# A 72-year-old client with non-valvular atrial fibrillation is starting apixaban 5 mg orally twice daily for stroke prevention. Which statement by the client demonstrates correct understanding? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 72-year-old client with non-valvular atrial fibrillation is starting apixaban 5 mg orally twice daily for stroke prevention. Which statement by the client demonstrates correct understanding? ## Option 1. I will take my apixaban once daily in the morning, since it provides 24-hour protection, and I will not need to inform any healthcare provider before procedures like dental cleanings or skin biopsies because routine monitoring is not required and it has fewer restrictions than warfarin. 2. I will take this medication twice a day approximately 12 hours apart, with or without food, and contact the provider before any new prescription, OTC, or herbal product because routine INR is not used but the medication still has many drug interactions. **✔ Correct answer** 3. Since routine blood testing is unnecessary with apixaban, it is safe for me to take ibuprofen for my arthritis and to use herbal products like St. John's wort or ginkgo without checking with my provider, because these substances interact with warfarin and pose no risk with this medication. 4. I plan to monitor my pulse and stop apixaban when my rhythm feels regular, because the danger of clots is temporary, and if I miss a few doses, I can restart with a double dose to quickly restore protection without needing to inform my provider. **Correct answer: 2** ## Explanation Apixaban — patient teaching Apixaban is a direct factor Xa inhibitor used for stroke prevention in non-valvular atrial fibrillation, treatment and prevention of VTE. Key teaching: • 5 mg PO twice daily approximately 12 hours apart; reduce to 2.5 mg BID if any 2 of: age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. • Take with or without food; do NOT crush or split unless using the pre-approved crushed-administration option (apixaban CAN be crushed and dispersed in water/apple juice for NG tube — different from dabigatran). • No routine coagulation monitoring — apixaban does NOT prolong INR predictably, so INR is not used. Anti-Xa specific to apixaban can confirm presence in select cases. • Drug interactions: avoid concurrent strong CYP3A4 / P-gp inhibitors (ketoconazole, ritonavir) — increase bleeding; strong inducers (rifampin, phenytoin, carbamazepine, St. Johns wort) reduce effect. • Bleeding precautions: soft toothbrush, electric razor, fall prevention, avoid IM injections, avoid NSAIDs/aspirin without provider, report any bruising/dark stool/pink urine/persistent headache/fall. • Do NOT self-discontinue: even when rhythm feels normal, afib stroke risk persists; abrupt cessation increases stroke risk significantly. • Surgery: hold 24–48 hours pre-op (low risk) or 48 hours+ (high risk) per provider; resume per surgeon. • Reversal: andexanet alfa for major bleeding; PCC alternative if andexanet unavailable. ## In-depth explanation Clinical reasoning summary Apixaban — patient teaching Apixaban is a direct factor Xa inhibitor used for stroke prevention in non-valvular atrial fibrillation, treatment and prevention of VTE. Key teaching: • 5 mg PO twice daily approximately 12 hours apart; reduce to 2.5 mg BID if any 2 of: age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. • Take with or without food; do NOT crush or split unless using the pre-approved crushed-administration option (apixaban CAN be crushed and dispersed in water/apple juice for NG tube — different from dabigatran). • No routine coagulation monitoring — apixaban does NOT prolong INR predictably, so INR is not used. Anti-Xa specific to apixaban can confirm presence in select cases. • Drug interactions: avoid concurrent strong CYP3A4 / P-gp inhibitors (ketoconazole, ritonavir) — increase bleeding; strong inducers (rifampin, phenytoin, carbamazepine, St. Johns wort) reduce effect. • Bleeding precautions: soft toothbrush, electric razor, fall prevention, avoid IM injections, avoid NSAIDs/aspirin without provider, report any bruising/dark stool/pink urine/persistent headache/fall. • Do NOT self-discontinue: even when rhythm feels normal, afib stroke risk persists; abrupt cessation increases stroke risk significantly. • Surgery: hold 24–48 hours pre-op (low risk) or 48 hours+ (high risk) per provider; resume per surgeon. • Reversal: andexanet alfa for major bleeding; PCC alternative if andexanet unavailable. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=374975&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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