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    Wgu HESI RN Pharmacology 1 Proctored Exam

    A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation, on the advice of a friend. Which information is most significant about this finding?

    Explanation & Rationale

    A) Adding the herb can decrease the need for corticosteroids: There is no substantial evidence that St. John’s Wort affects the need for corticosteroids. Its primary interactions are with medications metabolized by the liver, particularly cyclosporine, rather than affecting corticosteroid requirements directly. B) Ingestion of St. John's Wort can reduce the client's intake of sodium: St. John’s Wort does not impact sodium intake. Its known interactions are with drugs, particularly those metabolized by the liver, rather than affecting dietary intake or sodium levels. C) St. John's Wort can decrease plasma concentrations of cyclosporine: St. John’s Wort is a potent inducer of cytochrome P450 enzymes, which can lead to decreased plasma levels of cyclosporine, an immunosuppressant crucial for preventing graft rejection. This interaction can result in subtherapeutic levels of cyclosporine and increase the risk of graft rejection. D) The client probably used this herb to treat depression: While it is true that St. John’s Wort is commonly used for its antidepressant effects, this is not the most significant concern in the context of a renal transplant. The primary issue is its interaction with cyclosporine, which can significantly impact transplant outcomes.

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