A nurse is interviewing a pre-operative patient scheduled for a total hip replacement. Which of the following findings would require the nurse to collaborate with the surgeon immediately before sending the patient to the operating room?

The client took phenytoin 100mg with a sip of water at 6 a.m.

The client took metoprolol 25mg with a sip of water at 6 a.m.

The client took half their morning dose of insulin at 6 a.m.

The client took warfarin 2.5mg with a sip of water at 6 a.m.