A nurse is caring for a client prescribed Lithium. Which nursing action is most appropriate regarding monitoring serum lithium levels and maintaining adequate fluid and sodium intake?

• 1 I will keep vitamin K-rich foods, such as kale, spinach, and broccoli, out of my meals from now on because even a small serving could interfere with warfarin's action and raise my risk for a stroke; I will also steer clear of any supplement containing vitamin K.
• 2 If I forget to take my warfarin at bedtime and remember the next day before noon, I will take the missed dose right away and then resume my usual schedule that evening, because taking it late is better than skipping, but if it is after noon, I will take two doses that night.
• 3 When I get a headache or joint pain, I will take ibuprofen or naproxen sodium from the pharmacy because they are available without a prescription and are safer than prescription anti-inflammatories; they do not increase my risk of bleeding and I can take them without notifying my provider.
• 4 I will eat a consistent amount of vitamin K-containing foods from week to week, take warfarin at the same time each day, report any unusual bruising or pink/dark urine, and check with the provider before starting any new prescription, OTC, or herbal product. ✓ Correct answer

For study reference only. Always follow current clinical guidelines and your institution’s protocols.