A client is started on a direct acting oral anticoagulant drug. Which teaching will the nurse include for this client (Select all that apply)

Direct-acting oral anticoagulants (DOACs) exert their pharmacological effects by inhibiting specific clotting factors, such as factor Xa or thrombin, without requiring the routine hematologic monitoring seen with warfarin. Despite their convenience, patients remain at high risk for hemorrhagic complications and must adhere strictly to dosing. A. Unlike warfarin therapy, which necessitates frequent monitoring of the International Normalized Ratio (INR), direct-acting oral anticoagulants have a predictable pharmacokinetic profile. This predictability eliminates the clinical requirement for monthly laboratory monitoring, which is one of the primary advantages of utilizing this specific class of medication. B. Direct-acting oral anticoagulants are susceptible to various drug-drug interactions, particularly with agents that induce or inhibit the cytochrome P450 3A4 system or P-glycoprotein. Patients must be educated to consult healthcare providers before starting any new medications, including over-the-counter herbal supplements like St. John's wort. C. Patients taking anticoagulants should carry medical identification to alert emergency responders of their increased bleeding risk in the event of trauma or incapacitation. This ensures that healthcare teams can provide appropriate interventions and consider the use of specific reversal agents if a life-threatening hemorrhage occurs. D. The primary adverse effect of all anticoagulant therapies is the increased risk of internal and external hemorrhage. Nurses must instruct patients to assess for clinical manifestations of bleeding, such as epistaxis, hematuria, melena, or easy bruising, and to report these findings to their healthcare provider immediately. E. Doubling the dose of a direct-acting oral anticoagulant following a missed dose significantly increases the serum concentration of the drug beyond the therapeutic window. This action drastically elevates the risk of spontaneous and severe bleeding; patients should follow specific protocols for missed doses provided by their prescriber