A client with atrial fibrillation has a new prescription for extended-release diltiazem. Which nursing instruction is most important to emphasize?

• A. Report unusual bruising or bleeding
• B. Avoid standing up quickly
• C. Limit fluid intake to prevent edema
• D. Increase vitamin K intake

Answer: (A)

The important concept here is recognizing a bleeding risk due to interactions between diltiazem and anticoagulants commonly used in atrial fibrillation. Diltiazem can affect how anticoagulants like warfarin are metabolized, potentially increasing their effect and the chance of bleeding. Because of this, the most essential nursing instruction is to have the patient report any unusual bruising or bleeding right away. This warning sign can indicate a significant rise in anticoagulant activity, requiring prompt evaluation, possible dose adjustments, and closer monitoring of anticoagulation status.

Other suggestions don’t target the same immediate safety concern. Standing up quickly can cause dizziness from vasodilation but is less critical than bleeding risk. Limiting fluid intake isn’t a standard need with diltiazem and isn’t a preventive measure for AFib management. Increasing vitamin K would counteract anticoagulation and isn’t appropriate in this context.