<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 73-year-old woman presents to the emergency department with diffuse abdominal pain, nausea, and vomiting. Her daughter who accompanies her says she was in her usual state of health until two days ago when she started to complain of abdominal pain and was unable to tolerate oral intake. She has hypertension, congestive heart failure, atrial fibrillation, and osteoarthritis. She underwent an exploratory laparotomy for an ovarian mass a year ago where a mucinous cystadenoma was excised. Her medications include aspirin, nifedipine, lisinopril, metoprolol, warfarin, and Tylenol as needed for pain. She does not drink alcohol or smoke cigarettes. She appears ill and disoriented. Her temperature is 37.9C 100.3F, blood pressure is 10260 mm Hg, pulse is 110min and irregular, and respirations are 16min. Examination shows diffuse tenderness to palpation of the abdomen. The abdomen is tympanitic on percussion. Bowel sounds are hyperactive. The lungs are clear to auscultation bilaterally. There is a soft crescendo-decrescendo murmur best auscultated in the right second intercostal space. Laboratory studies show:Hemoglobin 10.2 gdLLeukocyte count 14,000mm3Platelet count 130,000mm3Prothrombin time 38 secondsINR 3.2SerumNa 132 mEqdLK 3.6 mEqdLCl- 102 mEqdLHCO3- 19 mEqdLUrea nitrogen 36 mgdlCreatinine 2.3 mgdLLactate 2.8 mEqdL N 0.5-2.2 mEqdLAn x-ray of the abdomen shows multiple centrally located dilated loops of gas filled bowel. There is no free air under the diaphragm. A nasogastric tube is inserted and IV fluids and empiric antibiotic therapy are started. Emergent exploratory laparotomy is planned. Which of the following is the next best step in management?? A: Administer unfractionated heparin, B: Administer protamine sulfate, C: Administer fresh frozen plasma and Vitamin K, D: Administer platelet concentrate, E: Administer recombinant activated factor VII,  <response>: This is a question about a 73-year-old woman with abdominal pain, nausea, vomiting and a history of abdominal surgery who presents with signs and symptoms of small bowel obstruction. Key findings include an elevated INR of 3.2, thrombocytopenia, and planned emergent exploratory laparotomy. The goal is to identify the best next step in management prior to surgery.The elevated INR and history of atrial fibrillation on warfarin suggest she has warfarin-induced coagulopathy. Her thrombocytopenia also contributes to an increased bleeding risk. Prior to an invasive procedure like surgery, the coagulopathy and thrombocytopenia should be corrected to decrease procedural bleeding risk. Choice A, heparin, would be contraindicated as it could worsen coagulopathy. Choice B, protamine sulfate, reverses heparin but the patient is not on heparin. Choice D, platelet transfusion, may help correct the thrombocytopenia but does not address the more pressing issue of elevated INRcoagulopathy. Choice C, fresh frozen plasma and Vitamin K, would replace clotting factors and allow hepatic production of clotting factors to correct her coagulopathy. This would be the best option to correct her coagulopathy prior to her planned surgery.Choice E, factor VII, could transiently correct INR but fresh frozen plasma and Vitamin K would provide more complete and sustained correction of INR and should be given prior to surgery.C: Administer fresh frozen plasma and Vitamin K 