A nurse is caring for a client who asks for information about advance directives and states, “I want to make sure my wishes are respected.” Which of the following responses should the nurse make?

Choice A reason: Comparing the medication label to the provider’s prescription three times is a safety step during administration, not reconciliation. Reconciliation verifies the client’s home medications against new orders to prevent errors like omissions or duplications. This action occurs post-reconciliation, focusing on administration accuracy, not the initial verification of the medication list.
Choice B reason: Medication reconciliation involves comparing the client’s home medication list to admission prescriptions to ensure continuity and accuracy. This process identifies discrepancies, such as missed medications or incorrect doses, preventing adverse drug events. It requires verifying with the client or family and cross-checking provider orders, making it the cornerstone of safe transitions in care settings.
Choice C reason: Administering medications to treat a condition to the actual prescriptions is unclear and not part of reconciliation. Reconciliation focuses on verifying and documenting medications, not administering them. This option does not align with the systematic process of ensuring all medications are correctly prescribed upon admission, making it incorrect.
Choice D reason: Ensuring administration within 3 hours of the scheduled time relates to medication administration protocols, not reconciliation. Reconciliation verifies the accuracy of the medication list before administration. This step is about timing, not the verification process critical to preventing errors during care transitions, rendering it irrelevant to the task.

Choice A reason: Advising over-the-counter medications as safe is incorrect, as many, like NSAIDs, increase warfarin’s bleeding risk by inhibiting platelets or affecting liver metabolism. Warfarin’s narrow therapeutic index requires careful management to prevent hemorrhage, making broad safety claims dangerous without specific evaluation.
Choice B reason: Consulting the pharmacist identifies interactions with warfarin, a vitamin K antagonist metabolized by CYP450 enzymes. Many drugs alter warfarin’s efficacy, risking thrombosis or bleeding. Pharmacist expertise ensures safe polypharmacy, maintaining therapeutic INR levels critical for managing pulmonary emboli effectively.
Choice C reason: Recommending warfarin with other medications ignores interaction risks and timing needs. Warfarin’s absorption is unaffected by timing, but CYP450 interactions can alter INR. This advice is irrelevant to safety, missing the need for individualized regimen assessment to prevent complications in anticoagulation therapy.
Choice D reason: Cranberry juice may enhance warfarin’s effect by inhibiting CYP2C9, increasing INR and bleeding risk. Advising its use without monitoring is unsafe, as dietary factors can destabilize anticoagulation, potentially causing hemorrhage in clients with pulmonary emboli, requiring careful dietary guidance.