A 34-year-old female client started warfarin 5 mg PO daily 2 weeks ago after a deep vein thrombosis. The clinic nurse reviews the home self-management plan. Which actions described by the client demonstrate safe and accurate self-management? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Why these 6 are correct Safe warfarin self-management requires consistent INR monitoring, recognition of bleeding warning signs, stable dietary vitamin K intake, communication with all prescribers, avoidance of high-bleed-risk activity, and effective contraception in women of childbearing age because warfarin is teratogenic.
Why the others are unsafe Daily extra vitamin K supplements counteract warfarin and destabilize INR. NSAIDs sharply increase GI bleed risk. Heavy alcohol intake elevates INR unpredictably. Self-adjusting the warfarin dose without lab and prescriber input is dangerous.
Step 1 — Anchor the goal Warfarin therapy targets an INR window (typically 2.0 to 3.0 for VTE). Anything that pushes INR outside this window — extra vitamin K, NSAIDs, heavy alcohol, self-titration — increases either clot or bleed risk.
Step 2 — Test each statement ①(weekly INR) ✓ — required during titration. ②(extra vitamin K) ✗ — antagonizes warfarin, destabilizes INR. ③(report bleeding signs) ✓ — gum bleeding, nosebleed that does not stop, melena are red flags. ④(consistent vitamin K diet) ✓ — consistency matters more than restriction. ⑤(ibuprofen for pain) ✗ — NSAIDs increase GI bleed risk; acetaminophen is preferred. ⑥(disclose to all prescribers and dentist) ✓ — many drugs interact (antibiotics, amiodarone, fluconazole). ⑦(unlimited alcohol) ✗ — heavy alcohol elevates INR unpredictably; up to 1 drink per day is generally tolerated. ⑧(avoid contact sports) ✓ — bleeding risk from minor trauma. ⑨(effective contraception) ✓ — warfarin is a known teratogen (warfarin embryopathy in first trimester). ⑩(self-titrate dose) ✗ — dose changes require INR-guided prescriber adjustment.
Key concept NCLEX evaluates whether the candidate distinguishes consistency (correct) from restriction (incorrect) for vitamin K, and recognizes that warfarin self-management is collaborative — never autonomous.
Scenario64-year-old female, 2 weeks into oral warfarin 5 mg daily after a lower-extremity DVT.
TodayThe clinic nurse reviews home self-management. The client recites a list of actions and the nurse must identify which statements reflect safe and accurate self-management.
BackgroundWarfarin has a narrow therapeutic INR window (2.0 to 3.0 for VTE). Diet, drug, alcohol and pregnancy considerations all interact with anticoagulation control.
Warfarin — A vitamin K antagonist oral anticoagulant. Inhibits hepatic synthesis of clotting factors II, VII, IX, X. Narrow therapeutic window monitored by INR. Many food and drug interactions; teratogenic.
INR (International Normalized Ratio) — A standardized prothrombin time used to monitor warfarin. Therapeutic range is 2.0 to 3.0 for most VTE indications and 2.5 to 3.5 for mechanical mitral valves.
Vitamin K — A fat-soluble vitamin and warfarin antagonist. Rich in green leafy vegetables. Patients should keep intake consistent rather than restricted; supplements destabilize INR.