A client who is taking an oral dose of a tetracycline reports gastrointestinal (GI) upset. Which snack should the nurse instruct the client to take with the tetracycline?

Choice A reason: Taking a multi-vitamin supplement daily is not a necessary instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. However, some vitamins, such as vitamin K, vitamin E, and vitamin C, can interact with warfarin and affect its effectiveness. Patients should consult their health care provider before taking any supplements or herbal products.

Choice B reason: Using an astringent for superficial bleeding is not a sufficient instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should report any signs of bleeding, such as bruising, nosebleeds, gum bleeding, blood in urine or stool, or prolonged bleeding from cuts or wounds, to their health care provider. They should also avoid activities or products that can increase the risk of bleeding, such as shaving with a razor, using dental floss, or taking aspirin or NSAIDs.

Choice C reason: Adding large amounts of spinach to the diet is an incorrect instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Spinach is a leafy green vegetable that is high in vitamin K, which can counteract the effect of warfarin and increase the risk of clotting. Patients should maintain a consistent intake of vitamin K-rich foods and avoid sudden changes in their diet.

Choice D reason: Avoiding going barefoot, especially outside, is a correct instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should protect their feet from injury or infection by wearing shoes or slippers at all times.

Choice A reason: Storing unused vials at room temperature is incorrect information that indicates a need for further education by the nurse, because somatropin is a growth hormone that should be stored in the refrigerator (2°C to 8°C) until use. Exposure to heat or light can degrade the medication and reduce its effectiveness.

Choice B reason: Rotating injection sites to minimize discomfort is correct information that does not indicate a need for further education by the nurse, because somatropin is administered subcutaneously and repeated injections at the same site can cause skin irritation, bruising, or infection.

Choice C reason: Discarding the medication if the solution is cloudy is correct information that does not indicate a need for further education by the nurse, because somatropin is a clear and colorless solution that should not be used if it appears cloudy, discolored, or contains particles. This may indicate contamination or degradation of the medication.

Choice D reason: Administering the medication subcutaneously is correct information that does not indicate a need for further education by the nurse, because somatropin is a growth hormone that is given by subcutaneous injection using a syringe or a pen device. Subcutaneous injection allows for better absorption and bioavailability of the medication.