A nurse is reviewing the laboratory values of a client who is at risk for disseminated intravascular coagulopathy. Which of the following values should the nurse report to the provider?
Platelets 156,000/mm³
Fibrinogen 85 mg/dL
PT 12 seconds
PTT 64 seconds
The Correct Answer is B
A. Platelets 156,000/mm³: This platelet count is within the normal range (normal range: 150,000 to 400,000/mm³). Although disseminated intravascular coagulopathy (DIC) can lead to thrombocytopenia (low platelet count), the platelet count in this scenario is not indicative of DIC.
B. Fibrinogen 85 mg/dL: This is the correct answer. A decreased fibrinogen level is often seen in DIC. Fibrinogen is consumed in the formation of microclots, and a low level may indicate ongoing coagulation.
C. PT 12 seconds: The prothrombin time (PT) is within the normal range. In DIC, the PT may be prolonged due to the consumption of clotting factors, but in this case, the PT is normal.
D. PTT 64 seconds: The partial thromboplastin time (PTT) is prolonged, which can be an indication of DIC. However, the more specific indicator in this scenario is the low fibrinogen level.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Correct answer: D
A.Elevate the head of the bed 45":Do not elevate the head of the bed more than 15 degrees.Elevating the head of the bed can increase the risk of bleeding from the insertion site.
B.Keep the affected leg slightly flexed: The affected leg should be kept straight to prevent movement at the insertion site, which can cause bleeding
C. Keep the client NPO for 4 hr: There is typically no need to keep the client NPO for an extended period after a cardiac catheterization. However, individual protocols may vary, and the nurse should follow the specific instructions provided by the healthcare provider.
D.Have the client lie flat in bed: After a cardiac catheterization, it is important to keep the client lying flat to prevent bleeding or hematoma formation at the catheter insertion site. This position helps to maintain pressure on the insertion site, particularly if the catheter was inserted through the femoral artery.
Correct Answer is B
Explanation
A. Providing immediate rest for the client: Rest is important, but in the context of an acute asthma exacerbation, addressing the underlying respiratory distress is the priority.
B. Administering a nebulized beta-adrenergic agonist: This is the correct answer. Beta-adrenergic agonists, such as albuterol, are bronchodilators that help relieve bronchoconstriction and improve airflow. Administering a nebulized beta-adrenergic agonist is a key intervention during an acute asthma exacerbation to alleviate symptoms and improve respiratory function.
C. Positioning the client in high-Fowler's: While positioning can assist with respiratory effort, administering a bronchodilator is a more direct and immediate intervention to relieve airway obstruction.
D. Initiating oxygen therapy: While oxygen therapy may be necessary, addressing bronchoconstriction with a beta-adrenergic agonist is the primary intervention during an acute asthma exacerbation.
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