# A client taking warfarin has an INR of 5.8 and reports black, tarry stools. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397253&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking warfarin has an INR of 5.8 and reports black, tarry stools. Which action should the nurse take first?

## Option

1. Hold the warfarin and notify the provider immediately. **✔ Correct answer**
2. Give the next dose with a large meal.
3. Tell the client that dark stools are expected with warfarin.
4. Encourage vigorous tooth brushing to assess gum bleeding.

**Correct answer: 1**

## Explanation

An elevated INR with black, tarry stools suggests possible gastrointestinal bleeding and excessive anticoagulation. The nurse should hold warfarin according to protocol and notify the provider promptly. Continuing the dose or dismissing bleeding cues is unsafe.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits Warfarin bleeding concern.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For Warfarin bleeding concern, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Warfarin** — An oral anticoagulant that requires monitoring of clotting effect.
- **INR** — A laboratory measure used to monitor warfarin anticoagulation.
- **Melena** — Black, tarry stool that can indicate gastrointestinal bleeding.

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