A patient on warfarin has an INR of 5.0 with no bleeding. What is your immediate nursing action?

• A. Notify the physician and hold the next dose; monitor for bleeding and reassess INR.
• B. Increase the next dose of warfarin.
• C. Ignore the result and administer as scheduled.
• D. Immediately administer vitamin K.

Answer: (A)

The key concept is managing elevated anticoagulation safely. An INR of 5.0 indicates the blood is thinner than desired and the patient is at higher risk for bleeding, even if no bleeding is present yet. The correct action is to notify the physician and hold the next dose of warfarin to prevent further anticoagulation, while closely monitoring for any signs of bleeding and reassessing the INR per protocol. Increasing the dose would worsen the risk of bleeding. Ignoring the result is inappropriate because the elevated INR represents a real safety concern. Administering vitamin K immediately is not the default course without a physician order or evidence of bleeding; reversing warfarin too early can lead to insufficient anticoagulation and potential thrombosis. The physician may decide to withhold or adjust the dose and determine if reversal is needed based on subsequent INR values and clinical status.