A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?
Excessive thrombosis and bleeding
Increased clotting factors
Progressive increase in platelet production
Immediate sodium and fluid retention
The Correct Answer is A
A. Excessive thrombosis and bleeding
Disseminated Intravascular Coagulation (DIC) is a complex and serious condition characterized by widespread activation of the coagulation cascade, leading to both excessive clot formation (thrombosis) and simultaneous consumption of clotting factors and platelets, resulting in bleeding. DIC can occur as a secondary complication to various conditions such as sepsis, trauma, or obstetric complications.
B. Increased clotting factors: In DIC, there is consumption and depletion of clotting factors, not an increase.
C. Progressive increase in platelet production: Platelet production does not increase in DIC; instead, there is consumption and decreased platelet count.
D. Immediate sodium and fluid retention: DIC is not associated with immediate sodium and fluid retention; instead, it is characterized by fluid loss due to bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Instruct the woman to call 911: This is a correct action, but it should be the second step after the nurse initiates first aid measures. Directing someone to call for emergency assistance is crucial, but immediate intervention to relieve the choking takes precedence.
B. The Heimlich maneuver involves abdominal thrusts and is the recommended technique for relieving choking in a conscious person. It is essential to act quickly and decisively to clear the airway.
C. Ask the partner if he can speak: If the person is unable to speak, cough, or breathe, it may indicate complete airway obstruction. The nurse should not delay intervention by asking if the person can speak but should immediately proceed with measures to relieve the choking.
D. Perform chest compressions: Chest compressions are not indicated for a conscious choking victim. Chest compressions are performed in the context of cardiopulmonary resuscitation (CPR) for an unconscious person with no pulse.
Correct Answer is C
Explanation
A. "This test will help my provider adjust my warfarin dosages": aPTT is not typically used to monitor warfarin therapy. Instead, it is more commonly associated with monitoring heparin therapy.
B. "If my levels are too low, I am at an increased risk for bleeding": This statement is inaccurate. Low levels of clotting factors could lead to a prolonged aPTT, which might increase the risk of bleeding.
C. "It measures deficiencies in clotting factors."
Activated partial thromboplastin time (aPTT) is a laboratory test that evaluates the intrinsic pathway of the coagulation cascade. The aPTT measures the time it takes for a clot to form and reflects the activity of various clotting factors, including factors VIII, IX, XI, and XII. An elevated aPTT may indicate a deficiency or dysfunction of one or more clotting factors.
D. "I will need to skip breakfast until after the test is complete": There is no need for the client to skip breakfast before an aPTT test. The test is not affected by food intake.
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