A nurse is assessing a client who is in active labor and just received an epidural. Which of the following findings should the nurse document as an adverse effect?

Rationale:

• Instruct client to avoid foods that have been fermented or aged: This dietary restriction applies to monoamine oxidase inhibitors (MAOIs), not trazodone, which is a serotonin antagonist and reuptake inhibitor (SARI).
• Encourage client to sleep until later in the morning: Oversleeping can disrupt circadian rhythms and worsen fatigue. A consistent, balanced sleep schedule is more therapeutic.
• Advise client to notify provider if pregnant: Trazodone is a category C medication and should only be used in pregnancy if the benefits outweigh the risks. The provider must be informed if the client is or may become pregnant.
• Encourage high-calorie finger foods: The client has experienced weight loss and decreased appetite. Nutrient-dense, easy-to-eat foods can support caloric intake without requiring full meals.
• Advise client to rise slowly from sitting position: Trazodone can cause orthostatic hypotension. Educating the client to change positions slowly helps prevent dizziness and potential falls.
• Encourage naps during the day when client is tired: Daytime napping can interfere with nighttime sleep and may reduce trazodone’s effectiveness in establishing a healthy sleep pattern.
• Encourage a regular sleep-wake schedule: Trazodone is often prescribed for sleep difficulties. A consistent routine supports sleep hygiene and enhances the medication’s effectiveness.

Rationale:

A. Bleeding time: This test evaluates platelet function and capillary integrity, not anticoagulation status. It is not used to monitor warfarin therapy.

B. aPTT: Activated partial thromboplastin time is used to monitor heparin therapy, not warfarin. Warfarin affects different clotting factors primarily measured by PT/INR.

C. Factor VIII: This assesses clotting factor levels, particularly relevant in hemophilia A. It does not provide information about warfarin’s anticoagulant effects.

D. INR: The International Normalized Ratio is the standard test used to monitor warfarin therapy. It adjusts for variability in PT results and determines if warfarin is in the therapeutic range.