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Anticoagulants - Priority Sheet
Warfarin INR Goals NCLEX Priority Sheet
Warfarin questions usually test INR monitoring, bleeding assessment, vitamin K teaching, pregnancy risk, interacting drugs, and what to do when INR is too high.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Priority 1
What to do first
1. Check INR before giving warfarin when ordered.
2. Assess for bleeding: gums, urine, stool, bruising, headache, mental status change, or oozing IV sites.
3. Review new antibiotics, NSAIDs, supplements, alcohol changes, and diet changes.
Safety
Hold If
Notify the provider and follow protocol for active bleeding, supratherapeutic INR, major fall/head injury, severe headache, neurologic change, or black/tarry stools.
Do not independently give vitamin K, PCC, or FFP. Anticipate ordered reversal therapy when clinically indicated.
Monitoring
Labs to Watch
PT/INR: common NCLEX target for many indications is INR 2.0-3.0. Some mechanical valve contexts use higher targets, often around 2.5-3.5.
Watch CBC, hemoglobin/hematocrit, liver function when relevant, and stool/urine bleeding signs.
Review Details
NCLEX Review Notes
Memory Rule
Warfarin = Watch INR.
It is oral, slower onset, monitored by PT/INR, and reversed with vitamin K as ordered. It crosses the placenta, so pregnancy is a major safety issue.
NCLEX Trap
Trap: choose between increasing green vegetables or avoiding them forever.
Safer answer: keep vitamin K intake consistent. Sudden increases or decreases can change INR response.
Bleeding Signs
Bruising, gum bleeding, epistaxis, hematuria, melena, heavy menstrual bleeding, oozing from lines, severe headache, dizziness, or mental status change should trigger bleeding assessment and provider notification.
Mini Quiz
Question: A patient on warfarin has INR 5.4 and reports black stools. What should the nurse do first?
Answer: hold warfarin per protocol, assess bleeding and vital signs, notify the provider, and anticipate ordered reversal or evaluation.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; DailyMed warfarin sodium labeling; anticoagulation guideline references.
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