The client is receiving oral anticoagulant therapy with warfarin (Coumadin). The result of a newly drawn prothrombin time (PT) is 40 seconds. The nurse anticipates carrying out a prescription to do which of the following?
1. Hold the next dose of warfarin.
2. Increase the next dose of warfarin.
3. Administer the next dose of warfarin.
4. Stop the warfarin, and administer heparin.
1
Rationale: The normal PT is 11.0 to 12.5 seconds for adults. Appropriate therapy for full anti-coagulation should prolong the PT by 1.5 to 2 times. Because the value stated is extremely high, the nurse should anticipate that the client would not receive further doses at this time. If the level were too high, then the antidote (vitamin K) could also be prescribed. It would be dangerous to add a different anticoagulant to the client's regimen at this time ("stop the warfarin, and admin-ister heparin").
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