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?
1I 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.
2If 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.
3When 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.
4I 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
Explanation
When administering Lithium, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Clinical reasoning summary Warfarin self-management — pillars of teaching Warfarin inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, X. INR goal is 2.0–3.0 for most indications (2.5–3.5 for mechanical mitral valve). Effective patient education has four major pillars:
(1) Diet consistency, not avoidance. Vitamin K does not need to be eliminated; consistent weekly intake of green leafy vegetables (spinach, kale, broccoli, brussels sprouts) keeps INR predictable. Wide swings cause dose adjustments. (2) Take at the same time daily (usually evening so dose can be adjusted same day after morning INR). If a dose is missed and noticed within a few hours, take it; if it is close to the next dose, skip and resume next day. Never double up. (3) Bleeding precautions. Soft toothbrush, electric razor; report unusual bruising, pink/red/dark urine, black/tarry stool, hemoptysis, persistent headache, or any fall (especially head injury — risk of intracranial hemorrhage). (4) Drug/herb/alcohol awareness. NSAIDs (ibuprofen, naproxen, aspirin), antibiotics (sulfa, metronidazole, fluoroquinolones), amiodarone, statins, herbal supplements (ginkgo, garlic, ginseng, ginger, Saint-John-wort), and grapefruit juice all alter INR. Verify any new agent with the provider/pharmacy. Limit alcohol to ≤1-2 drinks/day; binge drinking destabilizes INR.
Other teaching: keep a wallet medical alert card, schedule regular INR checks, contact the provider if pregnancy is suspected (warfarin is teratogenic), and alert dentists/surgeons before procedures.