Question

The client has been diagnosed with a pulmonary embolism and has been on heparin therapy for 24 hours. In addition, the health care provider orders warfarin (Coumadin) 5mg orally every day for INR < 2.5 The client's laboratory values are given in the table below. What action should the nurse take?

Coagulation laboratory values
PTT PT INR
96 seconds 13.3 seconds 1.4

Select one:
a. Prepare to administer Protamine Sulfate as an antidote for the high PTT
b. Administer the warfarin 5mg as ordered.
c. Discontinue the heparin before starting the warfarin and continue to monitor the lab values.
d. Call the health care provider to inform them of the elevated PT

Answer 1

The nurse should administer the warfarin 5mg as ordered because the elevated PTT aligns with heparin's anticoagulant effect, and warfarin is typically co-administered until the therapeutic INR level is reached.

Step-by-step explanation:

In the scenario where a client has been diagnosed with a pulmonary embolism and has been on heparin therapy for 24 hours, with the health care provider ordering warfarin 5mg orally every day for INR < 2.5, and the client's laboratory values are PTT of 96 seconds, PT of 13.3 seconds and INR of 1.4, the correct action for the nurse would be to administer the warfarin 5mg as ordered. The elevated PTT is likely due to the heparin therapy, which is aligned with the drug's effect of prolonging clotting time to prevent further embolism. Warfarin therapy is typically overlapped with heparin until the therapeutic INR level (generally 2.0-3.0 for most indications) is achieved. Therefore, administering warfarin without discontinuing heparin is part of standard care for managing pulmonary embolism.