A nurse is flushing a client’s intermittent infusion device. The client states, “Why do you have to do that if you are not giving me medicine?” Which of the following statements should the nurse make?

Choice A reason: Nurses can witness advance directives in many settings, depending on state laws, so stating they cannot is inaccurate. This response dismisses the client’s request without providing guidance, making it incorrect and unhelpful for addressing their wishes.
Choice B reason: Including the client’s desire for advance directives in the medical record ensures their wishes are documented and respected. This aligns with the Patient Self-Determination Act, facilitating care planning, making it the correct and supportive response.
Choice C reason: Stating the client’s name can be removed from advance directives is confusing, as directives are personal and revocable, not about name removal. This response is inaccurate and irrelevant to the client’s request, making it incorrect.
Choice D reason: There is no universal age requirement of 21 for advance directives; competent adults (typically 18+) can create them. This statement is incorrect and restrictive, misinforming the client about their rights, making it inappropriate.

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.