A client who has atrial fibrillation is prescribed warfarin therapy.

Which of the following statements by the client indicates an understanding of the medication?

This is the priority action by the practical nurse (PN) because it can help identify and prevent a potential adverse reaction to the medication. A client who is reaching saturation with medication means that the client has reached the maximum level of medication in the blood that can produce the desired therapeutic effect. However, this also means that the client is at a higher risk of developing toxicity or side effects from the medication. The PN should report the findings of muscle soreness, fatigue, and warm skin to the charge nurse, as these may indicate signs of inflammation, infection, or allergic reaction to the medication. The PN should also monitor the client's vital signs, oxygen saturation, and laboratory values, and document the findings. The charge nurse should notify the health care provider and adjust the medication dosage or regimen as ordered.

a) Administer a PRN dose of acetaminophen.

This is not the priority action by the PN because it does not address the underlying cause of the client's symptoms. Acetaminophen is an analgesic and antipyretic medication that can help reduce pain and fever. However, it does not treat inflammation, infection, or allergy, which may be the reasons for the client's muscle soreness, fatigue, and warm skin. The PN should administer a PRN dose of acetaminophen only after reporting the findings to the charge nurse and obtaining an order from the health care provider.

b) Encourage the client to drink fluids.

This is not the priority action by the PN because it does not address the underlying cause of the client's symptoms. Drinking fluids can help maintain hydration and electrolyte balance in the body, which are important for normal functioning of cells and organs. However, it does not treat inflammation, infection, or allergy, which may be the reasons for the client's muscle soreness, fatigue, and warm skin. The PN should encourage the client to drink fluids only after reporting the findings to the charge nurse and obtaining an order from the health care provider.

d) Monitor the client's serum lipid levels.

This is not the priority action by the PN because it is not related to the client's symptoms. Serum lipid levels are measures of fats and cholesterol in the blood, which are important for energy production, hormone synthesis, and cell membrane structure. However, they are not related to inflammation, infection, or allergy, which may be the reasons for the client's muscle soreness, fatigue, and warm skin. The PN should monitor the client's serum lipid levels only if they are prescribed a medication that can affect lipid metabolism, such as statins or fibrates.

Choice A rationale:

The nurse should monitor the client for tachycardia as an adverse effect of beta blockers like metoprolol. Beta blockers work by reducing heart rate and blood pressure, so the presence of tachycardia would be unexpected and could indicate a potential adverse reaction to the medication.

Choice B rationale:

Hyperglycemia is not a common adverse effect of beta blockers like metoprolol. In fact, these medications can sometimes mask the symptoms of hypoglycemia, making it important for diabetic patients to closely monitor their blood glucose levels. However, hyperglycemia is not a typical side effect.

Choice C rationale:

Bronchospasm is not a common adverse effect of metoprolol. Beta blockers like metoprolol can cause bronchoconstriction in some individuals, but this effect is generally more prominent with non-selective beta blockers like propranolol. It is not a common adverse effect of metoprolol and would not be the primary concern when monitoring a patient on this medication.

Choice D rationale:

The nurse should monitor the client for hyperkalemia as an adverse effect of metoprolol. Beta blockers can inhibit the release of insulin from the pancreas, which can lead to elevated blood potassium levels (hyperkalemia). This is particularly important in patients with renal impairment, as they may have difficulty clearing excess potassium from the body.