A nurse is reinforcing teaching about warfarin with a client who has a new onset of atrial fibrillation. Which of the following statements should the nurse include in the teaching?

Choice A reason : Assisting the client into a standing position is part of the process for checking orthostatic hypotension, but it is not the first action to take. The initial measurement should be taken while the client is supine to establish a baseline blood pressure before any position changes.

Choice B reason : Determining the client's blood pressure 1 minute after each position change is important for diagnosing orthostatic hypotension, but it follows after the initial supine measurement. This step is to observe changes in blood pressure that may indicate orthostatic hypotension.

Choice C reason : Placing the client in a sitting position is another step in the process of checking for orthostatic hypotension. However, it is not the first action. The nurse should first measure the blood pressure in the supine position, then sitting, and finally standing.

Choice D reason : This is the correct first action. Checking the client's blood pressure in a supine position provides a baseline measurement. After this, the nurse can compare the blood pressure readings after the client sits and stands to identify any significant drops that would indicate orthostatic hypotension.

Choice A reason : Epinephrine is an adrenergic agonist primarily used in the management of cardiac arrest, anaphylaxis, and severe asthma attacks. It is not used to reverse the effects of warfarin overdose. Warfarin acts as an anticoagulant by inhibiting vitamin K-dependent clotting factors, and epinephrine has no role in this mechanism.

Choice B reason : Vitamin K is the antidote for warfarin toxicity. Warfarin works by inhibiting the vitamin K-dependent clotting factors II, VII, IX, and X. In the event of an overdose, vitamin K is administered to reverse the anticoagulant effects of warfarin and restore the clotting factor levels to normal. The administration can be oral or intravenous, depending on the severity of the overdose and the urgency of the situation.

Choice C reason : Atropine is an anticholinergic drug used to treat bradycardia (slow heart rate) and as an antidote for organophosphate poisoning. It does not have a role in reversing warfarin overdose as it does not affect the clotting cascade or vitamin K metabolism.

Choice D reason : Protamine is used to reverse the effects of heparin, another anticoagulant, but not warfarin. Protamine sulfate binds to heparin, forming a stable complex and neutralizing its anticoagulant effects. Since warfarin's mechanism of action is different from heparin's, protamine is not effective in reversing warfarin toxicity.