The nurse is caring for a client receiving warfarin therapy for atrial fibrillation. Laboratory results show an INR of 3.9. The nurse would expect which order from the health care provider?

  1. an order to increase the warfarin dose
  2. an order to decrease the warfarin dose
  3. an order for protamine sulfate
  4. no new order; the INR is therapeutic
Number 2 is correct.
Rationale: The therapeutic INR is generally 2.0 to 3.0, so the nurse should expect an order to decrease the warfarin dose. Increasing the warfarin dose increases the risk of bleeding. Protamine sulfate is the antidote for heparin, not warfarin. The client should be observed closely for signs of bleeding until the INR stabilizes in a therapeutic range.