A client taking warfarin (Coumadin) should be instructed to avoid herbal supplements such as green tea, ginkgo, feverfew, garlic, and ginger because these could:

Increase the risk for bleeding

Cause severe headache

Decrease the effects of the warfarin (Coumadin)

Cause severe hypotension

Answer and Explanation

The Correct Answer is A

A. Increase the risk for bleeding: Herbal supplements like green tea, ginkgo, feverfew, garlic, and ginger can potentiate the effects of warfarin by enhancing its anticoagulant properties. This increases the risk of bleeding, as warfarin itself is a blood thinner designed to prevent clot formation. These herbs can further inhibit platelet aggregation or enhance anticoagulation, leading to a higher risk of bleeding complications.

B. Cause severe headache: While some herbal supplements can cause headaches as a side effect, this is not the primary concern when combined with warfarin. The interaction between these herbs and warfarin does not commonly result in severe headaches. The primary issue is the increased risk of bleeding.

C. Decrease the effects of the warfarin (Coumadin): These particular herbal supplements do not generally decrease the effects of warfarin. In fact, they are more likely to increase its anticoagulant effects. Some other substances might interfere with warfarin's efficacy, but the herbs listed are known to enhance its bleeding risk.

D. Cause severe hypotension: Severe hypotension is not a common result of combining these herbal supplements with warfarin. The primary interaction is related to the blood-thinning effects, not to blood pressure regulation. Herbal supplements that might affect blood pressure are not typically those that interact significantly with warfarin in this manner.

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Correct Answer is C

Explanation

A. Hypothermia: Clopidogrel is not typically associated with temperature regulation and wouldn't cause hypothermia.

B. Hypotension: While some medications can cause low blood pressure (hypotension), clopidogrel is not a common culprit.

C. Black stools: This can be a sign of upper gastrointestinal bleeding, which is a potential side effect of clopidogrel. Clopidogrel inhibits platelet aggregation, which can increase bleeding risk.

D. Constipation: Constipation is not a common side effect of clopidogrel.

A. Use a 22-gauge needle to inject the medication. B. Inject the medication into the abdomen above the level of the iliac crest. C. Massage the injection site after administration of the medication. D. Use a 1-inch needle to inject the medication.

Correct Answer is B

Explanation

A. Use a 22-gauge needle to inject the medication.

This is inappropriate. Subcutaneous injections typically require a smaller gauge needle, usually between 25 to 30 gauge, to minimize tissue damage and discomfort. A 22-gauge needle is too large for subcutaneous injections and is more appropriate for intramuscular injections.

B. Inject the medication into the abdomen above the level of the iliac crest.

This is appropriate. The preferred site for subcutaneous heparin injection is the abdomen, avoiding areas near the umbilicus by at least 2 inches. Injecting above the level of the iliac crest is appropriate as it ensures the medication is administered into the subcutaneous tissue where it can be properly absorbed. The abdomen is chosen due to its ample subcutaneous tissue and relatively few large blood vessels, reducing the risk of bleeding and bruising.

C. Massage the injection site after administration of the medication.

This is inappropriate. Massaging the injection site after administering heparin is not recommended as it can cause bruising and increase the risk of bleeding. Heparin is an anticoagulant, and massaging the site can disrupt the tissue and lead to complications.

D. Use a 1-inch needle to inject the medication.

This is inappropriate. A 1-inch needle is generally used for intramuscular injections, not subcutaneous injections. For subcutaneous injections, a shorter needle (usually 3/8 to 5/8 inch) is sufficient to reach the subcutaneous tissue without penetrating too deeply into muscle tissue.

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A client taking warfarin (Coumadin) should be instructed to avoid herbal supplements such as green tea, ginkgo, feverfew, garlic, and ginger because these could:

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