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. Complete a medication variance report: This action is important if there is a concern about the medication’s impact or if the adverse effects might be related to an error in administration or dosage. Documenting and reporting these issues help ensure safety and provide information for evaluating the medication’s use. B. Obtain a soft bristle toothbrush for client: Using a soft bristle toothbrush is a critical intervention to minimize gum trauma and bleeding, especially in clients on anticoagulants who are at higher risk for bleeding and gum tenderness. This helps reduce the risk of further bleeding and discomfort. C. Report findings to healthcare provider: It is essential to inform the healthcare provider about the bleeding, tender gums, and bruising. These symptoms indicate potential complications related to the anticoagulant therapy that may require adjustment of the medication or additional interventions to manage the bleeding risk. D. Provide a PRN NSAID for gum discomfort: NSAIDs (nonsteroidal anti-inflammatory drugs) should generally be avoided in clients on anticoagulants because they can further increase bleeding risk. Instead, other methods for managing discomfort should be considered, and this action could potentially exacerbate the bleeding issue. E. Review most recent coagulation lab values: Checking the most recent coagulation lab values is important to assess whether the anticoagulant is at an appropriate level and to determine if adjustments are needed. This helps in managing and preventing further bleeding complications.