The nurse has reviewed the Nurses' Notes, Vital Signs, and Laboratory Results from 3 months ago.

Exhibits

The nurse is reviewing the client's plan of care. Which of the following findings indicate the client's condition has improved? Select all that apply.

Rationale:

A. Magnesium sulfate: Magnesium sulfate does not have significant interactions with warfarin and is not contraindicated. It can be safely administered with appropriate monitoring, making it safe in this context.

B. Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding when taken with warfarin. It inhibits platelet function and can potentiate anticoagulation, making it contraindicated.

C. Cetirizine: Cetirizine is an antihistamine that does not significantly affect coagulation or interact with warfarin. It can be safely used with warfarin under normal circumstances.

D. Gingko biloba: Gingko biloba can increase the risk of bleeding by inhibiting platelet aggregation. Clients on warfarin should avoid herbal supplements like gingko that can potentiate anticoagulation effects.

E. Aspirin: Aspirin has antiplatelet effects and can significantly increase the risk of bleeding when combined with warfarin. Concurrent use is generally contraindicated unless specifically approved and closely monitored by the provider.

Rationale:

A. Assign the AP to ask the client if she has taken her antidiabetic medication today: Asking about medication adherence is part of assessment and requires clinical judgment. Delegating this task to an AP is inappropriate because it involves interpreting client responses and making clinical decisions.

B. Determine if the AP has the skills to perform the test: Before delegating any task, the nurse must verify that the AP is competent and trained to perform the procedure safely. Ensuring skill competency protects the client from harm and aligns with the nurse’s responsibility for delegation.

C. Have the AP check the medical record for prior blood glucose test results: Reviewing medical records and interpreting trends involves clinical judgment and falls outside the typical scope of practice for an AP. This task should remain with the licensed nurse.

D. Help the AP perform the blood glucose test: Assisting the AP is not necessary if the AP is competent and has been properly trained. The nurse’s role is to delegate appropriately, supervise as needed, and ensure safe completion, rather than performing the task alongside the AP.