The patient uses Ginkgo biloba to enhance memory functioning, but has not told the nurse about this herb. The physician orders warfarin (Coumadin) for the patient. What will the best assessment of the nurse include?
1. Headache, dizziness, sweating, and agitation
2. A blood glucose of 56
3. An international normalized ratio (INR) of 3.0
4. Petechiae and bleeding from the gums
Correct Answer: 4
Rationale: Ginkgo biloba will interact with warfarin (Coumadin) to promote increased bleeding potential that may lead to petechiae and bleeding from the gums. An international normalized ratio (INR) of 3.0 is within a normal range. Hypoglycemia, (blood glucose of 56), is not the result of an interaction between Ginkgo biloba and warfarin (Coumadin). Headache, dizziness, sweating, and agitation, which are signs of serotonin syndrome, are not the result of an interaction between Ginkgo biloba and warfarin (Coumadin).
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