A nurse is planning to administer mannitol to a client who has heart failure and pulmonary edema. Which of the following actions should the nurse take before giving the medication?

Warfarin is an anticoagulant that prevents blood clots from forming or growing larger. It works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. The INR (international normalized ratio) is a measure of how long it takes the blood to clot.The therapeutic range for INR depends on the indication for warfarin therapy, but for atrial fibrillation, it is usually between 2 and 3. An INR level of 3.5 is above the therapeutic range, which means the blood is too thin and the patient is at risk of bleeding. The nurse should hold the warfarin dose and notify the physician, who may order vitamin K to reverse the effects of warfarin.

Choice A) Administer vitamin K as ordered by physician is wrong because vitamin K is not indicated unless the physician orders it based on the patient’s condition and INR level.

Vitamin K is an antidote for warfarin overdose and can reverse its anticoagulant effects.

However, administering vitamin K without a physician’s order may cause the INR to drop below the therapeutic range and increase the risk of clotting.

Choice B) Administer heparin as ordered by physician is wrong because heparin is another anticoagulant that works by activating antithrombin, a natural inhibitor of clotting factors.

Heparin is used for acute treatment of thromboembolic disorders, such as deep vein thrombosis or pulmonary embolism.

It is not indicated for atrial fibrillation unless there is evidence of acute thrombosis.

Administering heparin to a patient with an elevated INR would increase the risk of bleeding.

Choice C) Administer warfarin as ordered by physician is wrong because warfarin is the cause of the elevated INR and should be withheld until the INR returns to the therapeutic range.

Continuing to administer warfarin would further increase the INR and the risk of bleeding.

Adrenergic drugs.These are drugs that stimulate the sympathetic nervous system by mimicking or enhancing the effects of epinephrine and norepinephrine, the chemical messengers that activate adrenergic receptors.Adrenergic drugs can increase blood pressure, heart rate, cardiac output, vascular tone, and renin release by acting on different types of adrenergic receptors.

Choice A is wrong because beta blockers are drugs that inhibit the sympathetic nervous system by blocking the beta adrenergic receptors, which are responsible for increasing heart rate and contractility. Beta blockers can lower blood pressure and reduce cardiac workload.

Choice B is wrong because calcium channel blockers are drugs that inhibit the movement of calcium ions across the cell membrane of smooth muscle cells, which are found in blood vessels and the heart.Calcium channel blockers can relax blood vessels and lower blood pressure, as well as reduce heart rate and contractility.

Choice C is wrong because angiotensin II receptor blockers (ARBs) are drugs that block the action of angiotensin II, a hormone that causes vasoconstriction and stimulates the release of aldosterone, which increases sodium and water retention.

ARBs can lower blood pressure by dilating blood