A nurse is teaching a client who has pernicious anemia to self-administer nasal cyanocobalamin. Which of the following information should the nurse include in the teaching?

Choice A Reason:
Decrease the dose of the medication is incorrect. Lowering the dose could potentially drop the INR below the therapeutic range, increasing the risk of clot formation.
Choice B Reason:
Increase the dose of the medication is incorrect. Raising the dose might push the INR above the therapeutic range, increasing the risk of bleeding.
Choice C Reason:
Withhold the medication is incorrect. Withholding the medication might lead to inadequate anticoagulation and an increased risk of clot formation.
Choice D Reason:
Administer the current dose of the medication. An INR of 2.5 is within the therapeutic range for many indications, including atrial fibrillation. This means the blood is appropriately anticoagulated to prevent clot formation without an excessive risk of bleeding. In this scenario, maintaining the current dose of warfarin is often appropriate to sustain the desired therapeutic effect.

Choice A Reason:
Hct 44% is incorrect. A hematocrit (Hct) level of 44% falls within the normal range for most adults. It represents the proportion of red blood cells in the blood and is not typically concerning unless it significantly deviates from the normal range, indicating anemia or polycythemia.
Choice B Reason:
WBC count 5,000/mm3 is incorrect. A white blood cell (WBC) count of 5,000/mm3 falls within the normal range for adults, reflecting a normal immune response. There's usually no cause for immediate concern unless there are specific clinical symptoms or significant deviations from the normal range.
Choice C Reason:
Potassium 4.2 mEq/L is incorrect. A potassium level of 4.2 mEq/L is within the normal range for serum potassium levels. It's crucial to monitor potassium levels, especially with medications that can affect electrolyte balance, but this value falls within the typical range and may not prompt immediate action unless there are notable fluctuations or clinical symptoms related to potassium imbalance.
While the majority of the laboratory values provided fall within the normal range, the value that the nurse should consider reporting to the provider, particularly when a client is taking amitriptyline, is:
Choice D Reason:
Total bilirubin 1.5 mg/dL is correct. Elevated levels of total bilirubin might indicate potential liver function impairment. Amitriptyline, an antidepressant, can affect liver enzymes in some individuals, causing hepatic changes. Therefore, it's crucial to monitor liver function tests, including total bilirubin, during amitriptyline therapy. An increase in bilirubin levels could signal hepatotoxicity or liver dysfunction related to the medication.