A client taking warfarin has gastrointestinal bleeding, hypotension, and an INR of 6.2. Which action should the nurse anticipate?
1Hold warfarin, activate urgent treatment, and administer prescribed 4-factor PCC with intravenous vitamin K.✓ Correct answer
2Continue warfarin and recheck the INR at the next routine visit because the value is below 10.
3Replace warfarin with aspirin immediately because aspirin reverses vitamin K antagonist activity.
4Give oral vitamin K and discharge the client once the INR begins to fall, despite ongoing bleeding.
Explanation
Hemodynamic instability with gastrointestinal bleeding is major bleeding. Warfarin is held, urgent resuscitative care is initiated, and rapid reversal uses 4-factor prothrombin complex concentrate with intravenous vitamin K when ordered. Vitamin K alone acts too slowly for major bleeding, aspirin does not reverse warfarin, and outpatient observation is unsafe.
Clinical reasoning Major warfarin-associated bleeding requires both immediate replacement of vitamin K-dependent clotting factors and vitamin K for sustained reversal. The INR value does not outweigh the client's unstable clinical condition.
Decision rule Major bleed means stop the anticoagulant, stabilize the client, and use 4-factor PCC plus slow intravenous vitamin K according to the emergency plan. Plasma is a fallback when 4-factor PCC is unavailable.