In which scenario should the nurse take immediate action in a client prescribed apixaban?

The scenario that necessitates immediate action involves the client taking indomethacin for osteoarthritis while also being prescribed apixaban. Apixaban is an anticoagulant that works by inhibiting factor Xa in the coagulation cascade, thereby reducing the risk of thromboembolic events in conditions like atrial fibrillation and preventing embolic strokes.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastrointestinal bleeding, especially in patients who are already at risk due to anticoagulation. The use of apixaban alongside an NSAID can significantly heighten the risk of serious bleeding events due to their synergistic effects on blood coagulation and platelets. This combination demands careful monitoring, and any concerns regarding the patient's status should be addressed immediately to mitigate the risk of complications such as gastrointestinal bleeding or hemorrhage.

In contrast, other scenarios such as the client following a vegetarian diet or having chronic atrial fibrillation do not present an immediate risk that would require urgent nursing intervention. A vegetarian diet does not inherently interact negatively with apixaban, and chronic atrial fibrillation is, in fact, one of the primary indications for its use. Additionally, a platelet count of 176 x