Pharmacology and the Nursing Process

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Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements
Lilley: Pharmacology and the Nursing Process, 9th Edition

MULTIPLE CHOICE

1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to
go “natural” with her pregnancy. She shows the nurse a list of herbal remedies that she
wants to buy so that she can “avoid taking any drugs.” Which statement by the nurse is
correct?
a. “Most herbal remedies are not harmful and are safe for use during pregnancy.”
b. “Please read each label carefully before use to check for cautionary warnings.”
c. “Keep in mind that products from different manufacturers are required to contain
consistent amounts of the herbal products.”
d. “It’s important to remember that herbal remedies do not have proven safety ratings
for pregnant women.”
ANS: D
The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely
administered to children, infants, or pregnant or lactating women. Many herbal products
have not been tested for safety during pregnancy. Simply reading the labels may not
provide enough information for use during pregnancy. Last, manufacturers of herbal
products are not required to guarantee the reliability of the contents.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. The nurse is giving a lecture about current U.S. laws and regulations of herbal products.
According to the Dietary Supplement and Health Education Act of 1994, which statement
is true?
a. Medicinal herbs are viewed as dietary supplements.
b. Herbal remedies are held to the same standards as drugs.
c. Producers of herbal products must prove therapeutic efficacy.
d. Herbal remedies are protected by patent laws.
ANS: A
Current U.S. laws view herbal products as dietary supplements and do not hold them to the
same efficacy standards as drugs. The other options do not correctly reflect current U.S.
laws regarding herbal supplements.

DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process:

General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The patient wants to take the herbal product kava to help him rest at night. The nurse
would be concerned about potential interactions if he is taking a medication from which
class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants
 ANS: C
Kava may cause increased central nervous system depression if used with sedatives.
Digitalis, anticoagulants, and immunosuppressants do not have interactions with kava.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has
had “stomach problems” for several months. He tells the nurse that the medicine helps as
long as he takes it, but once he stops it, the symptoms return. Which statement by the
nurse is the best advice for this patient?
a. “The over-the-counter drug has helped you, so you should continue to take it.”
b. “The over-the-counter dosage may not be strong enough. You should be taking
prescription-strength for best effects.”
c. “For best results, you need to watch what you eat in addition to taking this drug.”
d. “Using this drug may relieve your symptoms, but it does not address the cause.
Please make an appointment with your health care provider.”
ANS: D
The use of OTC drugs may postpone effective management of chronic disease states and
may delay treatment of serious or life-threatening disorders because these drugs may
relieve symptoms without necessarily addressing the cause of the disorder. The other
options do not address the need to investigate the cause of the symptoms and are incorrect.

DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:

Planning
MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. During an assessment, the patient tells the nurse that he eats large amounts of garlic for its
cardiovascular benefits. Which drug or drug class, if taken, would have a potential
interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Insulin
c. Antilipemic drugs
d. Sedatives
ANS: B
The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect
because acetaminophen, antilipemic drugs, and sedatives do not have interactions with
garlic.

DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process:

Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

6. A patient calls the clinic to ask about taking cranberry dietary supplement capsules
because a friend recommended them. The nurse will discuss which possible concern when
a patient is taking cranberry supplements?
a. It may increase the risk for bleeding if the patient is taking anticoagulants.
b. It may increase the risk of toxicity of some psychotherapeutic drugs.
 c. It may reduce elimination of drugs that are excreted by the kidneys.
d. Cranberry may increase the intensity and duration of effects of caffeine.
ANS: C
The use of cranberry decreases the elimination of many drugs that are renally excreted.
The other concerns do not occur with cranberry supplements.

DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:

Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

7. A patient wants to take the herb gingko to help his memory. The nurse reviews his current
medication list and would be concerned about potential interactions if he is taking a
medication from which class of drugs?
a. Digitalis
b. Antiplatelet drugs
c. Sedatives
d. Immunosuppressants
ANS: B
The use of gingko increases the risk of bleeding with antiplatelet drugs (aspirin,
clopidogrel) and anticoagulants (warfarin, heparin). The other concerns do not occur with
gingko supplements.

DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:

Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC)
drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.)
a. Use of OTC drugs may delay treatment of serious ailments.
b. Drug interactions with OTC medications are rare.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
d. OTC drugs are indicated for long-term treatment of conditions.
e. Patients may misunderstand product labels and use the drugs improperly.
ANS: A, C, E
It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may
relieve symptoms without addressing the cause of the problem, and patients may
misunderstand product labels and use the drugs improperly. These statements should be
included when teaching patients about their use. In contrast, drug interactions with OTC
medications are not rare and may indeed occur with prescription medications and other
OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
 2. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for
over-the-counter status in the United States are accurate? (Select all that apply.)
a. The drug must be easy to use.
b. The drug must have a low therapeutic index.
c. The consumer must be able to monitor the drug’s effectiveness.
d. The drug must have a low potential for abuse.
e. The drug must not have any interactions with other drugs.
ANS: A, C, D
In the United States, criteria for over-the-counter status include the drug being easy to use,
the drug having a low potential for abuse, and the consumer must be able to monitor the
drug’s effectiveness for the condition. The drug must have a high therapeutic index (not a
low one), and the drug must have limited interactions with other drugs.

DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:

General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

COMPLETION

1. A patient with a PEG tube is to receive ferrous sulfate, 65 mg per the tube, daily. The
medication is available as an elixir, 220 mg/5 mL. How many milliliters will the patient
receive per dose? Record your answer using one decimal place.

ANS:
1.5 mL

220 mg:5 mL :: 65 mg:x mL

(220  x) = (5  65); 220x = 325; x = 1.477 which rounds to 1.5 mL/dose

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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