A nurse is educating a patient who is starting a new antidepressant medication. Which statement by the nurse is most accurate regarding the risk of suicidal thoughts and behaviors associated with antidepressant use?

• Losartan: As an angiotensin II receptor blocker (ARB), losartan reduces aldosterone secretion, leading to decreased potassium excretion and potential hyperkalemia, especially in patients with renal impairment or those on potassium supplements.

• Furosemide: This loop diuretic promotes the excretion of sodium and potassium in the urine, commonly resulting in hypokalemia. Patients on furosemide often require potassium monitoring or supplementation.
• Spironolactone: A potassium-sparing diuretic and aldosterone antagonist, spironolactone reduces potassium excretion in the distal nephron. This can lead to hyperkalemia, particularly when used with other potassium-elevating drugs.
• Lisinopril: An ACE inhibitor that blocks the conversion of angiotensin I to II, reducing aldosterone levels and thereby decreasing potassium excretion. This places patients at risk for hyperkalemia.
• Digoxin: This cardiac glycoside may cause hypokalemia indirectly by increasing sensitivity to potassium shifts. Additionally, low potassium levels enhance digoxin toxicity, so maintaining normal potassium is critical during therapy.

A. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay.": Heparin does not enhance the effect of warfarin directly. Their mechanisms of action are different, and warfarin’s effect is delayed. Heparin is used to maintain anticoagulation until warfarin becomes effective.
B. "Both heparin and warfarin work together to dissolve the clots.": Neither heparin nor warfarin dissolves existing clots; they prevent further clot formation and allow the body’s natural fibrinolytic system to break down clots. This statement misrepresents their action.
C. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level.": Warfarin requires 3–5 days to reach therapeutic INR levels due to its action on vitamin K-dependent clotting factors. Heparin provides immediate anticoagulation, which is why it is continued until warfarin is therapeutic.
D. "I will call the provider to get a prescription for discontinuing the IV heparin today.": Discontinuing heparin too soon places the patient at risk for clot progression or embolization, as warfarin will not yet be therapeutic. The nurse should understand and educate the patient about the rationale for overlap.