A client taking warfarin for atrial fibrillation reports 2 episodes of black, tarry stool since 0400. History includes heparin-induced thrombocytopenia (HIT) diagnosed during cardiac surgery 5 weeks ago. At 0700: BP 88/54 mm Hg (baseline 132/78), HR 122/min, INR 5.8, hemoglobin 8.1 g/dL (12.4 g/dL 3 days ago), weight 70 kg. Two large-bore IVs are in place. Which prescription should the nurse anticipate?

Quick answer
Fresh frozen plasma with IV vitamin K 10 mg.

Why this is correct
Two details decide the answer. First, BP 88/54 from a baseline of 132/78 and a hemoglobin drop from 12.4 to 8.1 g/dL define a major bleed, so the client needs clotting factors now, not only vitamin K. Second, the history of HIT rules out 4F-PCC, which contains heparin. Plasma replaces the factors, and IV vitamin K sustains the correction.

Easy analogy or mental picture
Reversal is a two-part rescue: a fast crew (factors) to stop the bleeding now and a slow crew (vitamin K) to keep it stopped. When the usual fast crew carries a banned item (heparin), send the backup fast crew (plasma).

Memory hook
Major bleed = factors + IV K. HIT history = no PCC, use plasma.

NCLEX decision rule
After deciding a bleed is major, check the history for contraindications to the first-line reversal agent before selecting it.

Why the other choices are wrong
4F-PCC with IV vitamin K is the usual first-line answer for major warfarin bleeding, which makes it the strongest trap, but the history of HIT is a labeled contraindication because the product contains heparin. IV vitamin K alone is the right route and dose, but it takes hours to lower the INR and does not replace factors in an unstable client. Recombinant factor VIIa has been used off-label for bleeding, but it replaces only factor VII, does not correct the other warfarin-depleted factors, and increases thrombotic risk.