The patient receives an appropriate dose of warfarin (Coumadin), but the international normalized ratio (INR) is in the high range. The patient denies taking any aspirin products. What is the best assessment question to ask the patient at this time?
1. "Have you been eating much garlic?"
2. "Have you been eating a lot of salads and vegetables?"
3. "Have you been drinking too much milk?"
4. "Are you restricting your fluids too much?"
Correct Answer: 1
Rationale: Garlic has been shown to decrease the aggregation of platelets, thus producing an anticoagulant effect. Patients taking anticoagulant medications should limit their intake of garlic. Salads and vegetables contain vitamin K, which is an antidote for warfarin (Coumadin). This would not impact the international normalized ratio (INR). Milk does not impact the international normalized ratio (INR) when a patient receives warfarin (Coumadin). Dehydration does not impact the international normalized ratio (INR) when a patient receives warfarin (Coumadin).
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