinary tract wall. It does not acidify the urine or treat established infections. It can reduce odor, but this action does not contribute to decreased infections.

Question 9

A patient asks a nurse how to know whether dietary supplements are safe. The nurse will tell this patient that:

Accepted Answer

Dietary supplements are regulated under the Dietary Supplement Health and Education Act of 1994 (DSHEA). This special category exempts them from the scrutiny applied to foods and drugs. A set of standards issued by the FDA in 2007 is designed to ensure that supplements are devoid of adulterants, contaminants, and impurities and that labels reflect the contents-these standards do not ensure safety and efficacy. Efficacy claims must be provided but are not required to prove these claims; a claim to efficacy does not guarantee safety. Regulations prohibiting disease-specific claims do not ensure safety. The FDA does not approve dietary supplements prior to marketing.

Question 10

A patient will begin taking drugs for hyperlipidemia. The patient asks about using flaxseed supplements to increase fiber. What will the nurse tell this patient?

Accepted Answer

Flaxseed may reduce the absorption of conventional drugs and should be taken 1 hour prior to or 2 hours after taking drugs. Defatted flaxseed is not recommended for patients with hyperlipidemia. It does not help with the absorption of medications. It has shown efficacy in reducing cholesterol and LDL.

Quiz 108: Dietary Supplements