# A 68-year-old client with atrial fibrillation is starting warfarin 5 mg orally each evening with a target INR of 2.0–3.0. Which statement by the client demonstrates correct understanding of self-management? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 68-year-old client with atrial fibrillation is starting warfarin 5 mg orally each evening with a target INR of 2.0–3.0. Which statement by the client demonstrates correct understanding of self-management? ## Option 1. I will eat a consistent amount of vitamin K-containing foods from week to week, take warfarin at the same time each day, report any unusual bruising or pink/dark urine, and check with the provider before starting any new prescription, OTC, or herbal product. **✔ Correct answer** 2. If I forget to take my warfarin at bedtime and remember the next day before noon, I will take the missed dose right away and then resume my usual schedule that evening, because taking it late is better than skipping, but if it is after noon, I will take two doses that night. 3. When I get a headache or joint pain, I will take ibuprofen or naproxen sodium from the pharmacy because they are available without a prescription and are safer than prescription anti-inflammatories; they do not increase my risk of bleeding and I can take them without notifying my provider. 4. I will keep vitamin K-rich foods, such as kale, spinach, and broccoli, out of my meals from now on because even a small serving could interfere with warfarin's action and raise my risk for a stroke; I will also steer clear of any supplement containing vitamin K. **Correct answer: 1** ## Explanation Warfarin self-management — pillars of teaching Warfarin inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, X. INR goal is 2.0–3.0 for most indications (2.5–3.5 for mechanical mitral valve). Effective patient education has four major pillars: (1) Diet consistency, not avoidance. Vitamin K does not need to be eliminated; consistent weekly intake of green leafy vegetables (spinach, kale, broccoli, brussels sprouts) keeps INR predictable. Wide swings cause dose adjustments. (2) Take at the same time daily (usually evening so dose can be adjusted same day after morning INR). If a dose is missed and noticed within a few hours, take it; if it is close to the next dose, skip and resume next day. Never double up. (3) Bleeding precautions. Soft toothbrush, electric razor; report unusual bruising, pink/red/dark urine, black/tarry stool, hemoptysis, persistent headache, or any fall (especially head injury — risk of intracranial hemorrhage). (4) Drug/herb/alcohol awareness. NSAIDs (ibuprofen, naproxen, aspirin), antibiotics (sulfa, metronidazole, fluoroquinolones), amiodarone, statins, herbal supplements (ginkgo, garlic, ginseng, ginger, Saint-John-wort), and grapefruit juice all alter INR. Verify any new agent with the provider/pharmacy. Limit alcohol to ≤1-2 drinks/day; binge drinking destabilizes INR. Other teaching: keep a wallet medical alert card, schedule regular INR checks, contact the provider if pregnancy is suspected (warfarin is teratogenic), and alert dentists/surgeons before procedures. ## In-depth explanation Clinical reasoning summary Warfarin self-management — pillars of teaching Warfarin inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, X. INR goal is 2.0–3.0 for most indications (2.5–3.5 for mechanical mitral valve). Effective patient education has four major pillars: (1) Diet consistency, not avoidance. Vitamin K does not need to be eliminated; consistent weekly intake of green leafy vegetables (spinach, kale, broccoli, brussels sprouts) keeps INR predictable. Wide swings cause dose adjustments. (2) Take at the same time daily (usually evening so dose can be adjusted same day after morning INR). If a dose is missed and noticed within a few hours, take it; if it is close to the next dose, skip and resume next day. Never double up. (3) Bleeding precautions. Soft toothbrush, electric razor; report unusual bruising, pink/red/dark urine, black/tarry stool, hemoptysis, persistent headache, or any fall (especially head injury — risk of intracranial hemorrhage). (4) Drug/herb/alcohol awareness. NSAIDs (ibuprofen, naproxen, aspirin), antibiotics (sulfa, metronidazole, fluoroquinolones), amiodarone, statins, herbal supplements (ginkgo, garlic, ginseng, ginger, Saint-John-wort), and grapefruit juice all alter INR. Verify any new agent with the provider/pharmacy. Limit alcohol to ≤1-2 drinks/day; binge drinking destabilizes INR. Other teaching: keep a wallet medical alert card, schedule regular INR checks, contact the provider if pregnancy is suspected (warfarin is teratogenic), and alert dentists/surgeons before procedures. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=374950&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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