A nurse is caring for a client who has an acute exacerbation of chronic pain. Which of the following medications should the nurse anticipate administering for the client?

Rationale:

A. "I will avoid all alcohol while taking this medication.": Alcohol can increase the risk of bleeding while a client is on anticoagulants by affecting platelet function and liver metabolism of the drug. Avoiding alcohol reduces the likelihood of complications such as gastrointestinal bleeding or excessive bruising, making this an appropriate and effective understanding of anticoagulant safety.

B. "I will ask my provider before taking any supplements.": Many herbal supplements and over-the-counter medications can interact with anticoagulants, either increasing or decreasing their effect. Consulting the provider ensures the client avoids dangerous interactions that could lead to bleeding or clotting complications.

C. "I will call my provider if I have blood in my urine.": Hematuria may indicate significant bleeding while on anticoagulant therapy. Promptly reporting this symptom allows early intervention and prevents serious complications such as anemia or renal damage, showing that the client understands the need to monitor for adverse effects.

D. "I will plan to eat a green salad every day.": While leafy green vegetables are healthy, they are high in vitamin K, which can interfere with certain anticoagulants like warfarin. Regular high intake without provider guidance could reduce the medication’s effectiveness, so this statement reflects a misunderstanding rather than effective teaching.

E. "I will stop taking the anticoagulant if I get a nosebleed.": Stopping anticoagulants without provider instruction can increase the risk of thromboembolism. Minor bleeding like a nosebleed should be reported, not managed by abruptly discontinuing the medication, so this reflects unsafe practice.

F. "I will be careful to not cut myself.": Minimizing trauma and preventing cuts or injuries is essential while on anticoagulants because even minor injuries can lead to significant bleeding. This shows the client understands the practical precautions needed to stay safe during therapy.

Rationale for Correct Choices

• Endometritis: This uterine infection is common after cesarean delivery, especially with prolonged rupture of membranes. The client’s uterine tenderness, elevated fundus, boggy consistency, and foul-smelling lochia are hallmark signs of endometritis, making it the most likely diagnosis.
• Uterus and lochia: The presence of a tender uterus that is elevated above the umbilicus and only firms with massage, combined with dark, malodorous lochia, strongly suggests infection of the uterine lining. These findings point specifically to endometritis rather than general postpartum changes.

Rationale for Incorrect Choices

• Mastitis: Although the client reports heavy, warm breasts with nipple discomfort, there is no breast erythema, localized swelling, or high-grade fever typical of mastitis. These symptoms are likely due to engorgement related to lactation rather than infection.
• Pneumonia: The client’s respiratory assessment shows clear lungs with only slight basal changes common postoperatively. There are no signs of cough, sputum production, hypoxia, or respiratory distress, which makes pneumonia an unlikely cause of her symptoms.
• Fever: A temperature of 38.2°C is above normal, but mild postpartum fever can have various causes, including engorgement, dehydration, or early infection. Fever alone is not specific enough to confirm a diagnosis without targeted findings.
• WBC count: Although an elevated WBC of 33,000/mm³ raises concern, postpartum leukocytosis can be physiologic or related to many infections. It is not diagnostic of endometritis without more specific correlating signs like uterine tenderness and abnormal lochia.