# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395555&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question 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. First, ::선택::stop further warfarin and activate emergency hemorrhagic-stroke reversalcontinue warfarin while waiting for the next INRencourage oral fluids before repeating the neurologic examinationarrange routine outpatient follow-up. Anticipate prescribed ::선택::aspirin4-factor prothrombin complex concentratesubcutaneous heparinroutine platelet transfusion for every client together with ::선택::oral ironintramuscular phytonadioneintravenous vitamin Kprotamine sulfate. ## 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. ## In-depth explanation 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 ## Clinical scenario The hemorrhagic-stroke response is active. The nurse prepares prescribed vitamin K antagonist reversal without waiting for further neurologic deterioration. ## Key concepts - **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. ## 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 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 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395555&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395555&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395555&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395555&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395555&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._