The nurse is caring for a client with atrial fibrillation who receives a prescription for warfarin. The international normalized ratio (INR) is 2.8. Which action should the nurse take?

Choice A reason: Suggesting the use of an antacid two hours after taking risedronate is not the best initial response. While antacids can help with heartburn, they can also interfere with the absorption of risedronate if taken too close to the medication. It is more important to first understand how the client is taking the medication to ensure proper administration.

Choice B reason: Reminding the client to take the medication with plenty of water is good advice, as risedronate should be taken with a full glass of water to prevent esophageal irritation. However, this response does not address the immediate concern of increasing heartburn. Understanding the client’s current administration method is crucial.

Choice C reason: Asking the client to describe how she takes the medication is the most appropriate response. This allows the nurse to identify any potential issues with the administration technique, such as not taking the medication with enough water or not remaining upright for at least 30 minutes after taking it. Correcting these issues can help reduce heartburn and improve the medication’s effectiveness.

Choice D reason: Advising the client to go to the nearest emergency department is not necessary unless the heartburn is severe or accompanied by other symptoms such as chest pain or difficulty swallowing. Initially, it is more appropriate to assess the client’s administration technique and provide guidance on proper medication use.

Choice A reason:

Documenting the client’s refusal of the medication at this time is not the best response. While it is important to document any refusal of medication, the nurse should first educate the client on the proper administration of sucralfate. Sucralfate works by forming a protective barrier over ulcers, and it is most effective when taken on an empty stomach, at least 1 hour before meals.

Choice B reason:

Explaining the need to take the medication at least 1 hour before meals is the correct response. Sucralfate should be taken on an empty stomach to ensure it can effectively coat the stomach lining and protect it from acid. Taking it before meals maximizes its efficacy in treating and preventing ulcers.

Choice C reason:

Allowing the client to take the medication up to 1 hour after breakfast is not appropriate. Sucralfate needs to be taken on an empty stomach to form a protective barrier over the ulcer. Taking it after a meal would reduce its effectiveness, as the presence of food can interfere with its action.

Choice D reason:

Instructing the client to take it when the meal tray is delivered is incorrect. Sucralfate should be taken on an empty stomach, at least 1 hour before meals, to ensure it can properly coat the stomach lining and provide the necessary protection against stomach acid