# A client on warfarin for atrial fibrillation has an INR of 5.2 and reports bleeding gums when brushing teeth. For each group, select all responses that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=620042&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client on warfarin for atrial fibrillation has an INR of 5.2 and reports bleeding gums when brushing teeth. For each group, select all responses that apply.

Nursing actions

Hold the warfarin dose

Notify the healthcare provider

Administer the scheduled warfarin

Apply heat to the gums

Client teaching to prevent bleeding

Use a soft-bristled toothbrush

Avoid aspirin and NSAIDs

Increase intake of vitamin K-rich foods

Use a straight razor for shaving

## Explanation

INR 5.2 is above therapeutic range (2-3 for atrial fibrillation) and bleeding gums indicate over-anticoagulation. The nurse should hold warfarin and notify the provider. Heat would promote bleeding. To prevent bleeding, the client should use a soft toothbrush and avoid aspirin/NSAIDs which increase bleeding risk. Increasing vitamin K-rich foods would counteract warfarin and is not advised without provider guidance; straight razors increase risk of cuts.

## In-depth explanation

Quick answer
INR 5.2 is above therapeutic range (2-3 for atrial fibrillation) and bleeding gums indicate over-anticoagulation. The nurse should hold warfarin and notify the provider. Heat would promote bleeding. To prevent bleeding, the client should use a soft toothbrush and avoid aspirin/NSAIDs which increase bleeding risk. Increasing vitamin K-rich foods would counteract warfarin and is not advised without provider guidance; straight razors increase risk of cuts.
Key cues
Use the client-specific assessment findings and timing in the scenario rather than a memorized diagnosis label.
Clinical reasoning
Connect the relevant cues to the safest nursing interpretation and action for this exact care setting.
Why the alternatives do not fit
The distractors are plausible in another context but are unsupported, mistimed, lower priority, or incomplete for the findings presented.
Priority and safety
Address immediate threats first, stay within nursing scope, and reassess the client after the selected intervention.
Takeaway
For warfarin bleeding safety, select responses that are both clinically supported and appropriate at this point in care.
**Sources**
- FDA Drug Safety Information

## Clinical scenario

A client on warfarin for atrial fibrillation has an INR of 5.2 and reports bleeding gums when brushing teeth. For each group, select all responses that apply.

## Key concepts

- **INR** — International Normalized Ratio, a measure of warfarin's anticoagulant effect; therapeutic range varies by indication.
- **warfarin** — Oral anticoagulant that inhibits vitamin K-dependent clotting factors.
- **vitamin K** — Nutrient that reverses warfarin effect; consistent intake is important.

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