A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

Choice A reason: Ginkgo biloba use should be limited and not taken during pregnancy is a true statement, but not the most important information for the nurse to include in the teaching plan. Ginkgo biloba may have adverse effects on the fetus, such as bleeding, seizures, or malformations. However, this information is only relevant if the client is pregnant or planning to become pregnant. The nurse should assess the client's reproductive status and advise her accordingly.

Choice B reason: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo is the most important information for the nurse to include in the teaching plan. Ginkgo biloba has antiplatelet and anticoagulant properties, which means it can prevent blood clots from forming. However, this also increases the risk of bleeding, especially when combined with other drugs that affect blood clotting, such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). The nurse should instruct the client to avoid taking these drugs with ginkgo biloba and inform the healthcare provider of all the medications and supplements she is using.

Choice C reason: Nausea and diarrhea can occur when using this supplement is a possible side effect of ginkgo biloba, but not the most important information for the nurse to include in the teaching plan. Nausea and diarrhea are usually mild and transient, and can be reduced by taking ginkgo biloba with food or water. The nurse should inform the client of this possibility and advise her to report any severe or persistent symptoms to the healthcare provider.

Choice D reason: Anxiety and headaches increase with the use of ginkgo biloba is a false statement, and not the information for the nurse to include in the teaching plan. Ginkgo biloba may actually have beneficial effects on anxiety and headaches, as it can improve blood circulation and oxygen delivery to the brain. The nurse should not discourage the client from using ginkgo biloba for these reasons, unless there is a contraindication or an interaction with other drugs.

Choice A reason: Increased urinary clearance of the multiple medications is not the cause of the client's syncope. Diuresis is a common side effect of some antihypertensive medications, such as diuretics, but it does not lower the blood pressure to a dangerous level. The nurse should monitor the client's fluid and electrolyte balance and urine output, but it is not the priority action in this situation.

Choice B reason: The synergistic effect of the multiple medications is not the cause of the client's syncope. Synergism is when two or more drugs work together to produce a greater effect than the sum of their individual effects. This can be beneficial or harmful, depending on the drugs and the doses. The nurse should check the client's medication history and avoid prescribing drugs that have a negative synergistic effect, but it is not the most likely explanation for the client's hypotension.

Choice C reason: The antagonistic interaction among the various blood pressure medications is not the cause of the client's syncope. Antagonism is when two or more drugs work against each other to reduce or cancel out their effects. This can decrease the effectiveness of the treatment and increase the risk of complications. The nurse should check the client's medication history and avoid prescribing drugs that have a negative antagonistic effect, but it is not the most likely explanation for the client's hypotension.

Choice D reason: The additive effect of multiple medications is the most likely cause of the client's syncope. Additivity is when two or more drugs have a similar effect and their combined effect is equal to the sum of their individual effects. This can lower the blood pressure too much and cause symptoms such as dizziness, fainting, and shock. The nurse should hold the client's scheduled antihypertensive medications and notify the healthcare provider. The nurse should also monitor the client's vital signs, level of consciousness, and perfusion.