Rifampin is part of the 4-drug RIPE regimen (rifampin, isoniazid, pyrazinamide, ethambutol), in which multiple anti-TB medications are given together during the first 2-4 weeks of therapy. All RIPE medications carry a high risk for hepatotoxicity, which can cause life-threatening liver failure characterized by fluid and electrolyte imbalances and bleeding. If the client develops jaundice, malaise (extreme, flu-like fatigue), pale stools, or other signs of hepatotoxicity, the health care provider should be notified immediately.

Direct oral anticoagulants (DOACs), such as rivaroxaban (Xarelto) and apixaban (Eliquis), are given to treat or prevent thromboembolism (e.g., atrial fibrillation, pulmonary embolism). When a client is taking anticoagulants, it’s essential to:
Take as prescribed: Follow the prescribed dosing schedule to maintain therapeutic drug levels. Doubling the dose of an anticoagulant can greatly increase the risk of bleeding [Choice 3]. Clients should take a missed dose as soon as possible unless it’s close to the time of the next dose.
Minimize risk of bleeding: Use soft-bristled toothbrushes, stool softeners, avoid activities that could lead to cuts or bruises (e.g., contact sports), and use electric razors when shaving.

Preeclampsia is characterized by maternal endothelial cell dysfunction, which causes vasoconstriction, hypertension, and increased vascular permeability, allowing fluid to leak from the vascular space into the tissue. This can cause cerebral edema, leading to central nervous system (CNS) hyperactivity and seizures (i.e., eclampsia). Magnesium sulfate is administered to depress the CNS and prevent seizures. Additionally, it lowers blood pressure by relaxing vascular smooth muscle. Magnesium sulfate infusions increase the risk for CNS and respiratory depression. Infusions should be stopped if the client experiences decreased urinary output, CNS depression (e.g., absent deep tendon reflexes), or respiratory depression (i.e., shallow or slow respirations [rate <12]). Calcium gluconate, an antidote for magnesium sulfate toxicity, may be needed.

In the context of acute myocardial infarction, the priority is to manage life-threatening arrhythmias. Lidocaine is specifically indicated for the treatment of ventricular arrhythmias, such as PVCs, which can be indicative of an increased risk for more serious arrhythmias like ventricular tachycardia or ventricular fibrillation. The presence of PVCs on a cardiac monitor would be the most immediate concern that lidocaine can address in this scenario. While the other factors listed are important to monitor, they are not the primary indications for lidocaine administration in the context of arrhythmia management.

Clients taking warfarin should be educated about maintaining a consistent intake of vitamin K, as it is necessary for the clotting cascade, and warfarin works by inhibiting the effects of vitamin K, thereby reducing the blood’s ability to clot. Sudden increases in vitamin K intake can decrease the effectiveness of warfarin and increase the risk of clot formation. Clients should also be advised to report any incidents of diarrhea (A) since it can affect the absorption of the medication and potentially lead to unstable anticoagulation levels. Using a straight razor (C) is not advised due to the increased risk of bleeding; a safety razor or electric razor would be safer alternatives. Taking aspirin for pain relief (D) is not recommended without a physician’s approval because aspirin can increase the risk of bleeding when taken with an anticoagulant. Monitoring for signs of bleeding (E), checking blood pressure regularly (F), and informing all healthcare providers about anticoagulant therapy (G) are also important instructions for a patient on warfarin therapy, but avoiding foods high in vitamin K is directly related to the effectiveness of the anticoagulant medication and is thus the priority teaching point.