A nurse is assessing a client who reports feeling dizzy while getting out of bed. The nurse suspects orthostatic hypotension related to a medication the client is taking Which of the following medications should the nurse identify as likely causing this adverse effect?

A. Hemoglobin level: The hemoglobin level measures the amount of hemoglobin, the oxygen-carrying protein in red blood cells, in the blood. Warfarin is not directly responsible for increasing or decreasing the hemoglobin level. While warfarin can lead to bleeding complications in some cases, it does not specifically target the hemoglobin level, so it is not a direct indicator of the medication's effectiveness.

B. Platelet count: The platelet count measures the number of platelets in the blood, which are essential for blood clotting. Warfarin does not directly affect platelet production or count. It works by inhibiting the production of certain clotting factors, not by affecting platelets. Monitoring the platelet count is important, but it is not an indicator of warfarin's effectiveness in preventing excessive clotting.

C. Prothrombin time (PT) or activated partial thromboplastin time (aPTT): Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are coagulation tests used to assess different types of anticoagulant medications, such as heparin. Warfarin's effect is measured using the International Normalized Ratio (INR). PT and aPTT are not specific to warfarin therapy and are not used to monitor its effectiveness. The INR is the appropriate laboratory test for assessing the efficacy of warfarin therapy.

D. International Normalized Ratio (INR): This is the correct answer. The International Normalized Ratio (INR) is the laboratory test used to monitor the effectiveness of warfarin therapy. The INR measures the time it takes for the blood to clot and reflects the anticoagulant effect of warfarin. A therapeutic INR within the target range (e.g., INR = 2.0 to 3.0 for most indications) indicates that warfarin has been effective in preventing excessive clotting and reducing the risk of complications associated with blood clots.

A. Alopecia: Alopecia, or hair loss, is a common side effect of many chemotherapy drugs, including paclitaxel. While it can be distressing for the client, alopecia is not a life-threatening side effect and does not require immediate intervention. It is essential for the nurse to provide emotional support to the client experiencing hair loss and educate them about potential ways to cope with it.

B. Muscle pain: Muscle pain, also known as myalgia, is another common side effect of paclitaxel and many other chemotherapy agents. While it can cause discomfort for the client, myalgia is generally managed with pain medications and supportive care. It is not a priority finding that requires immediate reporting to the provider unless it becomes severe or debilitating.

C. Nausea: Nausea is a well-known side effect of chemotherapy, including paclitaxel. It is often managed with antiemetic medications and other supportive measures. While severe or persistent nausea can lead to dehydration and other complications, it is not an immediate life-threatening concern in most cases.

D. Bradycardia: This is the correct answer. Bradycardia (slow heart rate) is a less common but more concerning side effect of paclitaxel. It may indicate potential cardiac toxicity, which is a serious and potentially life-threatening complication. The healthcare provider should be notified promptly so that appropriate evaluation and intervention can be initiated to manage any cardiac issues and prevent further complications.