A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

I eat a green salad every night with dinner.

I take this medication at the same time each day.

I have started taking ginger root to treat my joint stiffness.

I had my INR checked three weeks ago.

Answer and Explanation

The Correct Answer is C

Choice A reason: Eating a green salad every night with dinner is not the statement that indicates a need for further teaching. This is a consistent and balanced dietary choice for the client, as long as the amount of vitamin K in the salad is not excessive or variable. Vitamin K is a nutrient that helps the blood to clot and can interfere with the action of warfarin, which is an anticoagulant that inhibits the formation of blood clots. The client should avoid sudden changes in their intake of vitamin K and inform the provider of any dietary modifications.

Choice B reason: Taking this medication at the same time each day is not the statement that indicates a need for further teaching. This is a correct and important instruction for the client, as it helps to maintain a steady and effective level of warfarin in the blood. Warfarin has a narrow therapeutic range and requires frequent monitoring and dose adjustment. The client should take the medication as prescribed and avoid missing or skipping doses.

Choice C reason: Starting to take ginger root to treat joint stiffness is the statement that indicates a need for further teaching. This is a risky and potentially harmful herbal supplement for the client, as it can interact with warfarin and increase its anticoagulant effect. Ginger root has antiplatelet and fibrinolytic properties, which can inhibit the formation of blood clots and enhance the breakdown of fibrin, a protein that stabilizes blood clots. Taking ginger root with warfarin can increase the risk of bleeding and bruising and alter the international normalized ratio (INR), which is a measure of the blood's clotting ability. The client should avoid taking ginger root and other herbal supplements without consulting the provider.

Choice D reason: Having the INR checked three weeks ago is not the statement that indicates a need for further teaching. This is a reasonable and appropriate frequency for the client, depending on their stability and response to warfarin therapy. The INR is a blood test that measures the time it takes for the blood to clot and indicates the effectiveness of warfarin. The target INR range for most clients is 2 to 3, but it may vary depending on the indication and the risk of bleeding. The client should have their INR checked regularly and follow the provider's orders and the protocol for dose adjustment.

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Correct Answer is C

Explanation

Choice A reason: Naloxone is not the correct medication. Naloxone is an opioid antagonist that reverses the effects of opioid overdose, such as respiratory depression, sedation, and hypotension. Naloxone has no effect on magnesium sulfate, which is a mineral and electrolyte that is used to prevent seizures in clients with preeclampsia or eclampsia.

Choice B reason: Protamine is not the correct medication. Protamine is a heparin antagonist that reverses the effects of heparin overdose, such as bleeding, bruising, and thrombocytopenia. Protamine has no effect on magnesium sulfate, which is not an anticoagulant.

Choice C reason: Calcium gluconate is the correct medication. Calcium gluconate is a calcium salt that antagonizes the effects of magnesium sulfate overdose, such as hypotension, bradycardia, respiratory depression, and muscle weakness. Calcium gluconate is the antidote for magnesium sulfate toxicity, which can occur when the serum magnesium level is above 7.5 mEq/L. The nurse should monitor the client's vital signs, deep tendon reflexes, and urine output, and report any signs of toxicity to the provider.

Choice D reason: Flumazenil is not the correct medication. Flumazenil is a benzodiazepine antagonist that reverses the effects of benzodiazepine overdose, such as drowsiness, confusion, and coma. Flumazenil has no effect on magnesium sulfate, which is not a sedative.

A. Reduce intake of potassium-rich foods. B. Avoid grapefruit juice. C. Take this medication before bedtime. D. Monitor for leg cramps.

Correct Answer is D

Explanation

Choice A reason: Reducing intake of potassium-rich foods is not necessary for clients taking hydrochlorothiazide, as this medication can cause hypokalemia (low potassium levels) due to increased potassium excretion in the urine. Clients may need to increase their intake of potassium-rich foods or take potassium supplements to prevent hypokalemia.

Choice B reason: Avoiding grapefruit juice is not necessary for clients taking hydrochlorothiazide, as this medication does not interact with grapefruit juice. Grapefruit juice can affect the metabolism of some other medications, such as statins, calcium channel blockers, and cyclosporine, by inhibiting the enzyme CYP3A4 in the liver.

Choice C reason: Taking this medication before bedtime is not advisable for clients taking hydrochlorothiazide, as this medication can cause increased urination and nocturia (nighttime urination). Clients should take this medication in the morning or at least 6 hours before bedtime to avoid disrupting their sleep.

Choice D reason: Monitoring for leg cramps is an important instruction for clients taking hydrochlorothiazide, as this medication can cause muscle cramps due to electrolyte imbalances, such as hypokalemia, hyponatremia (low sodium levels), or hypomagnesemia (low magnesium levels). Clients should report any signs of muscle cramps, weakness, or fatigue to their provider.

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A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

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