# A 68-year-old client with atrial fibrillation has taken warfarin 5 mg daily for three months. Today's INR is 2.5 (goal 2.0–3.0). The nurse reinforces self-management teaching. Which client statements indicate correct understanding? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558418&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question A 68-year-old client with atrial fibrillation has taken warfarin 5 mg daily for three months. Today's INR is 2.5 (goal 2.0–3.0). The nurse reinforces self-management teaching. Which client statements indicate correct understanding? Select all that apply. 1 I can take ibuprofen for headaches as long as my INR stays in the target range. 2 I should eat extra spinach when my INR is above target to bring it back down. 3 I will keep my weekly intake of vitamin K–rich foods such as spinach and kale consistent. 4 I can skip a warfarin dose if I have a minor nosebleed and resume the next day. 5 I will report any unusual bruising, dark stools, or bleeding gums even when my INR is in range. 6 I will notify my provider before starting any new prescription, over-the-counter, or herbal product. ## Explanation Warfarin self-management requires consistent dietary vitamin K intake, prompt reporting of bleeding signs, and avoidance of interacting medications. NSAIDs such as ibuprofen increase bleeding risk independent of INR and should be avoided. Patients should not use food to self-correct INR values or skip doses for minor bleeding without provider guidance. Even with a therapeutic INR, any unusual bruising, dark stools, or mucosal bleeding warrants immediate reporting because bleeding can occur at any level. Before starting new prescriptions, over-the-counter products, or herbal supplements, patients must consult their provider or anticoagulation team, as many substances alter warfarin metabolism and can destabilize the INR. ## In-depth explanation Correct Answer Choices 3, 5, 6 Clinical Reasoning Warfarin self-management requires consistent dietary vitamin K intake, prompt reporting of bleeding signs, and avoidance of interacting medications. NSAIDs such as ibuprofen increase bleeding risk independent of INR and should be avoided. Patients should not use food to self-correct INR values or skip doses for minor bleeding without provider guidance. Even with a therapeutic INR, any unusual bruising, dark stools, or mucosal bleeding warrants immediate reporting because bleeding can occur at any level. Before starting new prescriptions, over-the-counter products, or herbal supplements, patients must consult their provider or anticoagulation team, as many substances alter warfarin metabolism and can destabilize the INR. Option Review - Incorrect — Ibuprofen and other NSAIDs increase bleeding risk by inhibiting platelet function and irritating the gastric mucosa, regardless of whether the INR is within the therapeutic range. Acetaminophen is preferred for mild pain, and even it should be used in moderation. - Incorrect — Dietary vitamin K intake should remain consistent rather than being used to self-adjust the INR. Sudden increases in vitamin K–rich foods can lower the INR, but patients should not manipulate diet to correct values; the provider adjusts the warfarin dose based on INR results. - Correct — Consistent weekly intake of vitamin K–rich foods prevents fluctuations in warfarin's anticoagulant effect. Patients do not need to avoid these foods entirely but should avoid major changes in consumption patterns. - Incorrect — Minor bleeding such as a nosebleed should be reported to the provider rather than managed by skipping a dose. Self-adjusting warfarin without guidance can lead to subtherapeutic INR and increased thromboembolic risk. - Correct — Bleeding signs must be reported promptly even when the INR is therapeutic, because individual responses vary and bleeding can occur at any anticoagulation level. Early reporting allows timely evaluation and management. - Correct — Many prescription medications, over-the-counter drugs, and herbal products interact with warfarin's metabolism, potentially raising or lowering the INR. The provider or anticoagulation team should review any new product before it is started. Sources 12026 NCLEX-RN Test Plan 2DailyMed: Warfarin sodium ## Clinical scenario A 68-year-old client with atrial fibrillation has taken warfarin 5 mg daily for three months. 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