A nurse is caring for a client who has a newly created colostomy. The client’s partner tells the nurse that the client refuses to look at the stoma. Which of the following actions should the nurse take?

Choice A reason: Advising over-the-counter medications as safe is incorrect, as many, like NSAIDs, increase warfarin’s bleeding risk by inhibiting platelets or affecting liver metabolism. Warfarin’s narrow therapeutic index requires careful management to prevent hemorrhage, making broad safety claims dangerous without specific evaluation.
Choice B reason: Consulting the pharmacist identifies interactions with warfarin, a vitamin K antagonist metabolized by CYP450 enzymes. Many drugs alter warfarin’s efficacy, risking thrombosis or bleeding. Pharmacist expertise ensures safe polypharmacy, maintaining therapeutic INR levels critical for managing pulmonary emboli effectively.
Choice C reason: Recommending warfarin with other medications ignores interaction risks and timing needs. Warfarin’s absorption is unaffected by timing, but CYP450 interactions can alter INR. This advice is irrelevant to safety, missing the need for individualized regimen assessment to prevent complications in anticoagulation therapy.
Choice D reason: Cranberry juice may enhance warfarin’s effect by inhibiting CYP2C9, increasing INR and bleeding risk. Advising its use without monitoring is unsafe, as dietary factors can destabilize anticoagulation, potentially causing hemorrhage in clients with pulmonary emboli, requiring careful dietary guidance.

Choice A reason: Varicella, a viral infection, is not treated with antibiotics, which target bacteria. Returning to school after 24 hours of antibiotics is incorrect, as contagiousness persists until lesions crust, typically 5-7 days, risking transmission if the child returns prematurely.
Choice B reason: A negative titer result indicates immunity or resolved infection but is not a practical criterion for school return. Varicella contagiousness depends on lesion crusting, not serology, which is complex and unnecessary when clinical signs confirm reduced infectivity in affected children.
Choice C reason: Fever subsidence does not ensure non-contagiousness in Varicella. The virus spreads via respiratory droplets and lesions until crusted. Allowing return based on fever ignores transmission risk, as active lesions remain infectious, potentially spreading the virus in school settings.
Choice D reason: Varicella is contagious until lesions crust over, typically 5-7 days post-rash. Crusting indicates the end of viral shedding, ensuring safety for school return. This aligns with infection control guidelines, preventing transmission via contact or respiratory routes in communal settings.