Reading the Medication Record for the Interaction Nobody Flagged
A full-width simulated electronic record frame with square tabs across the top, monospace interior on near-white card, and exactly one severity flag in the laboratory flag column.
ORDERS `MAR` LABS ALLERGIES NOTES
MAR · active tab · Rivera, J. · day 3
| MEDICATION | DOSE | ROUTE | SCHEDULE | 0800 | 1200 | 1700 | 2100 |
|---|---|---|---|---|---|---|---|
| warfarin (vitamin K antagonist) | 5 mg | oral | daily at 1700 | JR | |||
| furosemide (loop diuretic) | 40 mg | oral | daily | JR | |||
| lisinopril (angiotensin-converting enzyme inhibitor) | 10 mg | oral | daily | JR | |||
| levothyroxine (thyroid hormone) | 88 mcg | oral | daily, before breakfast | JR | |||
| pantoprazole (proton pump inhibitor) | 40 mg | oral | daily | JR | |||
| acetaminophen (analgesic antipyretic) | 650 mg | oral | every 6 hours as needed for pain | JR |
LABS · behind the active tab
| RESULT | VALUE | DATE | FLAG |
|---|---|---|---|
| prothrombin time and international normalized ratio | international normalized ratio 4.6 | today 0615 | crit |
| serum creatinine | 1.6 | today 0615 | H |
| potassium | 5.3 | today 0615 | H |
NOTES · nursing intake, day 1
Pt takes over-the-counter naproxen 220 mg twice daily for knee pain, started about 3 weeks ago. Also takes a daily herbal capsule that contains ginkgo. Neither obtained from pharmacy; not on home list.
The task
Answer three questions before you turn the page. Which two entries interact in a way that explains today's result. Which tab holds the evidence that makes the interaction visible. What the nurse does first, before anything is administered.
The interaction is warfarin, on the medication administration record, with the over-the-counter naproxen recorded only in the intake note. A nonsteroidal anti-inflammatory drug raises bleeding risk on warfarin through platelet inhibition and gastric injury, and the ginkgo adds to it. The same naproxen, sitting on top of lisinopril and furosemide, also explains the creatinine and the potassium. The evidence is in the NOTES tab, which is the tab nobody opens. The first action is to withhold the 1700 warfarin dose and notify the prescriber with the international normalized ratio result and the full home medication list, including the herbal product.
Margin notethe answer is never on the tab they open for you. Tick boxes: checked allergies · checked notes · checked labs. → BOOK 05 · P8. Exhibit anatomy → BOOK 01 · P61. No reference range is printed beside a result; the flag column does that work → BOOK 07.
TakeawayExhibit items hide the interaction across tabs, so read the intake note before answering anything about a medication record.