Exhibits

A nurse is caring for a client who has a seizure disorder. (Select all that apply.)

Administer supplemental oxygen to the client.

Restrain the client.

Time the duration of the seizure.

Place a tongue depressor in the client's mouth.

Turn the client to the side

Answer and Explanation

Correct Answer : A,C,E

A.   The client is experiencing apnea and has decreased oxygen saturation, indicating a need for supplemental oxygen.
B.   Restraining a client during a seizure is dangerous and can cause injury.
C.   This information is crucial for determining the type of seizure and guiding treatment.
D.   Placing a tongue depressor in the client's mouth can cause trauma to the teeth and mouth and should never be done.
E.   Turning the client to the side helps prevent aspiration of saliva or vomit, protecting the airway.

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Correct Answer is B

Explanation

A. In DIC, there is actually a consumption of clotting factors rather than an increase. The widespread activation of the clotting cascade leads to the consumption of clotting factors and platelets as they are used up in forming numerous small blood clots throughout the body. This depletion results in a paradoxical bleeding tendency due to a shortage of clotting factors.
B. This is characteristic of DIC. The condition involves both excessive clotting (thrombosis) and bleeding. The formation of small clots throughout the microcirculation leads to organ damage and depletion of clotting factors and platelets, which in turn causes bleeding tendencies. This dual process of clot formation and bleeding is a hallmark of DIC.
C. In DIC, there is a decrease in platelet count, not an increase. The condition causes widespread clotting, which consumes platelets rapidly, leading to a low platelet count. Therefore, a progressive increase in platelet count would not be expected in DIC.
D. Sodium and fluid retention are not primary features of DIC. Instead, DIC typically presents with symptoms related to clotting and bleeding rather than fluid balance. Fluid retention would be more associated with other conditions like heart failure or renal disorders, not directly with DIC.

A. Hypotension B. Increased respiratory rate C. Anuria D. Decreased level of consciousness

Correct Answer is B

Explanation

A. This is a late sign of shock. It occurs when the body's compensatory mechanisms fail to maintain blood pressure.
B. This is one of the earliest signs of shock. The body tries to compensate for decreased oxygen delivery by increasing the respiratory rate.
C. This is a very late sign of shock, indicating severe kidney damage due to decreased blood flow.
D. This is also a late sign of shock, occurring when the brain is deprived of oxygen.

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Exhibits A nurse is caring for a client who has a seizure disorder. (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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Exhibits

A nurse is caring for a client who has a seizure disorder. (Select all that apply.)