An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse anticipate the provider to order?

A. hyperkalemia: Spironolactone is a potassium-sparing diuretic that reduces sodium reabsorption while retaining potassium. This mechanism increases the risk of elevated serum potassium, which can cause cardiac arrhythmias. Regular monitoring of potassium levels is essential during therapy.

B. hypoglycemia: Spironolactone does not significantly affect blood glucose, so hypoglycemia is not a typical concern. Monitoring for low blood sugar is not a primary safety measure with this medication.

C. hypocalcemia: Spironolactone has minimal effect on calcium levels. Hypocalcemia is not a common adverse effect, so routine monitoring of calcium is not required for this purpose.

D. hypermagnesemia: While spironolactone may slightly affect magnesium retention, significant hypermagnesemia is uncommon. Monitoring focuses primarily on potassium rather than magnesium levels.

A. Continue with the current dose: An INR of 5.3 is above the therapeutic range, indicating a high risk of bleeding. Continuing the current dose without intervention could lead to serious hemorrhagic complications. Dose adjustment or reversal is necessary to ensure patient safety.

B. Administer additional warfarin: Giving more warfarin would further increase anticoagulation, greatly elevating the risk of spontaneous bleeding. This action is dangerous and contraindicated when the INR is already supratherapeutic.

C. Increase the dose of warfarin: Increasing the dose would exacerbate over-anticoagulation and heighten the risk of severe bleeding. The priority is to reduce the anticoagulant effect, not intensify it.

D. Administer vitamin K as ordered: Vitamin K acts as an antidote to warfarin by promoting clotting factor synthesis, which lowers INR and reduces bleeding risk. Administering it under provider guidance corrects over-anticoagulation safely and prevents hemorrhagic complications.