An older patient takes warfarin (Coumadin). The patient's international normalized ratio (INR) is 1.0. What action by the nurse is best?
a. Nothing; this level is therapeutic.
b. Assess the patient's diet history.
c. Prepare to administer vitamin K.
d. Double the warfarin dose.
B
The therapeutic INR is 2-3 (2-3.5 in some sources), so this level is not therapeutic. Foods rich in vitamin K antagonize warfarin. Before consulting the provider about adjusting the dose, the nurse should first assess the patient's diet history to see if too many vitamin K−rich foods are being eaten. The dose may need adjustment. Vitamin K would be given for an overdose.
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