A nurse is caring for a client who has cancer and is being transferred to hospice care. The client's daughter tells the nurse, "I'm not sure what to say to my mom if she asks me about dying." Which of the following responses by the nurse is appropriate? (Select all that apply.)

Rationale:

A. Consult the pharmacist about potential interactions between the client's regular medications and warfarin: Warfarin has numerous drug interactions that can increase bleeding risk or reduce effectiveness. Consulting the pharmacist ensures a thorough review of the client’s medication list for potential harmful interactions before discharge.

B. Tell the client they can continue to drink cranberry juice while taking warfarin: Cranberry juice can potentiate the effects of warfarin and increase bleeding risk by interfering with its metabolism. Clients should be advised to limit or avoid cranberry products.

C. Recommend the client take warfarin at the same time as other medications: Warfarin should be taken at the same time each day, but taking it with other medications may cause interactions. The timing should consider spacing it from medications that might interfere with absorption or potency.

D. Advise the client that over-the-counter medications remain safe to consume as needed: Many OTC medications, especially NSAIDs, can increase bleeding risk when combined with warfarin. Clients need to check with a healthcare provider before taking any new OTC drugs.

Rationale:

A. Acetaminophen: Acetaminophen is generally considered safe during pregnancy when used at recommended doses. It is commonly used to treat mild pain and fever without significant risk to the fetus.

B. Saline nasal spray: Saline nasal sprays are non-medicated and safe for use during pregnancy. They help relieve nasal congestion without systemic absorption or risk to fetal development.

C. Levothyroxine: Levothyroxine is a thyroid hormone replacement that is safe and essential during pregnancy for clients with hypothyroidism. Untreated hypothyroidism poses greater risks to both mother and fetus than the medication itself.

D. Ibuprofen: Ibuprofen is contraindicated, especially during the third trimester, due to risks such as premature closure of the ductus arteriosus, oligohydramnios, and delayed labor. Acetaminophen is preferred for pain relief in pregnancy.