# A client who takes apixaban was admitted after a fall. The abdomen is now firm and tender, the blood pressure is 82/48 mm Hg, and the heart rate is 118/min. Which action should the nurse take first?

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> language: en  
> subject: Hemodynamics  
> category: PA

## Question

A client who takes apixaban was admitted after a fall. The abdomen is now firm and tender, the blood pressure is 82/48 mm Hg, and the heart rate is 118/min. Which action should the nurse take first?

## Option

1. Give the prescribed reversal agent before contacting the rapid response team
2. Infuse a rapid crystalloid bolus and assess the abdomen after the pressure rises
3. Obtain abdominal imaging and report the findings to the provider when they return
4. Activate the rapid response team and prepare the client for bleeding control **✔ Correct answer**

**Correct answer: 4**

## Explanation

Firm tender abdomen with hypotension and tachycardia during anticoagulation suggests internal hemorrhage. Activating the rapid response team brings the team that can order reversal, blood products, and definitive control.

## In-depth explanation

Quick answer
Activate the rapid response team and prepare for urgent bleeding control.

Why this is correct
The findings point to ongoing internal blood loss rather than a stable postfall complaint. Reversal, transfusion, and definitive control each require a team and prescriptions, so escalation is the action that unlocks every other treatment.

Easy analogy or mental picture
Escalating is like pulling the alarm before fighting the fire yourself. The comparison highlights sequence and does not suggest the nurse stops assessing while the team arrives.

Memory hook
Bleeding on an anticoagulant escalates before it is imaged.

NCLEX decision rule
When an anticoagulated client shows signs of internal hemorrhage with unstable vital signs, escalate first. Treatments that need a prescription or a procedure follow the escalation rather than delay it.

Why the other choices are wrong
Reversal, fluid, and imaging are each part of real management, but every one of them is slower than the call that assembles the team.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]MedlinePlus: ApixabanU.S. National Library of Medicine

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