Introduction:
Introduction: ( 5 Questions)
A nurse is reviewing the medication history of a client who has epilepsy and is taking valproic acid. The nurse notes that the client is also taking warfarin for atrial fibrillation. What is the most appropriate action for the nurse to take?
Choice A is wrong because advising the client to stop taking warfarin and switch to aspirin is not appropriate. Warfarin is an anticoagulant that prevents blood clots from forming or growing, while aspirin is an antiplatelet that prevents platelets from sticking together and forming clots³. Warfarin and aspirin have different mechanisms of action and indications, and they are not interchangeable. The client should not stop taking warfarin without consulting their doctor, as this may increase the risk of stroke or other thromboembolic events due to atrial fibrillation³.
This is because valproic acid and warfarin have a potential drug interaction that can increase the anticoagulant effect of warfarin and cause bleeding complications¹². Valproic acid may displace warfarin from the protein binding sites, resulting in an increase in the free active form of warfarin and a rise in INR¹². The client should be advised to check their bleeding time and INR frequently and report any abnormal results or signs of bleeding to their doctor. The dose of warfarin may need to be adjusted based on the INR level².
Choice C is wrong because administering vitamin K to the client as an antidote is not necessary. Vitamin K is used to reverse the effects of warfarin in cases of severe bleeding or overdose⁴. The client does not have any signs of bleeding or overdose, and giving vitamin K may lower the INR too much and reduce the effectiveness of warfarin⁴. Vitamin K should only be given under the supervision of a doctor and with careful monitoring of INR⁴.
Choice D is wrong because informing the client that there is no interaction between valproic acid and warfarin is false. As mentioned above, valproic acid and warfarin have a clinically significant interaction that can affect the INR and bleeding risk of the client¹². The client should be aware of this interaction and take precautions to prevent adverse outcomes.