A nurse is obtaining a medication history from a client who is to start therapy with naproxen for rheumatoid arthritis. Which of the following medications places the client at risk for bleeding?

A. Digoxin: Digoxin is a cardiac glycoside used to treat heart failure and arrhythmias. It does not directly affect platelet aggregation or coagulation, so it does not increase the risk of bleeding. B. Ibuprofen: Ibuprofen is a NSAID that, like naproxen, inhibits cyclooxygenase (COX) enzymes. This reduces the production of prostaglandins, which are involved in inflammation and platelet aggregation. This increases the risk of bleeding, especially when used in combination with other NSAIDs like naproxen. C. Captopril: Captopril is an ACE inhibitor used primarily for hypertension and heart failure. While it can increase potassium levels and cause hypotension, it does not directly increase the risk of bleeding. Its primary effects are related to blood pressure and kidney function. D. Phenytoin: Phenytoin is an anticonvulsant. While it has numerous drug interactions, it does not directly increase bleeding risk. However, it can affect vitamin K metabolism, which may influence clotting factors, but its effect on bleeding is not as significant as that of NSAIDs.