An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

A. Advise the client that the healthcare provider needs to be made aware of the current diet: This is the most appropriate response. Warfarin is an anticoagulant that works by inhibiting vitamin K, which is essential for blood clotting. Leafy green vegetables, such as spinach and kale, are high in vitamin K and can interfere with the effectiveness of warfarin. It is important for the healthcare provider to be aware of the client’s diet to properly adjust the warfarin dosage and ensure effective anticoagulation while minimizing the risk of bleeding or clotting.
B. Suggest that the client replace the leafy vegetables with a protein source such as nuts or beans: This suggestion is not necessary unless there are specific dietary restrictions. While it's true that leafy green vegetables can affect warfarin, replacing them with other foods is not required. It’s more important to manage vitamin K intake consistently.
C. Confirm that the client’s diet choices will help the medication be more effective in preventing blood clots: This statement is incorrect. Leafy green vegetables can counteract the effects of warfarin due to their high vitamin K content.
D. Commend the patient for a healthy lifestyle and encourage the client to continue current diet habits: Although a diet rich in vegetables is generally healthy, it’s crucial to recognize that the high vitamin K content can impact the effectiveness of warfarin therapy. Therefore, simply encouraging the client to continue the current diet without considering its interaction with the medication is not appropriate

A) Determine if the client is taking the medication before meals: While the timing of medication relative to meals can affect absorption, this action assumes a specific problem without first clarifying the client's concerns. It's important to understand the nature of the client's issue before assessing medication administration.
B) Ask if his morning voiding is dark colored: Dark-colored urine may be a side effect of some medications, but this is a less direct approach to understanding why the client feels the medication is not working. It does not directly address the effectiveness of the medication.
C) Explore what the client means by the drug not working: This is the most appropriate initial intervention. Understanding the client's perception and specific concerns about the medication's effectiveness will guide further actions, such as assessing medication adherence, side effects, or the need for a medication adjustment.

D) Evaluate the client for signs of dyskinesia: While assessing for dyskinesia is important, it is more of a specific follow-up step. The priority is to understand the client's concerns about the medication's overall effectiveness before focusing on specific side effects.