The nurse has administered warfarin 2.5 mg orally daily for three days to a client who has deep vein thrombosis. The client's International Normalized Ratio (INR) today is 5.0. The nurse notifies the healthcare provider because today's dose of the medication should be:

Choice a reason:
Avoiding crossing the legs while sitting is crucial after a total hip replacement to prevent dislocation of the new joint. Crossing the legs can put undue pressure on the hip joint and may lead to misalignment or increased strain during the healing process.

Choice b reason:
Eliminating Vitamin K from the diet is not typically recommended after a total hip replacement. Vitamin K is essential for blood clotting, and maintaining a consistent intake is important, especially if the client is on anticoagulant therapy to prevent deep vein thrombosis. Sudden changes in Vitamin K intake can affect the efficacy of anticoagulants like warfarin.

Choice c reason:
Following a home exercise program is an essential part of recovery after a total hip replacement. Exercises help strengthen the muscles around the new joint, improve flexibility, and increase range of motion. It's important that these exercises are done regularly and as instructed by a physical therapist.

Choice d reason:
Using a raised toilet seat after hip replacement surgery helps to prevent excessive flexion at the hip, which can risk dislocating the new joint. It also makes it easier for the client to sit down and stand up with less strain on the hip.

Choice e reason:
Increasing high-impact activities is not recommended after a total hip replacement, especially in the early stages of recovery. High-impact activities can put excessive stress on the new joint and may lead to complications. Low-impact activities such as walking, swimming, or cycling are generally more appropriate.

Choice A Reason
A potassium level of 5.0 mEq/L is at the upper limit of the normal range, which is typically between 3.5 and 5.0 mEq/L. While this level should be monitored, especially in the context of diabetes where the patient may be at risk for hyperkalemia due to potential kidney issues, it is not immediately alarming¹.

Choice B Reason
A creatinine level of 4.4 mg/dL is significantly higher than the normal range of 0.6 to 1.2 mg/dL for males and 0.5 to 1.1 mg/dL for females. This indicates severe renal impairment or kidney failure, which is a serious complication of diabetes mellitus. Immediate intervention is required to address this critical issue¹.

Choice C Reason
A hemoglobin level of 10.7 g/dL is slightly below the normal range for adults, which is generally 13.8 to 17.2 g/dL for males and 12.1 to 15.1 g/dL for females. This could indicate mild anemia, which can be a complication of diabetes but is not as immediately concerning as a high creatinine level¹.

Choice D Reason
A Blood Urea Nitrogen (BUN) level of 22 mg/dL is within the normal range, which is typically between 7 and 20 mg/dL. This level does not indicate immediate concern and is not as critical as the elevated creatinine level¹.