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Difficulty: MediumPharmacological Therapies

During morning rounds, a practical nurse (PN) receives the updated coagulation profile for a client with atrial fibrillation. The client has an order for warfarin 5 mg orally each day at 0900. The laboratory report shows an International Normalized Ratio (INR) of 4.6. Which of the following is the priority action for the PN to take?

  1. Withhold the scheduled dose of warfarin and immediately notify the registered nurse.Answer
  2. B
    Administer the scheduled dose of warfarin and monitor the client for signs of bleeding.
  3. C
    Decrease the warfarin dose to 2.5 mg to reduce the risk of spontaneous hemorrhage.
  4. D
    Proceed with medication administration after verifying the client's identity using two identifiers.

Answer

Withhold the scheduled dose of warfarin and immediately notify the registered nurse.
For a client with atrial fibrillation, the therapeutic INR range is typically 2.0 to 3.0. An INR of 4.6 is significantly elevated, indicating that the client's blood is clotting too slowly and they are at a high risk for spontaneous bleeding. The correct and safe action for the practical nurse is to withhold the scheduled dose of warfarin to prevent further elevation of the INR and to immediately notify the registered nurse or healthcare provider so that the medication regimen can be evaluated and potentially adjusted.

Step-by-Step Solution

1
Review the client's laboratory results in relation to the prescribed medication.
The INR is 4.6, which is significantly above the standard therapeutic target of 2.0 to 3.0 for atrial fibrillation.
Warfarin dosing is directly dependent on coagulation profiles, specifically the INR, to balance clotting prevention and bleeding risk.
2
Determine the clinical significance of the abnormal result.
An elevated INR indicates that the client's blood is clotting too slowly, placing them at an imminent risk for bleeding if further anticoagulants are administered.
Identifying the risk of hemorrhage is a critical component of pharmacological safety.
3
Identify the appropriate nursing action based on the practical nurse scope of practice.
The practical nurse must withhold the medication to prevent harm and immediately escalate the critical finding to the registered nurse or healthcare provider.
The PN is responsible for ensuring safe medication administration and reporting significant changes in client condition without altering prescriptions.

Key Concept

The practical nurse must evaluate relevant laboratory values before administering high-alert medications like warfarin, withholding the dose and reporting critical values to ensure client safety.
Estimated Time:1m 0s
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Topics

Pharmacological Therapies

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