護理師指導服用 Warfarin 的病人，應避免下列哪些項目？（選所有適合的）

核心概念：服用 Warfarin（一種口服抗凝血劑）病人的注意事項。 為何正確答案對： B. 阿斯匹靈（Aspirin）本身具有抗血小板作用，與 Warfarin 合用會產生加成的抗凝血效果，大幅增加出血風險，因此未經醫師許可，絕對禁止與 Warfarin 同服。 C. 綠葉蔬菜（Green, leafy vegetables）富含維生素 K，維生素 K 是 Warfarin 的拮抗劑，大量攝取會抵銷 Warfarin 的藥效，導致抗凝血效果不足，增加血栓風險。病人應盡量保持維生素 K 攝取量穩定，而非突然大量攝取。 D. 牙線清潔（Flossing teeth vigorously）可能導致牙齦出血，若出血不止，則會增加 Warfarin 病人的出血風險。應建議使用軟毛牙刷輕柔清潔。 E. 接觸性運動（Participating in contact sports）有較高的身體碰撞風險，可能導致內出血或創傷，對服用抗凝血劑的病人而言風險極高，應避免。 為何其他選項錯： A. 使用軟毛牙刷（Using a soft-bristled toothbrush）是鼓勵的行為，因為這能減少刷牙時對牙齦的傷害，降低出血風險。

Core concept: precautions for patients taking warfarin (an oral anticoagulant). Why the correct answers are correct: B. Aspirin itself has antiplatelet activity, and when combined with warfarin produces an additive anticoagulant effect, substantially increasing the risk of bleeding; it is therefore absolutely forbidden to take aspirin together with warfarin without the physician's permission. C. Green, leafy vegetables are rich in vitamin K, which is a warfarin antagonist; large intakes will counteract warfarin's effect, leading to inadequate anticoagulation and an increased risk of thrombosis. Patients should try to keep their vitamin K intake stable rather than increase it suddenly. D. Vigorous flossing may cause gingival bleeding, and persistent bleeding increases bleeding risk in patients on warfarin. A soft-bristled toothbrush should be recommended for gentle cleaning. E. Participating in contact sports involves a higher risk of bodily collision, which may cause internal bleeding or trauma; this risk is extremely high for patients on anticoagulants and should be avoided. Why the other option is incorrect: A. Using a soft-bristled toothbrush is encouraged because it reduces gingival injury during brushing and lowers the bleeding risk.