A nurse is teaching a client who has been prescribed warfarin for atrial fibrillation. Which of the following statements by the client indicates a need for further education?

"I will avoid eating foods that are high in vitamin K."

"I will use a soft-bristled toothbrush to prevent bleeding."

"I will monitor my blood pressure regularly at home."

"I will report any signs of bruising or bleeding to my provider."

Answer and Explanation

The Correct Answer is A

A) Incorrect. The client should not avoid eating foods that are high in vitamin K, such as leafy green vegetables, because they can interfere with the anticoagulant effect of warfarin. The client should maintain a consistent intake of vitamin K and follow a balanced diet.

B) Correct. The client should use a soft-bristled toothbrush to prevent bleeding from the gums, which can occur due to the increased risk of bleeding caused by warfarin. The client should also avoid using dental floss and electric razors.

C) Correct. The client should monitor their blood pressure regularly at home, as warfarin can affect blood pressure and increase the risk of stroke or bleeding complications. The client should report any abnormal readings to their provider.

D) Correct. The client should report any signs of bruising or bleeding to their provider, as they may indicate an adverse reaction to warfarin or an overdose. The client should also report any signs of infection, such as fever, sore throat, or pus, as they may increase the risk of bleeding.

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Correct Answer is C

Explanation

A) Incorrect. Metformin does not cause hypoglycemia, as it does not stimulate insulin secretion. It lowers blood glucose levels by decreasing hepatic glucose production and increasing insulin sensitivity.

B) Incorrect. Metformin absorption is not affected by food intake. The medication can be taken with or without food, but taking it with meals can help reduce gastrointestinal side effects.

C) Correct. Metformin can cause gastrointestinal upset, such as nausea, diarrhea, and abdominal pain. Taking it with meals can help minimize these effects by slowing down the transit of the medication through the digestive tract.

D) Incorrect. Metformin effectiveness is not influenced by food intake. The medication works by improving glucose metabolism and insulin action.

A. Extrapyramidal symptoms B. Serotonin syndrome C. Neuroleptic malignant syndrome D. Lithium toxicity

Correct Answer is C

Explanation

A) Incorrect. Extrapyramidal symptoms (EPS), such as dystonia, akathisia, and tardive dyskinesia, are caused by dopamine antagonists, such as haloperidol. However, these symptoms are not related to the combination of medications that the client is taking.

B) Incorrect. Serotonin syndrome is a potentially life-threatening condition that results from excessive serotonin activity in the central nervous system. It is caused by serotonin-enhancing medications, such as antidepressants, opioids, and triptans. None of the medications that the client is taking have this effect.

C) Correct. Neuroleptic malignant syndrome (NMS) is a rare but serious condition that occurs due to dopamine blockade in the brain and peripheral tissues. It is caused by antipsychotic medications, such as haloperidol. The risk of NMS is increased when lithium carbonate is added to antipsychotic therapy, as lithium can potentiate the dopamine-blocking effect of antipsychotics.

D) Incorrect. Lithium toxicity is a condition that occurs when lithium levels exceed the therapeutic range of 0.6 to 1.2 mEq/L. It is caused by factors that affect lithium excretion, such as dehydration, renal impairment, drug interactions, and overdose. None of the other medications that the client is taking interact with lithium or affect its excretion.

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A nurse is teaching a client who has been prescribed warfarin for atrial fibrillation. Which of the following statements by the client indicates a need for further education?

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