A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Choice A reason: "I'll be sure to eat more foods with vitamin K." is not the correct statement. Vitamin K is a nutrient that helps the blood to clot. Warfarin is an anticoagulant that inhibits the action of vitamin K and prevents the formation of blood clots. Eating more foods with vitamin K can counteract the effect of warfarin and increase the risk of thrombosis. The client should maintain a consistent intake of vitamin K and avoid sudden changes in their diet.

Choice B reason: "I'll take aspirin for my headaches." is not the correct statement. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation and prolongs bleeding time. Taking aspirin with warfarin can increase the risk of bleeding and bruising. The client should avoid taking any NSAIDs without consulting their provider. The client should use acetaminophen or other non-NSAID pain relievers for their headaches.

Choice C reason: "I'll use my electric razor for shaving." is the correct statement. Using an electric razor for shaving can reduce the risk of cuts and bleeding. The client should avoid using sharp objects or instruments that can cause injury or trauma. The client should also use a soft toothbrush and floss gently to prevent bleeding gums.

Choice D reason: "It's okay to have a couple of glasses of wine with dinner each evening." is not the correct statement. Alcohol can interact with warfarin and affect its metabolism and effectiveness. Drinking alcohol with warfarin can either increase or decrease the blood levels of warfarin and alter the international normalized ratio (INR), which is a measure of the blood's clotting ability. The client should limit their alcohol intake and monitor their INR regularly.

Choice A reason: Expecting to gain weight while taking this medication is not a correct instruction, as it may discourage the client from adhering to the treatment and may worsen the hypertension. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers the blood pressure by preventing the formation of angiotensin II, a potent vasoconstrictor. Captopril does not cause significant weight gain, but it may cause fluid retention or edema in some cases. The nurse should advise the client to monitor the weight daily and report any sudden or excessive increase to the provider.

Choice B reason: Not using salt substitutes while taking this medication is a correct instruction, as it may prevent the risk of hyperkalemia, a potentially life-threatening condition. Captopril may increase the potassium level in the blood by reducing the secretion of aldosterone, a hormone that regulates the sodium and potassium balance. Salt substitutes may contain potassium chloride, which may further elevate the potassium level. The nurse should advise the client to avoid salt substitutes and high-potassium foods, such as bananas, oranges, or tomatoes, and to have regular blood tests to check the electrolyte levels.

Choice C reason: Counting the pulse rate before taking the medication is not a necessary instruction, as it may not reflect the effect of the medication on the blood pressure. Captopril does not affect the heart rate significantly, but it may lower the blood pressure too much, especially in the first few weeks of treatment or after a dose increase. This may cause hypotension, dizziness, or fainting. The nurse should advise the client to monitor the blood pressure regularly and report any symptoms of hypotension to the provider.

Choice D reason: Taking the medication with food is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Captopril should be taken on an empty stomach, at least one hour before or two hours after a meal, to ensure optimal bioavailability. The nurse should advise the client to take the medication at the same time every day and to avoid skipping or doubling the doses.