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Difficulty: MediumPharmacological Therapies

A practical nurse is reviewing the morning laboratory results for an adult client who is prescribed a scheduled dose of oral warfarin. The client's most recent international normalized ratio (INR) is 4.6. Which of the following actions should the practical nurse take first?

  1. Withhold the scheduled dose of warfarin and promptly notify the registered nurse.Answer
  2. B
    Administer the medication as scheduled and document the INR result in the medical record.
  3. C
    Independently decrease the medication dose by half to reduce the risk of bleeding.
  4. D
    Verify the client's room number and administer the medication to ensure timely treatment.

Answer

Withhold the scheduled dose of warfarin and promptly notify the registered nurse.
An INR of 4.6 is significantly above the standard therapeutic range of 2.0 to 3.0 for warfarin therapy, placing the client at a high risk for severe bleeding. The appropriate and safe nursing action, which falls strictly within the practical nurse scope of practice, is to withhold the scheduled dose and immediately escalate the critical laboratory finding to the supervising registered nurse or healthcare provider.

Step-by-Step Solution

1
Analyze the client's laboratory data prior to medication administration.
The client's INR is 4.6.
To determine if the anticoagulant therapy is within safe parameters.
2
Compare the INR result to the standard therapeutic range.
An INR of 4.6 is supra-therapeutic (standard range is typically 2.0 to 3.0), indicating an increased risk of hemorrhage.
To recognize contraindications that require withholding the medication.
3
Determine the most appropriate nursing intervention based on the practical nurse scope of practice.
The medication must be withheld and the critical finding escalated to the registered nurse or provider.
To maintain client safety and ensure appropriate medical management of the elevated INR.

Key Concept

Monitoring Adverse Effects and Recognizing Critical Lab Values
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Topics

Pharmacological Therapies

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