Gastrointestinal disturbances are a common adverse effect of direct oral anticoagulants (DOACs), which include nausea, vomiting, diarrhea, constipation, indigestion, and abdominal pain. These symptoms may be mild or severe, and may require dose adjustment or discontinuation of the DOAC.

Choice A is wrong because hypertension is not a known adverse effect of DOACs.In fact, some DOACs may lower blood pressure by reducing arterial stiffness.

Choice B is wrong because bradycardia is not a known adverse effect of DOACs.DOACs do not affect the cardiac conduction system or the autonomic nervous system.

Choice D is wrong because hypoglycemia is not a known adverse effect of DOACs.DOACs do not interfere with glucose metabolism or insulin secretion.

These are the instructions that the nurse should include in the teaching for a client who is receiving direct oral anticoagulants (DOACs).

Here is why:

Choice A is correct because DOACs increase the risk of bleeding and injury.The client should avoid activities that may cause trauma, such as contact sports, shaving with a razor, or using a toothpick.

Choice B is correct because DOACs should be taken at the same time every day to maintain a consistent level of anticoagulation.This helps to prevent fluctuations in the effect of the drug and reduces the risk of stroke or bleeding.

Choice C is correct because signs and symptoms of bleeding, such as bruising, bleeding gums, nosebleeds, blood in urine or stool, or prolonged bleeding from cuts, should be reported immediately to the health care provider.Bleeding can be a serious complication of DOACs and may require urgent treatment or reversal.

Choice D is correct because alcohol and aspirin can increase the risk of bleeding when taken with DOACs.

Alcohol can affect the liver function and interfere with the metabolism of DOACs.Aspirin can inhibit platelet function and impair the blood clotting process.

Choice E is wrong because monitoring vital signs regularly is not necessary for clients who are receiving DOACs.

Unlike warfarin, DOACs do not require frequent blood tests or dose adjustments based on the international normalized ratio (INR).However, the client should have periodic tests to check their kidney and liver function, as well as their blood count.

This statement by the client requires further assessment by the nurse because antacids can interfere with the absorption and effectiveness of direct oral anticoagulants (DOACs), which are used to prevent blood clots and stroke. The nurse should ask the client about the type, frequency, and dosage of antacids they are taking and inform the provider.

Choice A is wrong because taking the medication as prescribed is expected and does not indicate a problem.

Choice B is wrong because diarrhea can be a common side effect of DOACs and does not require further assessment unless it is severe or persistent.

Choice D is wrong because eating green leafy vegetables does not affect the action of DOACs, unlike vitamin K antagonists such as warfarin.

The client does not need to limit their intake of foods rich in vitamin K.

This statement by the client requires further assessment by the nurse because diarrhea can cause dehydration and electrolyte imbalance, which can affect the renal function and the clearance of direct oral anticoagulants (DOACs).Renal impairment can increase the risk of bleeding and adverse effects of DOACs. The nurse should monitor the client’s fluid intake and output, serum creatinine, electrolytes, and signs of bleeding. The nurse should also advise the client to report any persistent or severe diarrhea to their prescriber.

Choice A is wrong because taking the medication as prescribed is expected and does not indicate any problem with DOACs.

Choice C is wrong because over-the-counter antacids are generally safe to use with DOACs and do not affect their efficacy or safety.

However, the nurse should educate the client about potential drug interactions with other over-the-counter or herbal products and encourage them to consult their prescriber before taking any new medications.

Choice D is wrong because eating green leafy vegetables does not affect the anticoagulant effect of DOACs, unlike warfarin, which is influenced by dietary vitamin K intake.

The nurse should encourage the client to eat a balanced diet and maintain a consistent intake of vitamin K-rich foods.

The client is experiencing signs of a pulmonary embolism, which is a life-threatening complication of anticoagulant therapy. The priority action is to improve oxygenation and prevent hypoxia.Administering oxygen therapy can help achieve this goal.

Choice B is wrong because nitroglycerin is used to treat angina, not pulmonary embolism.

Nitroglycerin dilates the coronary arteries and reduces the workload of the heart, but it does not address the underlying cause of the chest pain and shortness of breath in this case.

Choice C is wrong because obtaining an electrocardiogram (ECG) is not the first action to take.

An ECG can help diagnose cardiac arrhythmias, ischemia, or infarction, but it does not provide immediate treatment for the client’s condition.

Choice D is wrong because aspirin is contraindicated in clients who are receiving direct oral anticoagulants (DOACs).

Aspirin increases the risk of bleeding and can interfere with the action of DOACs.DOACs are a newer class of anticoagulants that do not require regular blood testing or dietary restrictions like warfarin.Some examples of DOACs are rivaroxaban, edoxaban, apixaban, and dabigatran.