A nurse is assessing a patient who has Graves’ disease. Which of the following findings should the nurse expect? (Select all that apply)

Choice A reason: Tuna salad and chips are generally safe for patients on warfarin. These foods have low vitamin K content, which does not significantly affect warfarin’s anticoagulant effect. Warfarin inhibits vitamin K-dependent clotting factors, and consistent low-vitamin K intake supports stable INR levels, making this choice appropriate.

Choice B reason: Chicken tacos are unlikely to interfere with warfarin. Chicken and typical taco ingredients (e.g., lettuce, tomatoes) have minimal vitamin K. Maintaining a consistent diet with low-vitamin K foods prevents fluctuations in warfarin’s efficacy, as high vitamin K can counteract its anticoagulant effects. This choice does not indicate a need for education.

Choice C reason: Barley soup is safe for warfarin patients, as barley contains negligible vitamin K. Soups without high-vitamin K vegetables (e.g., spinach) do not significantly impact warfarin’s inhibition of clotting factors. Consistent dietary vitamin K intake is key, and this choice aligns with maintaining stable anticoagulation, requiring no additional patient education.

Choice D reason: A large chef’s salad may include high-vitamin K foods like spinach, kale, or broccoli, which counteract warfarin’s anticoagulant effect by promoting clotting factor synthesis. This could destabilize INR, increasing clotting risk. The patient needs education on avoiding high-vitamin K foods to maintain therapeutic anticoagulation, making this choice problematic.

Choice A reason: Heart failure is not directly caused by vasopressin in CAD patients. Vasopressin increases water reabsorption in the kidneys, potentially increasing blood volume, which could strain the heart in severe cases. However, its primary concern in CAD is vasoconstriction, not heart failure, as it does not directly impair cardiac contractility or cause decompensation.

Choice B reason: Thirst is a symptom of diabetes insipidus due to dehydration from excessive urine output, not a side effect of vasopressin. Vasopressin replaces ADH, reducing urine output and thirst. It does not induce thirst in CAD patients, making this choice irrelevant to the cardiovascular risks associated with vasopressin administration.

Choice C reason: Dysrhythmias are not a primary concern with vasopressin in CAD. Vasopressin causes vasoconstriction, increasing vascular resistance and myocardial oxygen demand, which can lead to ischemia in CAD patients. While ischemia may rarely trigger dysrhythmias, the direct effect of vasopressin is vasoconstriction, not arrhythmias, making this choice less accurate.

Choice D reason: Vasoconstriction is a significant risk of vasopressin in CAD patients. Vasopressin, an ADH analog, causes systemic vasoconstriction, increasing blood pressure and myocardial oxygen demand. In CAD, this can exacerbate ischemia by reducing coronary blood flow, potentially leading to angina or infarction, making caution necessary in these patients.