# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=en > language: en > subject: Dosage Calculations > category: PPT ## Question 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. 1I keep my regular INR appointments every week until the dose is stabilized. 2I take an extra vitamin K supplement every morning so that my blood is well balanced. 3I will call the clinic right away if I see bleeding gums, a nosebleed that does not stop, or black tarry stools. 4I will eat about the same amount of green leafy vegetables each week instead of changing the amount suddenly. 5I take ibuprofen 400 mg whenever I have joint pain because it works better than acetaminophen. 6I tell every new prescriber and my dentist that I am on warfarin before they prescribe a new medication or do a procedure. 7I drink as much beer or wine as I want with friends on the weekend because warfarin and alcohol do not really interact. 8I avoid contact sports such as rugby and boxing because even a small impact could cause internal bleeding. 9I use reliable contraception because my prescriber told me warfarin can cause harm to a developing baby. 10If I forget a dose I just double the next dose myself, and I sometimes adjust the dose based on how I feel that day. ## 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. ## In-depth explanation 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. ## Clinical scenario Scenario 64-year-old female, 2 weeks into oral warfarin 5 mg daily after a lower-extremity DVT. Today The 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. Background Warfarin has a narrow therapeutic INR window (2.0 to 3.0 for VTE). Diet, drug, alcohol and pregnancy considerations all interact with anticoagulation control. ## Key concepts - **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. ## Related questions - [A 72-year-old client on warfarin for atrial fibrillation has serial INR results and bleedi…](https://mymerci.kr/pages/nclex_q.php?qn_id=393482&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=369684&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._