The nurse is providing discharge teaching to a client who has been prescribed warfarin for the first time. Which of the following statements made by the client indicates a need for further teaching? (Select all that apply)

Introduction: Warfarin is a vitamin K antagonist that inhibits the synthesis of clotting factors II, VII, IX, and X. It has a narrow therapeutic range and requires meticulous laboratory monitoring and strict adherence to diet and dosing to prevent life-threatening hemorrhage or recurrent thromboembolic events in high-risk patients. A. This statement is incorrect. Warfarin therapy is monitored using the PT/INR (Prothrombin Time/International Normalized Ratio), not the PTT. The PTT (Partial Thromboplastin Time) is the laboratory parameter used to monitor unfractionated heparin therapy. The client needs further teaching to understand which blood test is required for their safety. B. This is a correct statement. While leafy green vegetables contain Vitamin K, which can counteract warfarin, the patient does not need to avoid them entirely. Maintaining a CONSISTENT INTAKE allows the provider to adjust the warfarin dose to a stable level of Vitamin K competition, ensuring a therapeutic INR. C. This is a correct statement. Warfarin increases the risk of bleeding from minor trauma. Using a SOFT TOOTHBRUSH and an ELECTRIC RAZOR are essential bleeding precautions that minimize the risk of gingival bleeding and skin lacerations, which could be difficult to control while the patient is anticoagulated. D. This statement is highly concerning. Doubling a dose of warfarin can lead to an dangerously high INR and severe INTERNAL BLEEDING. If a dose is missed, the patient should never "double up." They should be taught to notify their provider or follow a specific protocol for missed doses to maintain safety. E. This is a correct statement. Aspirin and NSAIDs like ibuprofen can increase the risk of gastrointestinal bleeding and interfere with platelet aggregation. Combining these with warfarin significantly elevates the risk of HEMORRHAGIC COMPLICATIONS, so the patient should be taught to use acetaminophen for mild pain relief instead.