The nurse is admitting a client diagnosed with mitral valve regurgitation. Which medication would help decrease afterload for this client?

a. Use a soft bristle toothbrush: Warfarin (Coumadin) therapy can increase the risk of bleeding. Using a soft bristle toothbrush can help reduce the risk of gum bleeding or oral mucosal injury, which is important for clients on anticoagulant therapy.
b. Risk of infection is increased: There is no direct association between warfarin therapy and an increased risk of infection. This option is not relevant to warfarin therapy.
c. Check for black, tarry stools: Warfarin therapy increases the risk of gastrointestinal bleeding. Black, tarry stools can indicate upper gastrointestinal bleeding, which requires immediate medical attention.
d. Limit aspirin to 650mg/day: Aspirin is typically avoided or used cautiously in combination with warfarin due to an increased risk of bleeding. However, there is no specific recommended limit of 650mg/day for aspirin use in conjunction with warfarin. This option does not accurately reflect guidance for warfarin therapy.
e. Keep appointments for PT/INR monitoring: Prothrombin time (PT) and international normalized ratio (INR) monitoring are essential for assessing the effectiveness and safety of warfarin therapy. PT/INR levels need to be within the therapeutic range to prevent both clotting and bleeding complications. Keeping appointments for monitoring ensures timely adjustments to the warfarin dosage.

In this scenario, the client is exhibiting signs of severe respiratory distress, which could indicate worsening acute heart failure and potential respiratory failure.

a. Check MAR for antianxiety medication: While anxiety may exacerbate the client's symptoms, the priority at this moment is to address the acute respiratory distress and ensure adequate oxygenation. Checking the medication administration record (MAR) for antianxiety medication can be done later but is not the immediate priority.

b. Ask when the dyspnea started: While obtaining a thorough history is important for understanding the onset and progression of the client's symptoms, it is not the first action to take in this critical situation. The client's current condition requires immediate intervention to ensure adequate oxygenation and stabilization.

c. Notify the provider: Notifying the provider is important, especially in a situation where the client's condition is deteriorating rapidly. However, this action may take some time, and the priority is to address the client's immediate needs first.

d. Increase oxygen from 3L/minute to 5L/minute: This is the most appropriate action to take first. The client is showing signs of severe respiratory distress with cyanosis and increased work of breathing. Increasing the oxygen flow rate from 3L/minute to 5L/minute can help improve oxygenation and alleviate hypoxemia, which is crucial in the management of acute heart failure exacerbation.