A nurse is teaching a client who has DVT and is prescribed warfarin.

Which of the following instructions should the nurse include in the teaching?

The correct answer is choice D. All of the above.

The nurse should include the following instructions in the teaching:

• Avoid foods that are high in vitamin K.Vitamin K can lower the effect of warfarin and increase the risk of blood clots.Foods rich in vitamin K are green vegetables, such as lettuce, spinach and broccoli.

• Use an electric razor for shaving.Warfarin can increase the risk of bleeding, so using a sharp blade can cause cuts and bruises.

• Monitor for signs of bleeding gums.Bleeding gums can be a sign of excessive anticoagulation and a potential side effect of warfarin.

Choice A is wrong because avoiding foods that are high in vitamin K is not enough to prevent bleeding complications.

The client should also follow other precautions, such as using an electric razor and monitoring for signs of bleeding gums.

Choice B is wrong because using an electric razor for shaving is not enough to prevent bleeding complications.

The client should also avoid foods that are high in vitamin K and monitor for signs of bleeding gums.

Choice C is wrong because monitoring for signs of bleeding gums is not enough to prevent bleeding complications.

The client should also avoid foods that are high in vitamin K and use an electric razor for shaving.

The correct answer is A. How to administer LMWH subcutaneously.LMWH is a class of anticoagulant medications that are used to prevent and treat blood clots, such as DVT and PELMWH can be given subcutaneously and does not require frequent blood tests to monitor coagulation, unlike unfractionated heparinTherefore, the nurse should teach the client how to inject LMWH into the fatty tissue under the skin, usually in the abdomen or thigh, using a prefilled syringe.

B. The need for frequent blood tests to monitor coagulation.This statement is wrong because LMWH has more predictable pharmacokinetics and anticoagulant effect than unfractionated heparin, and does not require routine monitoring of APTT or anti-factor Xa levelsHowever, some patients may need monitoring in special situations, such as extremes of weight, renal impairment, or pregnancy.

C. The signs and symptoms of heparin-induced thrombocytopenia (HIT).This statement is wrong because HIT is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosisHIT is more common with unfractionated heparin than with LMWH, but it can still occur with LMWH in some casesTherefore, the nurse should inform the client about the signs and symptoms of HIT, such as fever, chills, rash, bleeding, bruising, or new or worsening clots, and advise them to seek medical attention if they occur.

D. The antidote for LMWH in case of overdose.This statement is wrong because there is no specific antidote for LMWH in case of overdose or bleeding complicationsUnlike unfractionated heparin, which can be reversed with protamine sulfate, LMWH has only partial reversal with protamine sulfate and may require other measures such as transfusion of blood products or use of recombinant factor VIIaTherefore, the nurse should instruct the client to follow the prescribed dose and schedule of LMWH and to report any signs of bleeding or overdose, such as nosebleeds, gum bleeding, blood in urine or stool, or excessive bruising.