Unlike heparin, the anticoagulant activity of warfarin can take several

to reach its maximum effect.

A. Fish oil: While fish oil has some evidence for reducing inflammation, the evidence for its effectiveness in treating arthritis is mixed.

B. DHEA: DHEA is a hormone and there is not enough evidence to support its use for arthritis.

C. Garlic and soy: While garlic and soy have some general health benefits, there is no strong evidence they are effective for treating arthritis.

D. Chondroitin and glucosamine: These supplements are the most studied option for arthritis and some studies have shown they may provide modest pain relief, although the evidence is not conclusive.

A. Easy bruising indicates the medication is effective: While some bruising is possible, excessive bruising doesn't necessarily mean the medication is working effectively. It could indicate excessive anticoagulation, requiring dose adjustments.

B. Inject the medication deep into the thigh muscle: Heparin is injected subcutaneously, targeting the fatty tissue layer just beneath the skin. Injecting into the muscle can be painful and decrease absorption.

C. Expect stools to become black and tarry: Black stools can be a sign of upper gastrointestinal bleeding, a potential but uncommon side effect. The nurse should instruct the client to report any black stools but not expect them as a normal occurrence.

D. Use a soft bristle toothbrush: This is important because heparin increases bleeding risk, and a soft-bristled toothbrush minimizes gum irritation and potential bleeding.