A nurse is teaching a client who has an ileostomy about the care of their stoma. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason: Bleeding time assesses platelet function, not warfarin’s anticoagulant effect. Warfarin inhibits vitamin K-dependent clotting factors, unrelated to platelets. Monitoring bleeding time does not reflect therapeutic anticoagulation levels, making it irrelevant for adjusting warfarin doses to prevent thrombosis or bleeding.
Choice B reason: Factor VIII, deficient in hemophilia A, is not affected by warfarin, which targets vitamin K-dependent factors (II, VII, IX, X). Measuring Factor VIII does not indicate warfarin’s efficacy, as it is unrelated to the drug’s mechanism, making it unsuitable for dose monitoring.
Choice C reason: aPTT monitors heparin’s effect on the intrinsic clotting pathway, not warfarin’s action on vitamin K-dependent factors. Warfarin requires INR for therapeutic monitoring, as aPTT is insensitive to its effects, making it inappropriate for assessing warfarin’s anticoagulation range in patients.
Choice D reason: INR standardizes prothrombin time, measuring warfarin’s effect on vitamin K-dependent clotting factors. It ensures therapeutic anticoagulation (e.g., INR 2-3), preventing thrombosis or bleeding. INR is the gold standard for warfarin monitoring, guiding dose adjustments for safe and effective therapy.

Choice A reason: Decreased serotonin levels are linked to depression, as serotonin regulates mood in the brain’s limbic system. Antidepressants like SSRIs increase serotonin, alleviating low mood and anhedonia, making this client a prime candidate for therapy to address neurochemical imbalances in depression.
Choice B reason: Decreased cortisol is not directly tied to depression requiring antidepressants. Cortisol dysregulation may occur in stress disorders, but antidepressants target serotonin or norepinephrine, not adrenal function, making this client less suitable for antidepressant therapy based on this imbalance.
Choice C reason: Elevated dopamine is linked to schizophrenia or mania, not depression. Antidepressants target serotonin or norepinephrine, not dopamine. This client may need antipsychotics or mood stabilizers, not antidepressants, as dopamine excess does not indicate depressive pathology requiring such therapy.
Choice D reason: Elevated thyroid levels suggest hyperthyroidism, mimicking anxiety, not depression. Antidepressants are not indicated, as treatment targets thyroid function. Depression may coexist, but thyroid correction is prioritized, making this client unsuitable for primary antidepressant therapy based on this finding.