The nurse is caring for a client who lives below the poverty level. While providing discharge teaching, the nurse notes that the client has received a prescription for warfarin (Coumadin) and will need to return to the clinic for regular lab work. Which of the following is most appropriate for the nurse to ask the client?
“Do you know when your next appointment is for lab work?”
“Do you have a car or someone to take you to get your lab work done?”
“Can you tell me the side effects that you should report to your physician?”
Number 4 is correct.
Rationale: Warfarin is a high-alert drug and clients should know which side effects to report to their physician. Bloody, black, or tarry stools; pink urine; or excessive bleeding should be reported immediately. Which pharmacy the client uses is not as important as knowing which side effects to report. Knowing the next lab appointment is important but not as important as knowing the side effects of warfarin. Clients must undergo regular laboratory testing to ensure that the warfarin is at a therapeutic level. Clients living at poverty level often lack reliable transportation to return to clinics for follow-up lab work. The nurse should ensure that the client has transportation for lab work to prevent the risk of bleeding. If the client expresses doubt about being able to return for labs, the nurse should notify the health care provider and ask for a social worker consult. The social worker may know of free transportation for low-income individuals or be able to provide a bus or cab voucher. Nurses collaborate with other disciplines to ensure the best care for the client. The nurse is often the only one that the client confides in regarding obstacles to care.