A nurse is caring for an adolescent in the outpatient dermatologist's office.

Exhibits

Complete the following sentence by using the lists of options.

A nurse is providing education today on the newly-prescribed medication. The nurse recommends the adolescent notify the provider immediately if 

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or

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occurs during therapy.

A. Platelet count. While important for evaluating bleeding risk, platelet count is not directly used to adjust or determine daily warfarin dosing. Warfarin affects the coagulation cascade, not platelet function.
B. aPTT. The activated partial thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. It assesses the intrinsic pathway of coagulation and is not sensitive to warfarin’s effects on the clotting factors.
C. Fibrinogen level. Fibrinogen is involved in clot formation, but its measurement is not part of routine warfarin management. It is more relevant in evaluating bleeding disorders or disseminated intravascular coagulation (DIC).
D. INR. The international normalized ratio (INR) is the primary lab value used to monitor the effectiveness and safety of warfarin therapy. It helps guide daily dosing by reflecting how long it takes blood to clot, with therapeutic ranges typically between 2.0 and 3.0 for most conditions.

A. "I can adjust the time and schedule for when it's convenient for you." While the nurse should respect the client’s preferences, medication timing must follow facility policy and the prescribed schedule, especially for time-sensitive drugs like vancomycin.
B. "I can infuse the medication at a faster rate." Vancomycin must be infused slowly (typically over at least 60 minutes) to prevent Red Man Syndrome and other complications. Increasing the rate can be dangerous and is not appropriate.
C. “I have up to 2 hours after the usual scheduled time to give you this medication." This aligns with standard medication administration policies, which generally allow for a 1-hour window before or after the scheduled time for most medications (and up to 2 hours depending on policy and the medication). This response shows appropriate clinical judgment and adherence to safe timing.
D. “I can start the medication 30 minutes earlier." While this may be acceptable in some cases, it doesn't fully address the client’s request for 2 hours earlier, nor does it reflect the standard administration window as accurately as option C.