# A client taking rivaroxaban develops acute kidney injury. Classify each finding by the medication decision it supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking rivaroxaban develops acute kidney injury. Classify each finding by the medication decision it supports.

|  | Supports altered rivaroxaban exposure | Supports active bleeding | Supports renal or medication protection |
| --- | --- | --- | --- |
| Creatinine increased from 0.9 to 2.4 mg/dL |  |  |  |
| Urine output decreased to 20 mL/hour |  |  |  |
| New melena is reported |  |  |  |
| Hemoglobin decreased from 12.8 to 9.7 g/dL |  |  |  |
| The prescriber and pharmacist are reviewing the anticoagulant plan |  |  |  |
| NSAIDs and other avoidable nephrotoxins are held |  |  |  |

## Explanation

Rapid renal decline and oliguria support altered rivaroxaban exposure; melena and a hemoglobin fall support active bleeding; holding nephrotoxins and urgent dose or therapy review support renal and anticoagulant safety.

## In-depth explanation

Quick answer
Connect acute renal failure, anticoagulant exposure, and bleeding evidence.

Why this is correct
Rivaroxaban labeling directs clinicians to consider dose adjustment or discontinuation when acute renal failure develops. Bleeding severity and the continuing thrombotic indication must be evaluated together.

Easy analogy or mental picture
When the drug exit slows, exposure can rise; the stool and hemoglobin show whether harm may already be occurring.

Memory hook
Kidney down plus bleeding signs means immediate anticoagulant review.

NCLEX decision rule
Classify renal-change cues separately from direct bleeding evidence and protective interventions.

Why the other choices are wrong
A previously acceptable dose is not automatically safe after abrupt renal deterioration.References
1DailyMed: RivaroxabanRenal impairment, acute renal failure review, bleeding surveillance, and avoidance of unsafe exposure

## Clinical scenario

DOAC renal review
Trend creatinine clearance, urine output, last dose, interacting drugs, bleeding, hemoglobin, hemodynamics, indication, and the authorized hold or replacement plan.

## Related questions

- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en)
- [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en)
- [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en)
- [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522059&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._