A client on warfarin for atrial fibrillation has an INR of 5.2 and reports bleeding gums when brushing teeth. For each group, select all responses that apply.

INR 5.2 is above therapeutic range (2-3 for atrial fibrillation) and bleeding gums indicate over-anticoagulation. The nurse should hold warfarin and notify the provider. Heat would promote bleeding. To prevent bleeding, the client should use a soft toothbrush and avoid aspirin/NSAIDs which increase bleeding risk. Increasing vitamin K-rich foods would counteract warfarin and is not advised without provider guidance; straight razors increase risk of cuts.

Use the client-specific assessment findings and timing in the scenario rather than a memorized diagnosis label.

Connect the relevant cues to the safest nursing interpretation and action for this exact care setting.

The distractors are plausible in another context but are unsupported, mistimed, lower priority, or incomplete for the findings presented.

Address immediate threats first, stay within nursing scope, and reassess the client after the selected intervention.

For warfarin bleeding safety, select responses that are both clinically supported and appropriate at this point in care.

• INR — International Normalized Ratio, a measure of warfarin's anticoagulant effect; therapeutic range varies by indication.
• warfarin — Oral anticoagulant that inhibits vitamin K-dependent clotting factors.
• vitamin K — Nutrient that reverses warfarin effect; consistent intake is important.