A nurse is caring for a client who has multiple sclerosis.
Which of the following assessment findings should the nurse anticipate? (Select all that apply)

Choice A rationale

Using a floss pick instead of floss string does not inherently prevent complications of bleeding in a client with thrombocytopenia. Both methods can potentially cause gum irritation and bleeding if used improperly or aggressively. The key is gentle oral hygiene to minimize trauma, regardless of the specific tool used.

Choice B rationale

Thrombocytopenia, common in end-stage liver disease due to impaired platelet production and sequestration, significantly increases the risk of bleeding. Avoiding contact sports is crucial as these activities inherently carry a high risk of trauma, falls, and impact injuries, which can easily lead to severe and difficult-to-control internal or external hemorrhage in a client with a low platelet count.

Choice C rationale

Wearing sleeveless or short-sleeved shirts and shorts to better visualize skin issues is not a primary recommendation to prevent bleeding complications in thrombocytopenia. While monitoring for petechiae, ecchymoses, or other signs of bleeding is important, the clothing choice itself does not prevent the bleeding from occurring or minimize its severity. Protecting the skin from trauma is more critical.

Choice D rationale

Applying an ice pack over a bleeding wound can help promote vasoconstriction and reduce localized bleeding, but it is a measure for managing *existing* bleeding, not for *preventing* complications of bleeding in a broad sense. The best recommendation focuses on proactive strategies to avoid situations that could lead to bleeding in the first place, such as preventing trauma.

Choice A rationale

Heparin is an anticoagulant that can be used in some phases of DIC, particularly when thrombotic manifestations predominate. However, DIC is a complex disorder with both widespread clotting and bleeding, and its management is highly individualized. It is not controllable with lifelong heparin usage, and heparin can even exacerbate bleeding in certain phases of the disorder. Treatment focuses on addressing the underlying cause.

Choice B rationale

DIC is characterized by widespread activation of the coagulation cascade, leading to the formation of microthrombi throughout the microvasculature. This process consumes platelets and clotting factors, resulting in thrombocytopenia, which is a *decreased* platelet count, not an elevated one. A normal platelet count ranges from 150,000 to 450,000 per microliter of blood.

Choice C rationale

DIC is not a genetic disorder. It is an acquired condition that occurs as a complication of various underlying diseases, such as sepsis, trauma, cancer, and obstetric emergencies. While vitamin K is essential for the synthesis of certain clotting factors, DIC is not primarily caused by a vitamin K deficiency; rather, it involves a dysregulation of the entire coagulation system.

Choice D rationale

DIC is caused by abnormal coagulation involving fibrinogen. In DIC, there is excessive activation of thrombin, which converts fibrinogen into fibrin monomers. These monomers then polymerize to form fibrin clots, leading to widespread microvascular thrombosis. This consumption of fibrinogen, along with other clotting factors, subsequently leads to a paradoxical bleeding diathesis.