A client taking warfarin develops sudden severe headache, vomiting, right-sided weakness, and blood pressure 206/112 mm Hg. CT confirms intracerebral hemorrhage and the INR is 3.4. Complete the emergency plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Warfarin is stopped and the emergency hemorrhagic-stroke pathway is activated. Four-factor PCC provides rapid replacement of vitamin K-dependent clotting factors and is preferred to plasma when available. IV vitamin K is given with PCC to sustain reversal after the infused factors decline. Oral or intramuscular vitamin K is not the appropriate route for an active intracerebral hemorrhage, and aspirin, heparin, or routine follow-up would worsen or delay care.
Correct Answer Stop further warfarin and activate emergency reversal, then anticipate prescribed 4-factor PCC together with IV vitamin K.
Why It Fits Intracerebral hemorrhage is a critical-site bleed. PCC supplies factors quickly, while IV vitamin K supports sustained factor production.
Clinical Picture The INR need not be extremely high for a warfarin-associated brain bleed to require urgent reversal.
Memory Link PCC now, IV vitamin K for durability.
NCLEX Rule For vitamin K antagonist-associated intracerebral hemorrhage, reverse promptly and do not wait for clinical deterioration or a repeat INR.
Why the Alternatives Fail Holding warfarin alone is too slow. Oral or intramuscular vitamin K does not match the emergency route, and plasma is generally the alternative when 4-factor PCC is unavailable.
Sources
1AHA/ASA Intracerebral Hemorrhage Guideline
2ACC Anticoagulant-Related Bleeding Consensus
32026 NCLEX-RN Test Plan
The hemorrhagic-stroke response is active. The nurse prepares prescribed vitamin K antagonist reversal without waiting for further neurologic deterioration.
Hemorrhagic Stroke — Bleeding in or around the brain causing neurologic dysfunction.
Warfarin — An anticoagulant that increases bleeding risk when over-anticoagulated or during injury.
Neuroimaging — Imaging used to identify stroke type and guide treatment.