A nurse is caring for a male client who has peripheral vascular disease (PVD), is taking dietary supplements, and has a new prescription for warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the warfarin? (Select all that apply.)

Rationale: A. Black cohosh: This supplement is primarily used for menopausal symptoms and has estrogen-like effects. It is not strongly associated with increased bleeding risk when combined with anticoagulants, so it is not a priority to stop before starting warfarin. B. Gingko biloba: Gingko interferes with platelet aggregation, increasing the risk of bleeding when taken with warfarin. Combining these two agents can potentiate anticoagulant effects and raise the likelihood of serious hemorrhagic complications. C. Flaxseed oil: Flaxseed oil contains omega-3 fatty acids that can reduce platelet aggregation. When combined with warfarin, this increases the client’s risk for bleeding and should be discontinued prior to initiating therapy. D. Glucosamine: Glucosamine is typically used for osteoarthritis and joint health. It does not significantly impact coagulation pathways or platelet function, so it does not pose a major interaction risk with warfarin. E. Saw palmetto: Saw palmetto has antiplatelet effects that can increase the likelihood of bleeding in clients receiving anticoagulation. For safety, it should be discontinued before starting warfarin.