The nurse should monitor the INR regularly for a patient who is taking warfarin (Coumadin), which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors in the liver. The INR is a standardized measure of the prothrombin time (PT), which reflects the time it takes for blood to clot.The INR should be between2 and 3for most patients on warfarin therapy, unless otherwise specified by the provider.

Choice A is wrong becausehemoglobinis the protein in red blood cells that carries oxygen.

It is not affected by warfarin therapy and does not indicate the risk of bleeding or clotting.

Choice B is wrong becausehematocritis the percentage of blood volume that is occupied by red blood cells.

It is also not affected by warfarin therapy and does not indicate the risk of bleeding or clotting.

Choice C is wrong becauseplatelet countis the number of platelets in the blood.

Platelets are cell fragments that help with blood clotting by forming a plug at the site of injury.

Warfarin does not affect platelet production or function, but rather inhibits the clotting factors that are needed to stabilize the platelet plug.

Choice D is wrong becauseprothrombin time (PT)is the time it takes for blood to clot in the presence of a specific reagent.

It is affected by warfarin therapy, but it is not standardized and may vary depending on the reagent and the laboratory.

Warfarin (Coumadin) is an anticoagulant that works by inhibiting the synthesis of vitamin K-dependent clotting factors. Vitamin K is found in foods such as green leafy vegetables, broccoli, liver, and soybeans.Eating foods that are high in vitamin K can decrease the effectiveness of warfarin and increase the risk of blood clots.

Choice B is wrong because warfarin can be taken with or without food.

Taking the medication with food does not affect its absorption or action.

Choice C is wrong because stopping warfarin abruptly can increase the risk of thromboembolism.

If the patient experiences bleeding, they should notify their health care provider and follow their instructions.

They may need to adjust their dose or switch to another medication.

Choice D is wrong because aspirin is also an anticoagulant that inhibits platelet aggregation.

Taking aspirin with warfarin can increase the risk of bleeding and bruising.

The patient should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless prescribed by their health care provider.

The patient who is taking warfarin should also have regular blood tests to monitor their international normalized ratio (INR), which measures how long it takes for their blood to clot.The target INR range for most patients is 2 to 3.

The patient should report any signs of bleeding, such as nosebleeds, gum bleeding, blood in urine or stool, or prolonged bleeding from cuts or wounds.

They should also report any signs of thrombosis, such as chest pain, shortness of breath, leg pain or swelling, or stroke symptoms.They should wear a medical alert bracelet or carry a card that identifies them as taking warfarin.

This statement indicates a need for further teaching because aspirin is an antiplatelet drug that can increase the risk of bleeding when taken with warfarin (Coumadin), an anticoagulant.The patient should avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and use acetaminophen (Tylenol) or other pain relievers that do not affect blood clotting.

Choice A is wrong because it is a correct statement.The patient should avoid activities that could cause injury, such as contact sports, shaving with a razor, or using sharp objects, because they could lead to bleeding complications while on warfarin (Coumadin).

Choice C is wrong because it is a correct statement.The patient should report any unusual bleeding to their healthcare provider, such as nosebleeds, easy bruising, blood in urine or stool, heavy menstrual bleeding, or bleeding gums.

These could be signs of excessive anticoagulation or adverse effects of warfarin (Coumadin).

Choice D is wrong because it is a correct statement.The patient should use a soft-bristled toothbrush and floss gently to prevent gum bleeding while on warfarin (Coumadin).The patient should also avoid dental procedures without consulting their healthcare provider first.

The normal range for INR (international normalized ratio), a test that measures how long it takes blood to clot, is 0.75-1.25 for people who are not taking warfarin (Coumadin).For people who are taking warfarin (Coumadin), the therapeutic range is usually 2-3, depending on the condition being treated.The patient’s INR level should be monitored regularly to adjust the dose of warfarin (Coumadin) and prevent bleeding or clotting complications.

Warfarin (Coumadin) is an anticoagulant medication that prevents blood clots from forming or growing larger. It works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. Warfarin can increase the risk of bleeding, so patients should monitor for signs of bleeding and report them to their healthcare provider.Some signs of bleeding are bruising, nosebleeds, gum bleeding, blood in urine or stool, and heavy menstrual bleeding.

Choice A is wrong because patients taking warfarin should not avoid foods that are high in vitamin K, but rather maintain a consistent intake of vitamin K.

Vitamin K is found in green leafy vegetables, such as spinach, kale, broccoli, and cabbage.Vitamin K can counteract the effects of warfarin and lower its effectiveness, so sudden changes in vitamin K intake can alter the patient’s response to warfarin.

Choice B is wrong because patients taking warfarin should not take aspirin for pain relief.

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can also inhibit platelet aggregation and increase the risk of bleeding.

Patients taking warfarin should avoid NSAIDs and other medications that can interact with warfarin, such as antibiotics, antifungals, anticonvulsants, and herbal supplements.Patients should consult their healthcare provider before taking any new medications or supplements.

Choice D is wrong because patients taking warfarin should not use a hard-bristled toothbrush.

A hard-bristled toothbrush can cause gum bleeding and increase the risk of oral infection.

Patients taking warfarin should use a soft-bristled toothbrush and floss gently to prevent gum bleeding.They should also avoid dental procedures that can cause bleeding, such as extractions, implants, or scaling.

This statement indicates a need for further teaching because taking an antacid can interfere with the absorption of warfarin and affect its effectiveness. The client should not self-medicate with any over-the-counter drugs without consulting their healthcare provider first.

Choice A is wrong because reporting black tarry stools and abdominal pain to the healthcare provider immediately is the appropriate action.These symptoms may indicate gastrointestinal bleeding, which is a serious adverse effect of warfarin.

Choice B is wrong because stopping the medication if these symptoms persist is not advisable.Warfarin should not be discontinued abruptly without medical supervision, as this can increase the risk of thrombosis.

Choice D is wrong because increasing the intake of green leafy vegetables is not harmful.

Green leafy vegetables are rich in vitamin K, which is the antidote for warfarin overdose.However, the client should maintain a consistent intake of vitamin K and avoid sudden changes in their diet.