A nurse is caring for a client who has been taking warfarin and has an international normalized ratio (INR) time of 5. Which of the following medications should the nurse anticipate the provider to prescribe?

A. “Your cholesterol levels should be monitored monthly while taking this medication”: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. It does not typically affect cholesterol levels, so monthly cholesterol monitoring is not usually necessary.

B. “Make sure your diet contains a lot of potassium-rich foods.”: While a balanced diet is important for overall health, patients taking lisinopril should be cautious about consuming too much potassium. Lisinopril can increase potassium levels in the body, and consuming too many potassium-rich foods could lead to hyperkalemia, a condition characterized by high levels of potassium in the blood.

C. “Monitor your blood pressure on a regular basis.”: This is correct. Since lisinopril is used to treat high blood pressure, it’s important for patients to monitor their blood pressure regularly to ensure the medication is working effectively.

D. “Notify your doctor immediately if you become pregnant.”: This is correct. Lisinopril is not recommended during pregnancy as it can harm the unborn baby. If a patient becomes pregnant while taking lisinopril, they should notify their doctor immediately.

E. “Report the development of a persistent dry cough.”: This is correct. A persistent dry cough is a common side effect of ACE inhibitors like lisinopril. If a patient develops this symptom, they should report it to their healthcare provider.

A) Tingling of the lips:
This is the correct choice. Hypocalcemia, which is low calcium levels in the blood, can lead to neurological symptoms such as tingling sensations around the lips and in the extremities. This occurs due to the effect of low calcium levels on the nervous system.

B) Hypoactive bowel sounds:
Hypocalcemia primarily affects neuromuscular function rather than gastrointestinal function. While calcium imbalances can impact gastrointestinal motility, hypoactive bowel sounds are not typically associated with hypocalcemia.

C) Skeletal muscle weakness:
Skeletal muscle weakness is a common symptom of hypocalcemia. Low calcium levels affect the ability of muscles to contract effectively, leading to weakness and fatigue.

D) Decreased deep-tendon reflexes:
Hypocalcemia can actually lead to increased deep-tendon reflexes rather than decreased reflexes. Calcium plays a role in neuromuscular transmission, and low levels can result in hyperexcitability of nerves, leading to increased reflexes rather than decreased reflexes.