After receiving the third dose of a new oral anticoagulant prescription, an older adult client develops bleeding and tender gums and has many new bruises. Which actions should the nurse implement? Select all that apply.

A) Provide a PRN NSAID for gum pain: Administering NSAIDs is not recommended as they can exacerbate bleeding risks in clients on anticoagulants. NSAIDs can interfere with platelet function and increase bleeding tendencies. B) Complete a medication variance report: Documenting adverse effects and any discrepancies in medication administration is crucial for patient safety and quality control. A variance report helps track and address issues related to medication effects. C) Review most recent coagulation lab values: Evaluating recent lab results is essential to determine if the anticoagulant dosage is appropriate and if there is an increased risk of bleeding. This information guides decisions about further interventions or adjustments to the medication regimen. D) Report findings to healthcare provider: Immediate communication with the healthcare provider is necessary to address the client’s symptoms of bleeding and bruising. The provider can then evaluate the need for treatment modification or additional measures to manage bleeding risks. E) Obtain a soft bristle toothbrush for client: A soft bristle toothbrush helps minimize gum irritation and bleeding, which is important for clients on anticoagulants to reduce the risk of oral bleeding and maintain oral health.