NCLEX-RN practice › Pharmacological and Parenteral Therapies
NCLEX question: warfarin reversal in a major bleed (SATA)
Pharmacological and Parenteral Therapies · Select all that apply · Clinical judgment step: Generate solutions
Client record
Laboratory results
INR 8.9
Hemoglobin 7.4 g/dL (baseline 12.8)
Platelets 210,000/mm³
Vital signs
BP 86/52 mm Hg, HR 124/min, RR 22/min
A client taking warfarin arrives with melena and dizziness. Which interventions should the nurse anticipate? Select all that apply.
- A. Vitamin K 10 mg by slow IV infusion
- B. Vitamin K 1 mg orally and recheck INR in 24 hours
- C. Four-factor prothrombin complex concentrate
- D. Two large-bore IV catheters and type and crossmatch
- E. Protamine sulfate
- F. Platelet transfusion
- G. Hold the warfarin
Show the answer and rationales
Answer: A, C, D, G
Warfarin-associated major bleeding is treated by holding warfarin, giving IV vitamin K, and rapid factor replacement with 4F-PCC (or plasma if unavailable), plus resuscitation.
- A. Correct. IV vitamin K provides sustained reversal over hours.
- B. Incorrect. Low-dose oral vitamin K is for an elevated INR without bleeding; this client has a major bleed.
- C. Correct. 4F-PCC rapidly replaces vitamin K-dependent factors in major bleeding.
- D. Correct. The client is in hemorrhagic shock and needs access for fluids and blood.
- E. Incorrect. Protamine reverses heparin, not warfarin.
- F. Incorrect. The platelet count is normal; the bleeding is from factor deficiency.
- G. Correct. All warfarin is held during major bleeding.
Scoring: select all that apply items on the Next Generation NCLEX use plus/minus scoring. You gain a point for each correct option you choose and lose a point for each incorrect one, with a minimum of zero. This item is worth 4 points.
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