A nurse is caring for a patient with deep vein thrombosis. The nurse would expect all of the following orders to be on the care plan, except:

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: NSTEMI (non-ST-elevation myocardial infarction) is a heart attack caused by coronary artery occlusion, leading to myocardial ischemia. Symptoms include chest pain and elevated cardiac enzymes, not bradycardia, hyponatremia, or altered consciousness. Hypothyroidism does not directly cause NSTEMI, and these symptoms align with metabolic, not cardiac, pathology.

Choice B reason: Myxedema coma is a life-threatening complication of severe hypothyroidism, characterized by bradycardia, hyponatremia, hypotension, altered consciousness, and respiratory depression. Hypothyroidism slows metabolism, leading to fluid retention, low sodium, and reduced cardiac output. These symptoms match the patient’s presentation, making myxedema coma the most likely diagnosis in this scenario.

Choice C reason: SIADH causes hyponatremia due to excessive antidiuretic hormone, leading to water retention. However, it does not typically cause bradycardia, hypotension, or respiratory difficulty. SIADH is not a complication of hypothyroidism, and the patient’s symptoms, including altered consciousness, align more closely with myxedema coma than SIADH’s water imbalance.

Choice D reason: Thyroid storm is a life-threatening hyperthyroidism complication, presenting with tachycardia, hyperthermia, and agitation. The patient’s bradycardia, hypotension, and hyponatremia are opposite to thyroid storm’s hypermetabolic state. Hypothyroidism leads to myxedema coma, not thyroid storm, making this choice inconsistent with the patient’s clinical presentation and lab findings.