ANSWERS AND RATIONALES
The correct answer number and rationale for why St. John’s wort is a pill or can be taken in tea
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are not correct are also given, but they are
not in boldface type.
A Client Taking Herbs
1. 1. Dong quai increases the risk of bleed-
ing postoperatively, but the nurse would
not need to assess for abnormal bleeding
preoperatively.
2. The American Society of Anesthesi-
ologists recommends that all herbal
products be stopped at least 2 to 3
weeks before surgery to avoid potential
complications of herbal use. The client
should have been NPO since midnight;
therefore, determining when the client
last took the herb is the nurse’s first
intervention.
3. The client’s allergies, not the medication the
client is currently taking, should be docu-
mented on the front of the chart.
4. The nurse should first determine when the
client last took the herb before notifying the
surgeon.
2. 1. Aloe vera juice is used externally for
treatment of minor burns, insect bites,
and sunburn. It is a safe herb to use
externally and will not hurt the client.
2. Aloe taken internally is a powerful laxative,
but the client is asking about burns, not
about using aloe as a laxative. Additionally,
the U.S. Food and Drug Administration
(FDA) does not approve herbal supple-
ments; however, they are regulated as
dietary supplements.
3. This is a true statement about many herbal
supplements, but topical aloe does not have
any known complications that would pre-
vent it from being used for minor burns.
4. This is a false statement. Aloe can be used
externally for treating minor burns. Many
lotions have aloe as an ingredient.
3. 1. Users of St. John’s wort do not need to
avoid tyramine-rich foods. These types of
foods should be avoided in clients tak-
ing monoamine oxidase inhibitors for
depression.
2. This would be appropriate when applying
capsicum or cayenne pepper lotion.
6924_Ch16_401-416.indd 405
form.
3. St. John’s wort can cause photosensiti-
zation dermatitis; therefore, the client
should use sunscreen when outside.
4. Many herbal supplements are hepatotoxic,
but St. John’s wort is not one that causes
liver damage.
4. 1. Milk thistle simulates the effects of
estrogen, which can cause the growth of
endometriosis. The nurse should ques-
tion this supplement.
2. Omega-3 fatty acids in fish oil have been
found to reduce the inflammation associated
with endometriosis. The nurse would not
question this supplement.
3. Soy can increase estrogen levels, which
can cause the growth of endometriosis;
therefore, the nurse should question this
supplement.
4. Folic acid deficiency has been linked to
exacerbations of endometriosis. The nurse
would not question this supplement.
5. Raspberry leaves have been shown to
decrease the pain of endometriosis. The
nurse would not question this supplement.
5. 1. There is no reason to quit taking the medi-
cation because of the odor.
2. There have been no reports of habituation
or addiction with valerian root.
3. The “dirty socks” odor is related to the
dried plant. Valerian root is known as the
“herbal Valium,” and it has no hangover
effect.
4. The pungent odor and drowsiness are
expected with this medication, and there is
no reason to discuss this with the HCP.
6. 1. This is a guideline for prudent use of
herbs.
2. According to guidelines for prudent use of
herbs, babies and young children should not
be given any types of herbs.
3. Herbs exposed to sunlight and heat may
lose potency.
4. This is a guideline for prudent use of
herbs.
5. This is a guideline that both consumers
and HCPs must be aware of when using
herbal therapy.
7. 1. The nurse should not be judgmental when
clients request information about herbal
therapy.
405
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 406 PHARMACOLOGY SUCCESS
2. Garlic is one of the best-studied herbs. It
has been shown to decrease the aggrega-
tion of platelets, thus producing an anti-
coagulant effect that is useful in treating
atherosclerosis.
3. Horehound has been used as an herbal
remedy for the treatment of respiratory
disorders, including asthma, bronchitis,
whooping cough, and tuberculosis, but not
atherosclerosis.
4. This is a true statement, but aspirin is a
medical treatment and is not considered an
herb.
8. 1. Lactobacillus acidophilus, not E. purpurea,
is used to restore or to maintain the nor-
mal flora of the intestine during antibiotic
therapy.
2. Ginger is one of the best-studied herbs and
is used for treating nausea caused by motion
sickness, pregnancy morning sickness, and
postoperative procedures.
3. Goldenseal is an herb that when used topi-
cally is purported to be of value in treating
bacterial and fungal skin infections, and oral
conditions such as gingivitis and thrush.
4. Some substances in Echinacea appear
to have antiviral activity; thus, the herb
is sometimes taken to treat or prevent
the common cold, a use for which it has
received official approval in Germany.
MEDICATION MEMORY JOGGER: The nurse
determines the effectiveness of a medi-
cation by assessing for the symptoms, or
lack thereof, for which the medication was
prescribed.
9. 1. Clients taking cardiac glycosides should
avoid hawthorn because it has the abil-
ity to decrease cardiac output. The client
diagnosed with CHF would be taking car-
diac glycosides.
2. Hawthorn has been purported to lower
blood pressure after 4 weeks or longer
of therapy; therefore, the nurse would
not question the client diagnosed with
hypertension taking this medication.
3. Hawthorn is not recommended for a client
diagnosed with Alzheimer’s disease. Ginkgo
biloba is the herb that is recommended for
clients diagnosed with Alzheimer’s disease.
4. Hawthorn is not recommended for a client
diagnosed with diabetes mellitus. Stevia, an
herb indigenous to Paraguay, may be helpful
to people diagnosed with diabetes because it
is used as a sweetener.
6924_Ch16_401-416.indd 406
A Client Taking Vitamins/Minerals
10. 1. Signs and symptoms of vitamin A
overdose include nausea, vomiting,
anorexia, dry skin and lips, headache,
and loss of hair. The nurse should
instruct the client to quit taking
vitamin A immediately.
2. Paresthesia is not a sign of vitamin A toxic-
ity. It may be a sign of thiamine deficiency,
along with neuralgia and progressive loss
of feeling and reflexes.
3. Dermatitis, fatigue, and dementia are
symptoms of advanced niacin deficiency.
4. Bleeding gums and gingivitis are signs of
vitamin C deficiency.
11. 1. This is appropriate information for the
client who is taking vitamin A. Mineral oil
inhibits the absorption of vitamin A.
2. The client should avoid drinking
alcohol because it increases folic acid
requirements.
3. This is appropriate information for the
client who is taking vitamin A. Vitamin
A may cause miosis, papilledema, and
nystagmus.
4. Milk and milk products are a good source
of vitamin D, not folic acid.
MEDICATION MEMORY JOGGER: Alcohol
consumption is always discouraged when
taking any prescribed or OTC medication
because of adverse interactions. The nurse
should encourage the client not to drink
alcoholic beverages.
12. 1. Iron turns the stool a harmless black or
dark green. This statement indicates the
client does not understand the medication
teaching.
2. The iron tablet should be taken between
meals and with 8 ounces of water to pro-
mote absorption. The iron tablet should
not be taken within 1 hour of ingesting
antacid, milk, ice cream, or other milk
products such as pudding. This statement
indicates the client does not understand
the medication teaching.
3. Sitting upright will prevent esophageal
corrosion from reflux. This statement
indicates the client understands the
medication teaching.
4. The drug treatment for anemia is gener-
ally less than 6 months. This statement
indicates the client does not understand
the medication teaching.
7/11/18 4:39 PM

13. 1. Intramuscular iron, not vitamin B12, must
be administered Z-track to prevent stain-
ing of the skin.
2. Cyanocobalamin does not stain the teeth
and therefore does not need to be adminis-
tered through a straw. Liquid iron must be
administered through a straw.
3. This is required when administering insu-
lin or digoxin IVP, but it is not required
when administering this medication.
4. Because conversion to normal red
blood cell (RBC) production—the
purpose of giving cyanocobalamin
(Cyanabin), vitamin B12—increases the
need for potassium, hypokalemia is a
possible side effect of this medication,
especially during the first 48 hours
medication is administered.
14. 1. Vitamins are usually OTC medications. If
the client does not have money for OTC
medications, she would not have money
for a prescription.
2. A balanced diet can provide all of the
vitamins a client needs daily, but if the
client was taking a daily vitamin, the nurse
should not discourage her from taking the
vitamins.
3. Vitamin supplements are not necessary if
the person is healthy and receives proper
nutrition on a regular basis.
4. Signs or symptoms of vitamin deficien-
cies will not occur if the client has not
taken the vitamins in more than a week.
Vitamin deficiencies may take months
to occur, and if the client is eating a
well-balanced diet, vitamin deficiencies
will not occur.
15. 1. Vitamin E is a primary antioxidant that
prevents the formation of free radicals
that damage cell membranes and cellu-
lar structure.
2. This is the role of vitamin A in the body.
It is essential for general growth and
development.
3. This statement includes medical jargon
that the client probably would not under-
stand. The nurse needs to explain informa-
tion in layman’s terms.
4. Vitamin K, not the antioxidant vitamin E,
is required by the body to help the blood
clot.
16. 1. Copper is needed for the formation of
RBCs and connective tissue.
6924_Ch16_401-416.indd 407
CHAPTER 16 NONPRESCRIBED MEDICATIONS 407
2. Iron is vital for Hgb regeneration. More
than 60% of the iron in the body is found
in Hgb.
3. The use of zinc has greatly increased
in the past few years. It is thought by
some that zinc can alleviate the symp-
toms of the common cold.
4. Vitamin C aids in the absorption of iron
and in the conversion of folic acid.
17. 1. Vitamin A is a fat-soluble vitamin that
is essential for the maintenance of epi-
thelial tissues, skin, eyes, hair, and bone
growth.
2. Vitamin D is a fat-soluble vitamin that
has a major role in regulating calcium
and phosphorus metabolism, and is
needed for calcium absorption from the
intestines.
3. Vitamin E is a fat-soluble vitamin that
has antioxidant properties that protect
cellular components from being oxi-
dized and RBCs from hemolysis.
4. Vitamin C is a water-soluble vitamin that
aids in the absorption of iron and conver-
sion of folic acid.
5. Folic acid is a water-soluble vitamin that
is essential for body growth. It is needed
for DNA synthesis, and without folic acid
there is a disruption in cellular division.
18. 1. Most authorities believe that vitamin C
does not cure or prevent the common cold.
Rather, it is believed that vitamin C has a
placebo effect. This would not be appro-
priate information to share with the client.
2. Megadoses of vitamin C taken with
aspirin or sulfonamides may cause crys-
talluria, crystal formation in the urine.
3. Megadoses of vitamins can cause toxicity
and might result in a minimal desired
effect.
4. The use of megavitamin therapy, massive
doses of vitamins, is questionable at best.
The nurse should not recommend this
action.
A Client Self-Prescribing Medications
19. 1. Most adult clients self-medicate for minor
problems, such as a headache or indiges-
tion, and only seek medical attention if the
symptoms are unrelieved. This is not the
best response for the nurse to make.
2. Up to 90% of adult-onset asthma is
caused by gastroesophageal reflux
7/11/18 4:39 PM
 408 PHARMACOLOGY SUCCESS
disease (GERD). The nurse should
assess what other symptoms are
occurring.
3. The medication is taken for up to 2 weeks
per package instructions. Many clients
have been prescribed omeprazole (Pri-
losec) for many months to years.
4. The histamine2 blockers, such as cimeti-
dine (Tagamet), ranitidine (Zantac), or
famotidine (Pepcid), may or may not be
more effective than omeprazole (Prilosec).
It depends on the individual’s response to
the medication. Most clients report better
symptom control with the proton-pump
inhibitors.
20. 1. The ABGs would give information about
the immediate situation, not long-term
problems.
2. Acetaminophen (Tylenol) is toxic to the
liver, and the liver function tests should
be monitored in the hospital and in the
HCP’s office afterward to determine if
there is permanent liver damage.
3. BUN and creatinine tests determine
kidney functioning. Tylenol does not affect
the kidneys.
4. Tylenol does not damage the bone marrow.
It is not necessary to monitor the CBC.
21. 1. NSAIDs interfere with prostaglandin
production in the stomach, result-
ing in the client being susceptible to
ulcer formation. To prevent erosion of
the stomach lining, the client should
not take the medication on an empty
stomach.
2. NSAIDs will not affect the PTT/PT/INR
results.
3. If the NSAIDs are effective, there is
no reason for the HCP to prescribe a
narcotic.
4. The priority is to prevent complications
from the medication. The client is taking
the medication because fractures of the
bones are painful.
22. 1. The parent should be taught never to
administer aspirin to a child because
of the association of acetylsalicylic
acid (Aspirin) with Reye’s syndrome.
Acetaminophen (Tylenol) or ibuprofen
(Motrin) may be administered to a child
for a fever.
2. Diphenhydramine (Benadryl), an antihis-
tamine, can make the child drowsy and will
help nasal congestion, but it will not treat
a fever.
6924_Ch16_401-416.indd 408
3. Docosanol (Abreva), an anti-infective, is a
topical medication for cold sores, not for
fever.
4. Docusate sodium (Colace) is a stool soft-
ener, not an antipyretic.
5. Ibuprofen (Motrin) or acetaminophen
(Tylenol) may be administered to a
child for a fever.
23. 1. Tylenol Cold and Sinus contains ingre-
dients that cause vasoconstriction. The
client diagnosed with hypertension should
not take any medication that increases
vasoconstriction.
2. Advil Cold and Sinus contains ingredients
that cause vasoconstriction. The client
diagnosed with hypertension should
not take any medication that increases
vasoconstriction.
3. Nyquil contains ingredients that cause
vasoconstriction. The client diagnosed
with hypertension should not take any
medication that increases vasoconstriction.
4. Coricidin HBP has been formulated
to control symptoms of the cold or
flu without causing vasoconstriction.
This is the only medication in this list
that will not increase the client’s blood
pressure.
24. 1. Acetaminophen (Tylenol) is an analgesic.
It is not formulated with ingredients that
induce sleep. Tylenol PM contains diphen-
hydramine. This medication can be taken
to aid in sleep.
2. Ibuprofen (Motrin) is an analgesic and
antipyretic, not a sleeping medication.
3. Diphenhydramine (Benadryl) is an
antihistamine that has the side effect
of causing drowsiness. This is the main
ingredient in OTC sleep aids.
4. Zolpidem (Ambien) is not an OTC
medication.
5. Melatonin is a synthetic dietary supple-
ment that can assist with sleep.
25. 1. Pseudoephedrine can cause insomnia, not
drowsiness. It is the ability to rev people
up that makes it an ingredient in “uppers.”
2. Oral or topical contraceptive hormone
products interact with antibiotics, not
pseudoephedrine.
3. This is a class C medication. Its use during
pregnancy is questionable, but it is not
known to be teratogenic.
4. The federal government enacted a
law limiting the purchase of products
containing pseudoephedrine to adults
(at least 18 years of age) and to no
7/11/18 4:39 PM
 CHAPTER 16
more than 9 grams per month, such
as two 15-dose boxes of Claritin D
or six 24-dose boxes of Sudafed. The
client should be able to prove her age
when purchasing the products at the
pharmacy.
27. 1. This is true, but this is not the most
5. Pseudoephedrine is effective in cases of
acute congestion. If symptoms per-
sist longer than 7 days, this indicates
chronic congestion, and the client
should be evaluated by their HCP.
26. 1. This is an assessment question to
determine the extent of the client’s
problem. This is the first question.
2. The nurse should assess the problem
before making this statement.
3. This is a true statement, especially for
clients diagnosed with chronic illness, but
it is not the first statement.
4. Eating yogurt daily will prevent most
yeast infections when the client is taking
prescribed antibiotics, but assessing the
extent of the problem should be the nurse’s
first response.
6924_Ch16_401-416.indd 409
NONPRESCRIBED MEDICATIONS 409
MEDICATION MEMORY JOGGER: When-
ever the question asks for a “first”
intervention, even when discussing med-
ications, assessing is usually the correct
answer.
important information to provide the
client.
2. Nutrition is an important consideration
for clients diagnosed with cancer and
undergoing treatment. Many of the
antineoplastic medications can cause
stomatitis, and a combination of huge
amounts of vitamin C and chemother-
apy could result in a serious complica-
tion for the client.
3. There are many alternative treatments that
should be encouraged for use by clients
diagnosed with different diseases. This is
not one of them.
4. This is true, but it is not the most impor-
tant information for the nurse to teach the
client.
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