The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to:

A. These symptoms are signs of an allergic reaction to the medication.: Allergic reactions to prednisone are uncommon and usually present with rash, itching, or anaphylaxis rather than fatigue, edema, or weight gain. Mr. Johnson’s symptoms do not align with typical hypersensitivity responses.

B. These are expected side effects of short-term corticosteroid use.: While short-term prednisone use can cause minor side effects such as mood changes or insomnia, significant fluid retention, rapid weight gain, and swelling are more concerning and not typical of brief therapy.

C. These symptoms may indicate fluid retention and potential electrolyte imbalances: Prednisone can cause sodium and water retention, leading to edema, rapid weight gain, and fatigue. Electrolyte disturbances, particularly hypokalemia, may also occur. Monitoring and notifying the provider is important to prevent cardiovascular complications.

D. These symptoms are due to an underlying infection caused by the medication.: Prednisone can suppress the immune system, increasing infection risk, but the described symptoms do not specifically indicate infection. Fatigue and swelling are more consistent with fluid and electrolyte effects rather than an infectious process.

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.