Question

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Explanation:

Identify the clinical scenario and core issue

The client has peripheral vascular disease (PVD) and is taking dietary supplements. The nurse is instructing the client to stop certain supplements prior to starting a new medication or procedure (the text is partially cut off, but typically refers to starting antiplatelet/anticoagulant therapy or undergoing surgery where bleeding risk is a concern). The question asks to "Select All that Apply."

Analyze the listed herbal supplements and their bleeding risks

We need to evaluate the options for their potential to increase bleeding risk, which is the primary concern for clients with PVD who are often prescribed antiplatelets (like aspirin or clopidogrel) or anticoagulants, or who are preparing for surgical interventions:

• Black cohosh: Primarily used for menopausal symptoms. It does not significantly increase bleeding risk.
• Saw palmetto: Primarily used for benign prostatic hyperplasia (BPH). It can have mild antiplatelet effects and increase bleeding risk.
• Flaxseed oil: High in omega-3 fatty acids, which can have mild antiplatelet effects at high doses, but is generally not classified as a high-risk herbal supplement to stop compared to the classic "G" herbs unless specified.
• Gingko biloba: Well-known for its strong antiplatelet effects. It inhibits platelet-activating factor (PAF) and significantly increases the risk of bleeding, especially when combined with other blood thinners.
• Glucosamine (partially visible as "...amine" at the bottom): Glucosamine can increase the risk of bleeding, particularly when taken with warfarin.

Determine the standard nursing knowledge for "Select All that Apply"

In standard nursing exams (like NCLEX), the herbal supplements that significantly increase bleeding risk and must be discontinued prior to surgery or when taking anticoagulants/antiplatelets are often remembered by the "G" herbs (Ginkgo biloba, Garlic, Ginseng, Ginger) along with Feverfew and Saw palmetto.

• Ginkgo biloba is a definitive choice due to its potent antiplatelet activity.
• Saw palmetto is also known to increase bleeding risk and should be discontinued.

Answer:

• Black cohosh
• Saw palmetto (Correct answer)
• Flaxseed oil
• Gingko biloba (Correct answer)