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. Obtain a soft bristle toothbrush for client: This helps minimize gum injury and reduce further bleeding risk, which is important for patients on anticoagulants who are more prone to bleeding even from minor trauma. B. Review most recent coagulation laboratory values: Checking lab results such as PT/INR or other relevant coagulation tests can help determine if the anticoagulant effect is excessive and guide further treatment decisions. C. Complete a medication variance report: This is not indicated unless there is a confirmed medication error. The reaction here may be an expected but excessive pharmacologic effect, not necessarily an error. D. Provide a PRN NSAID for gum discomfort: NSAIDs can increase bleeding risk and should be avoided in patients on anticoagulants, as they have an additive anticoagulant effect and can worsen bleeding. E. Report findings to healthcare provider: The bleeding and bruising suggest possible over-anticoagulation or drug sensitivity. Promptly notifying the provider allows for timely adjustment or discontinuation of the medication to prevent serious hemorrhage.