The patient receives warfarin (Coumadin). The nurse notes that the patient's morning international normalized ratio (INR) is 7-. What are the priority nursing interventions at this time?
1. Hold the next dose of warfarin (Coumadin) and repeat the international normalized ratio (INR).
2. Administer protamine sulfate and hold the next dose of warfarin (Coumadin).
3. Hold the next dose of warfarin (Coumadin) and contact the physician.
4. Administer vitamin K and hold the next dose of warfarin (Coumadin).
Correct Answer: 4
Rationale: Vitamin K is the antidote for warfarin (Coumadin) overdose and its administration is warranted with an international normalized ratio (INR) of 7-. Repeating the international normalized ratio (INR) is appropriate, but the patient must receive vitamin K immediately. Protamine sulfate is the antidote for heparin, not warfarin. Consulting the physician is appropriate, but the patient must receive vitamin K immediately.
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