# A 65-year-old client is starting low-dose aspirin 81 mg orally daily for secondary prevention after a recent myocardial infarction. Which statement by the client demonstrates correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374995&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 65-year-old client is starting low-dose aspirin 81 mg orally daily for secondary prevention after a recent myocardial infarction. Which statement by the client demonstrates correct understanding?

## Option

1. I can crush the enteric-coated aspirin tablets into a powder and mix them with my food or drink so they start working sooner, and stomach bleeding isn't a concern because the coating is simply to aid swallowing.
2. I will take aspirin once daily with food, report black/tarry stool or unusual bruising, avoid OTC NSAIDs except acetaminophen unless approved, and not give aspirin to my grandchildren due to Reye syndrome risk. **✔ Correct answer**
3. I will take my daily low-dose aspirin with ibuprofen 400 mg twice daily, both with food, to boost the anti-inflammatory effect and better prevent blood clots, as I've heard inflammation is the main cause of heart attacks.
4. I will stop taking aspirin once my chest pain is gone because the medication served its purpose during the heart attack, and I can switch to a healthier diet instead to prevent future problems.

**Correct answer: 2**

## Explanation

Low-dose aspirin (cardioprotective)
Aspirin irreversibly inhibits COX-1 in platelets, reducing thromboxane A2 and platelet aggregation for the lifespan of the platelet (~7-10 days).

Key teaching:
• Once daily with food to reduce GI irritation; enteric-coated formulations are sometimes used but not always more protective.
• Bleeding signs: black/tarry stool (melena), bright red blood per rectum, hemoptysis, gum bleeding, persistent or unusual bruising, severe headache (potential ICH).
• Avoid concurrent NSAIDs (ibuprofen, naproxen) — they competitively block aspirin binding to COX-1, reducing cardioprotective effect AND increasing GI bleed risk; acetaminophen is the safer analgesic.
• Reye syndrome: do NOT give aspirin to children/teens with viral illness (chickenpox, flu) — risk of fatal hepato-encephalopathy.
• Do not stop aspirin without provider decision after MI/stent — chronic secondary-prevention indication.
• Enteric-coated tablets must NOT be crushed/chewed — defeats the coating; chewable aspirin is OK.
• Allergy: cross-reactivity with NSAIDs and rarely with sulfa.

## In-depth explanation

Clinical reasoning summary
Low-dose aspirin (cardioprotective)
Aspirin irreversibly inhibits COX-1 in platelets, reducing thromboxane A2 and platelet aggregation for the lifespan of the platelet (~7-10 days).

Key teaching:
• Once daily with food to reduce GI irritation; enteric-coated formulations are sometimes used but not always more protective.
• Bleeding signs: black/tarry stool (melena), bright red blood per rectum, hemoptysis, gum bleeding, persistent or unusual bruising, severe headache (potential ICH).
• Avoid concurrent NSAIDs (ibuprofen, naproxen) — they competitively block aspirin binding to COX-1, reducing cardioprotective effect AND increasing GI bleed risk; acetaminophen is the safer analgesic.
• Reye syndrome: do NOT give aspirin to children/teens with viral illness (chickenpox, flu) — risk of fatal hepato-encephalopathy.
• Do not stop aspirin without provider decision after MI/stent — chronic secondary-prevention indication.
• Enteric-coated tablets must NOT be crushed/chewed — defeats the coating; chewable aspirin is OK.
• Allergy: cross-reactivity with NSAIDs and rarely with sulfa.

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