NCLEX · General

A patient is prescribed warfarin (Coumadin). What dietary teaching is most important?

Correct answer

Maintain a CONSISTENT intake of vitamin K-rich foods — do not drastically increase or decrease them; sudden large changes in vitamin K intake affect INR control

  1. A Eliminate all vitamin K from the diet
  2. B Maintain a CONSISTENT intake of vitamin K-rich foods — do not drastically increase or decrease them; sudden large changes in vitamin K intake affect INR control
  3. C Take warfarin with meals only
  4. D Avoid all green vegetables

Why this is the answer

WARFARIN AND VITAMIN K: Warfarin works by blocking Vitamin K-dependent clotting factors (II, VII, IX, X). DIET TEACHING: DO NOT abruptly increase vitamin K-rich foods (leafy greens — kale, spinach, collards, broccoli): this will decrease INR (more clotting, less anticoagulation — risk of clot); DO NOT abruptly eliminate vitamin K foods: this will increase INR (less clotting, more anticoagulation — bleeding risk); CONSISTENT intake is the goal — if you eat spinach twice a week, keep eating it twice a week. This is a key teaching distinction: patients often think they must eliminate all vitamin K, but the instruction is CONSISTENCY, not elimination. Other warfarin interactions: alcohol increases INR; cranberry juice increases INR; many medications interact. Monitor INR regularly; report unusual bruising or bleeding.
Source: NCLEX-PN, Warfarin Dietary Teaching

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