MyLab Exemplar: Disseminated Intravascular Coagulation

A client is admitted to the intensive care unit with disseminated intravascular coagulation​ (DIC). Which clinical manifestations does the nurse​ anticipate? Select all that apply. A.Tachycardia B.Decreased breath sounds C.Increased blood glucose level D.Thick, tenacious bronchial secretions E.Confusion

A,B,E

A nurse caring for a client with suspected disseminated intravascular coagulation​ (DIC). Which test result is common in​ DIC? A.Decreased fibrinogen level B.Increased platelet count C.Decreased partial thromboplastin time D.Decreased prothrombin time

A.Decreased fibrinogen level

The nurse suspects that a patient who has severe sepsis now has disseminated intravascular coagulation​ (DIC). Which​ finding, if​ observed, helps confirm this​ suspicion? A. Polyuria B. Clear breath sounds C. Bradycardia D. Petechiae

D Rationale: Petechiae is a symptom of DIC due to the impaired clotting mechanism leading to bleeding and impaired tissue perfusion. Oliguria or anuria would be​ expected, as would tachycardia. Decreased breath​ sounds, tachypnea, and pleural friction rub are clinical manifestations of DIC.

A nurse is assessing a client during labor and delivery. Which condition should the nurse recognize as a risk factor for disseminated intravascular coagulation​ (DIC)? A.Placenta previa B.Polyhydramnios C.Gestational diabetes D.Placental abruption

D.Placental abruption

Disseminated intravascular coagulation​ (DIC) is triggered by an injury or agent that activates the clotting cascade. Which condition should the nurse identify as a trigger for the clotting​ cascade? (Select all that​ apply.) A. Head injury B. Placenta previa C. Bacterial infection D. Acute glomerulonephritis E. Acute leukemia

A,,C,D,E ​Rationale: Tissue damage such as head​ injury, abruptio​ placenta, and acute leukemia can trigger DIC. Vessel damage such as acute glomerulonephritis can trigger DIC.​ Infections, bacterial or​ viral, can also trigger DIC. Placenta previa is not directly associated with DIC.

A client with disseminated intravascular coagulation​ (DIC) has a nursing diagnosis of Ineffective Peripheral Tissue Perfusion. Which actions interventions are appropriate for this​ diagnosis? Select all that apply. A.Monitor the​ client's level of consciousness and mental status. B.Minimize the use of tape on the​ client's skin. C.Carefully reposition the client at least every 2 hours. D.Elevate the​ client's knees on the bed or with a pillow. E.Assess extremity​ pulses, warmth, and capillary refill.

A,B,E

The nurse is preparing an educational program about disseminated intravascular coagulation​ (DIC). Which condition should the nurse include as a risk factor for the development of this​ condition? (Select all that​ apply.) A. Fetal demise B. Primigravida C. Prolonged labor D. Septic abortion E. Preeclampsia

A,D,E ​Rationale: Pregnant clients are at risk for the development of acute DIC from the complications of​ preeclampsia, placental​ abruption, fetal​ demise, amniotic fluid​ embolism, and septic abortion. Prolonged labor and primigravida are not considered risk factors for the development of DIC. OK

A nurse is planning care for a patient diagnosed with disseminated intravascular coagulation (DIC) who reports pain in the knees. Which assessment should the nurse implement? A.Assess for blood in the stool. B.Observe for wheezing. C.Observe for bleeding or bruising every 4 hours. D.Assess renal function by monitoring complete blood count.

A. .Assess for blood in the stool. continual assessment of the patient with DIC includes assessing for blood in the stool, observing for bleeding or bruising every 1-2 hours, and assessing renal function by monitoring renal panel. The pain the patient is experiencing may be from bleeding in the joints, and continual assessment is required to monitor the bleeding. Observing for wheezing is not a typical assessment of this type of patient because wheezing is not usually found in DIC.

Which pregnant patient is at the greatest risk for developing disseminated intravascular coagulation (DIC)? A. A patient with high liver enzymes and low platelets B.A patient with low back pain C.A patient with hypertension D.A patient with swelling in the lower extremities

A. A patient with high liver enzymes and low platelets Pregnant patients with high liver enzymes and low platelet counts may haveHELLP (hemolysis, elevated liver enzymes, low platelets; a complication thought to be related to preeclampsia), and are at risk for DIC. Low back pain is expected on an obstetrics unit. Swelling and edema of the lower extremities may be expected, but severe edema or hypertension may indicate preeclampsia. HELLP is more urgent than preeclampsia.

The nurse is caring for a patient diagnosed with acute disseminated intravascular coagulation (DIC). Which clinical manifestation should the nurse recognize is caused by this condition? A.Oozing from the IV access site B. Bradypnea C.Polyuria D.Hypertension

A. Oozing from the IV access site Oozing around the IV site is a sign of DIC. Additionally, patients with DIC may have tachypnea, hypotension, and oliguria.

The nurse has identified Ineffective Peripheral Tissue Perfusion as a nursing diagnosis for a client with disseminated intravascular coagulation​ (DIC). What intervention would be appropriate for the​ client? A.Carefully repositioning the client every 2 hours B.Administering oxygen C.Encouraging deep breathing and coughing D.Monitoring oxygen saturation

A.Carefully repositioning the client every 2 hours

A client with disseminated intravascular coagulation​ (DIC) is anxious and has decreased oxygen saturation. Which is the priority nursing diagnosis for this​ client? A.Impaired Gas Exchange B.Anxiety C.Acute Pain D.Ineffective Peripheral Tissue Perfusion

A.Impaired Gas Exchange The decrease in oxygen saturation is a result of impairment in the​ client's gas exchange. Anxiety could contribute to the​ client's impaired gas exchange but is not the primary problem to address. Decreased oxygen saturation and anxiety would not be addressed with the diagnoses of Ineffective Peripheral Tissue Perfusion and Acute Pain.

A patient admitted for disseminated intravascular coagulation (DIC) reports shortness of breath, chest pain, and dark sputum when coughing. Which is the priority nursing intervention? A.Place the patient in high Fowler position. B.Explain that pain medication can be given in 1 hour. C.Institute careful nasotracheal suctioning. D.Ambulate the patient 20 yards.

A.Place the patient in high Fowler position. Placing the patient in high Fowler position improves diaphragmatic excursion and alveolar ventilation. The patient should be on bedrest, not ambulating. Telling the patient that pain medication can be given in 1 hour does not help the patient right now. Nasotracheal suctioning should only be done if coughing is not effective.

The nurse is caring for a patient newly diagnosed with acute disseminated intravascular coagulation (DIC). The main manifestation the patient is exhibiting is bleeding. Which collaborative therapy should the nurse anticipate will be administered as part of the first line of treatment? A.Aspirin B.Platelet concentrates C.Whole blood D.Heparin

B.Platelet concentrates When DIC manifests with bleeding, fresh frozen plasma and platelet concentrates are given to restore platelets and clotting factors. Whole blood is not administered for the patient with DIC who presents with bleeding. Heparin and aspirin may cause bleeding.

A client with disseminated intravascular coagulation​ (DIC) has a nursing diagnosis of Impaired Gas Exchange. Which action is appropriate when providing care based on this nursing​ diagnosis? A.Use continuous endotracheal suctioning instead of coughing and deep breathing B.Encourage frequent amulation C.Place the client in​ low-Fowler position to improve gas exchange Your answer is correct. D.Monitor the​ client's oxygen saturation intermittently

C.Place the client in​ low-Fowler position to improve gas exchange

The nurse is caring for a patient with chronic disseminated intravascular coagulation (DIC). Which finding in the patient's medical history should the nurse be concerned about most? A.Adenocarcinoma B.Acute glomerulonephritis C.Fat embolism D.Cirrhosis of the liver

D.Cirrhosis of the liver Patients with liver disease are more likely to experience severe complications from chronic DIC. Acute glomerulonephritis, fat embolism, and adenocarcinoma may precipitate DIC.

The nurse assesses a client who has bacterial pneumonia and finds​ tachycardia, hypotension,​ oliguria, and acrocyanosis of a foot. Schistocytes are found in a complete blood​ count, and the​ D-dimer is elevated. Which collaborative action should the nurse​ anticipate? A. Heparin therapy B. Foot amputation C. Dialysis D. Warfarin therapy

A ​Rationale: The client has signs and symptoms of disseminated intravascular coagulation​ (DIC). Low-molecular-weight heparin is used to interfere with the clotting cascade and reduce the consumption of clotting factors by uncontrolled thrombosis. Warfarin is not used to treat DIC. Dialysis and amputation are not indicated at this time. OK

The nurse is caring for a client who has been admitted to labor and delivery. What should the nurse recognize as risk factors for disseminating intravascular coagulation​ (DIC)? Select all that apply. A.Fetal death B.Placental abruption C.Multiparity D.Gestational diabetes E.Preterm labor

A,B

The nurse is caring for a client with disseminated intravascular coagulation​ (DIC). Which collaborative therapy should the nurse include in the​ client's care?​ (Select all that​ apply.) A. Monitoring intracranial pressure B. Monitoring for organ damage C. Monitoring for intracranial bleeding D. Monitoring client allergies E. Monitoring need for mechanical ventilation

A,B,C,E ​Rationale: Care of the client with DIC may include mechanical ventilation and control of organ damage from reduced tissue perfusion. Clients with DIC may develop intracranial bleeding resulting in altered levels of​ consciousness, damage to the respiratory​ center, and increased intracranial pressure. Monitoring for client allergies is an independent nursing intervention that would be implemented for all clients. OK

A client has disseminated intravascular coagulation​ (DIC). Which clinical manifestation should the nurse expect to​ observe? (Select all that​ apply.) A. Petechiae B. Joint pain C. Clotting D. Hypertension E. Bleeding

A,B,C,E ​Rationale: Manifestations of DIC include​ bleeding, clotting,​ petechiae, and joint pain.​ Hypotension, not​ hypertension, is also a manifestation of DIC.

The nurse is evaluating the lab results for a client suspected of having disseminated intravascular coagulation​ (DIC). Which laboratory finding supports the​ diagnosis? (Select all that​ apply.) A. The presence of schistocytes B. Decreased platelet count C. Shortened prothrombin time D. Increased fibrin degradation products E. Elevated hemoglobin

A,B,D ​Rationale: Laboratory findings that support a diagnosis of DIC include the presence of​ schistocytes, a decreased platelet​ count, and an increase in fibrin degradation products or fibrin split products. The client with DIC would not have an elevated hemoglobin or shortened prothrombin time.

The nurse is caring for a client who has signs of acute disseminated intravascular coagulation. Which intervention is​ appropriate? (Select all that​ apply.) A. Encourage deep breathing and effective coughing exercises. B. Administer analgesics and antianxiety​ medications, as ordered. C. Encourage ambulation. D. Continuously monitor oxygen saturation. E. Elevate the head of the bed

A,B,D,E Rationale: Microclots in the pulmonary vasculature can cause impaired gas exchange. Bedrest reduces oxygen demand and cardiac workload. The head of the bed is elevated to promote diaphragmatic movement and alveolar ventilation. Monitoring oxygenation saturation measures gas exchange. Controlling pain and anxiety reduces respiratory rate and improves the quality of ventilation and gas exchange. Deep breathing and effective coughing clear airways and improve alveolar ventilation and oxygenation.

Which risk factor should the nurse look for while performing an assessment on a client with a diagnosis of disseminated intravascular coagulation​ (DIC)? ​ (Select all that​ apply.) A. History of abnormal bleeding episodes B. Hematological disorder C. History of diabetes mellitus D. Recent abortion E. Presence of known malignant tumor

A,B,D,E ​Rationale: Risk factors include recent abortion​ (spontaneous or​ therapeutic), current​ pregnancy, presence of known malignant​ tumor, history of abnormal bleeding​ episodes, and a history of hematologic disorders. Diabetes mellitus is not considered a risk factor for the development of DIC.

The nurse is assessing a client suspected of having chronic disseminated intravascular coagulation​ (DIC). Which finding supports the​ diagnosis? (Select all that​ apply.) A. The client has a history of cancer. B. The client has excessive blood clotting. C. The client has multiple bruises on his skin. D. The​ client's IV infusion site continues to ooze blood. E. Development of DIC has taken months.

A,B,E ​Rationale: Chronic DIC may develop over a period of months or weeks and typically lasts longer. Chronic DIC is not diagnosed rapidly as in the case of the acute form. Excessive blood​ clotting, as opposed to​ hemorrhage, is usually seen with chronic DIC. Cancer is the most common cause of chronic DIC. Multiple bruises and an oozing IV site would be noted most often in clients with acute DIC.

The nurse determined that a client with disseminated intravascular coagulation is experiencing pain. Which intervention should the nurse​ provide? (Select all that​ apply.) A. Applying cool compresses to painful joints B. Encouraging frequent turning and coughing C. Continuously monitoring oxygen saturation and oxygen administration as ordered D. Using standard pain scale to evaluate and monitor pain and analgesic effectiveness E. Handling extremities gently

A,D,E ​Rationale: Interventions for managing pain include using a standard pain scale to evaluate and monitor pain and analgesic​ effectiveness, handling extremities​ gently, and applying cool compresses to painful joints. Monitoring oxygen saturation and encouraging frequent turning and coughing will not assist the client with treatment of pain. These interventions are more appropriate for promoting effective tissue perfusion.

The nurse is evaluating care provided to a client with disseminated intravascular coagulation​ (DIC). Which finding indicates care has been successful for this​ client? A.No evidence of bleeding B.Oxygen saturation level​ 86% C.Urine output 20 mL per hour D.Heart rate 110 beats per minute

A.No evidence of bleeding

The nurse is assessing a patient diagnosed with bacterial pneumonia. Which finding should the nurse immediately report to the healthcare provider? A.Oozing from the IV access site B.Thick, green mucus when coughing C.Pain with inspiration D.Rapid, shallow respirations

A.Oozing from the IV access site Oozing around the IV site is an indication of possible DIC. Thick, green mucus, pain on inspiration, and rapid shallow breathing are signs and symptoms of bacterial pneumonia and to be expected.

The nurse is caring for a patient who delivered a full-term, healthy baby via cesarean birth 8 hours ago. Which symptom observed by the nurse requires immediate follow up? A.Oozing of blood at the incisional site B.Low liver enzymes C. Clots visible at the incision site. D.Increased urine output

A.Oozing of blood at the incisional site Oozing of blood at the incisional site may indicate development of DIC and is an emergency. Clotting at the incision site, low liver enzymes, and increased urine output are expected.

The client with which condition is at the greatest risk of developing acute disseminated intravascular​ coagulation? A.Aortic aneurysm B.Third-degree burns and septic shock C.Gunshot wound to the distal arm D.Bacterial pneumonia treated with antibiotics

B ​Rationale: Clients with severe sepsis and septic shock are at the greatest risk for developing acute DIC. Aortic aneurysm is a risk for chronic DIC. Gunshot wounds and bacterial infections are a risk for​ DIC, but sepsis is a greater risk.

The nurse is caring for a client with suspected disseminated intravascular coagulation​ (DIC). Which diagnostic test result supports the diagnosis of​ DIC? A. Decreased​ D-dimer B. Normal fibrinogen levels C. Increased platelet count D. Decreased fibrin degradation products

B ​Rationale: Fibrinogen levels may be normal or even decreased in circumstances where elevated levels are expected.​ D-dimer will be elevated in both acute and chronic DIC. Decreased platelet count and the presence of schistocytes on the CBC indicate DIC. Fibrin degradation products will be increased as a result of fibrinolysis.

The nurse is assessing a client suspected of having acute disseminated intravascular coagulation​ (DIC). Which assessment finding supports the​ diagnosis? (Select all that​ apply.) A. A history of a malignant tumor B. Bleeding at the IV insertion site C. ​Pale, cool extremities D. Multiple bruises on various skin surfaces E. A history of thyroid disease

B,C,D, ​Rationale: Bleeding may result in multiple bruises on various skin surfaces and mucous membranes. Puncture sites such as those from injections or intravenous infusions may ooze blood when a client has DIC.​ Pale, cool extremities may be noted when a client is bleeding because blood is diverted back to major organs to maintain oxygenation. History of a malignant tumor supports the diagnosis of chronic DIC. Thyroid disease is not a known risk factor for acute DIC.

The nurse is caring for a child who has recurrent nosebleeds and headaches. Which question is most important for the nurse to ask? A."Have you been to the eye doctor?" B."Have you noticed any blood in the toilet when you go to the bathroom?" C."Have you gotten your flu shot?" D."Do you take allergy medications?"

B."Have you noticed any blood in the toilet when you go to the bathroom?" Signs of DIC in children include headaches, lightheadedness, nosebleeds, and blood in the urine or stool. A flu shot, eye problems, and allergies are not expected to cause headache or recurrent nosebleeds.

The nurse is caring for a patient diagnosed with chronic disseminated intravascular coagulation (DIC). Which collaborative intervention should the nurse expect to implement for long-term treatment? A.Administer oxygen. B.Administer heparin. C.Administer fresh frozen plasma. D.Administer platelet infusion.

B.Administer heparin. Patients with chronic DIC may receive heparin therapy, administered by injection or continuous infusion by pump for long-term treatment. Fresh frozen plasma, platelets, and oxygen are administered for acute DIC

The nurse is caring for a patient with disseminated intravascular coagulation (DIC) and has identified the need to promote tissue perfusion. Which intervention should the nurse include in the plan of care? A.Providing emotional support B.Assessing level of consciousness C.Using a standard pain scale to evaluate and monitor pain D.Applying cool compresses to painful joints

B.Assessing level of consciousness Interventions to promote effective tissue perfusion include assessing extremities, level of consciousness (LOC), and mental status; monitoring central and peripheral tissue perfusion; and gentle repositioning every 2 hours. Although the other choices may be needed for the care of a patient with DIC, they do not support the promotion of tissue perfusion.

Which pathological change related to disseminated intravascular coagulation​ (DIC) occurs late in the course of the​ disease? A.Damage to the endothelium B.Hemorrhage C.Formation of small clots D.Brain ischemia

B.Hemorrhage

Which goal of treatement for a patient with disseminated intravascular coagulation (DIC) should the nurse consider as most important? A.Resolving the bacterial infection B.Supporting and resuscitating the circulatory system C.Increasing thrombin levels D.Decreasing the number of platelets in circulation

B.Supporting and resuscitating the circulatory system The goal of treatment for DIC is supporting the cardiovascular system. Although treatment of the underlying disease is also important, the underlying disease is not always a bacterial infection. Decreased platelets and increased thrombin levels are symptoms of DIC.

The nurse is caring for a client who has not responded to platelet and whole blood transfusions as treatment for acute disseminated intravascular coagulation​ (DIC). Which action should the nurse anticipate​ next? A. Unfractionated heparin therapy B. Coumadin therapy C. ​Low-molecular-weight heparin therapy D. ​End-of-life protocol

C ​Rationale: Low-molecular-weight heparin has a lower risk of bleeding and organ failure when treating clients with DIC as compared to unfractionated heparin. Coumadin is not appropriate.​ End-of-life protocol is not indicated at this time.

The nurse concludes that both clotting and bleeding occur during disseminated intravascular coagulation​ (DIC) due to which​ process? A. Only clotting occurs during​ DIC, as clotting factors are replaced and available to prevent excess bleeding. B. Activation of intrinsic pathways results in release of excess clotting factors. C. Excess release of thrombin uses up clotting factors quicker than they can be replaced. D. Tissue damage from bleeding uses up clotting factors quicker than they can be replaced

C ​Rationale: Widespread activation of either the intrinsic or the extrinsic pathways results in excess release of thrombin. Thrombin and emboli cause tissue and organ damage. Clotting factors are consumed faster than they are​ replaced, leading to excessive bleeding. OK

The nurse is preparing a patient who is recovering with acute disseminated intravascular coagulation (DIC) for discharge. Which patient statement requires the nurse to follow up? A."I should call my healthcare provider if I have a fever." B."If I notice blood in my urine or stool I will call my healthcare provider." C."The issue has completely resolved and I will no longer need follow-up care." D."The home healthcare nurse will call me to schedule a time to care for my infusion pump."

C."The issue has completely resolved and I will no longer need follow-up care." The patient may continue to have residual effects from DIC after being discharged and should follow up regularly with the healthcare provider. Patients should call their healthcare provider if they have symptoms of an infection or of bleeding or clotting. Home healthcare may be needed if the patient is going home on an infusion pump of heparin.

Which patient needs immediate attention from the nurse? A.A 1-day-old newborn with blue hands and feet bilaterally B.A 5-hour-old newborn with a respiratory rate of 50 breaths per minute C.A 2-day-old newborn diagnosed with a congenital heart disease who has blood oozing from the umbilicus D.A 2-hour-old newborn with a heart rate of 140 beats per minute

C.A 2-day-old newborn diagnosed with a congenital heart disease who has blood oozing from the umbilicus Congenital heart disease is a risk factor for disseminated intravascular coagulation (DIC), and blood oozing from the umbilicus is a sign of DIC. Acrocyanosis is normal in a newborn. A respiratory rate of 50 is normal for a newborn. A heart rate of 140 is normal for a newborn

The nurse is caring for a patient with acute disseminated intravascular coagulation (DIC). Which order by the healthcare provider should the nurse question? A.Implement tube feedings. B.Implement measures to prevent skin breakdown. C.Ambulate 4 times a day. D.Implement total parenteral nutrition.

C.Ambulate 4 times a day. A patient with acute DIC will be on bedrest. A patient with DIC should receive nutritional support via tube feedings or total parenteral nutrition (TPN). Skin breakdown should be avoided.

The nurse is caring for a patient with burn injuries who has oozing around the IV site. Which diagnostic test should the nurse anticipate to be ordered by the healthcare provider? A.Chemistry panel B.X-rays C.Coagulation studies D.Positron emission tomography (PET) scan

C.Coagulation studies The patient at risk for DIC requires coagulation studies drawn to monitor the prothrombin time, thromboplastin time, and thrombin time. Chemistry panels, x-rays, and PET scans are not useful in the diagnosis of DIC.

Which diagnostic test should the nurse anticipate will be ordered for a patient at risk for developing disseminated intravascular coagulation (DIC)? A.CT scan B.X-ray C.Coagulation studies D.Electrolyte panel

C.Coagulation studies The patient at risk for DIC requires coagulation studies, drawn to monitor the prothrombin time, thromboplastin time, and thrombin time. Electrolyte panels, x-rays, and CT scans are not useful in the diagnosis of DIC.

Which statement is correct regarding disseminated intravascular coagulation (DIC) following a bacterial infection? A.A decrease in the total number of white blood cells results. B.Clotting factor VIII deficiency or dysfunction specifically occurs. C.Endotoxin causes an inappropriate activation of the clotting cascade. D.An autoimmune disorder resulting in platelet destruction occurs.

C.Endotoxin causes an inappropriate activation of the clotting cascade. DIC is triggered by trauma or a causative agent that activates the clotting cascade. Proteins that control clotting become overactive, forming small clots within the blood vessels. Widespread clotting uses up the supply of clotting factors quicker than they can be replaced. The result is hemorrhage. Therefore, DIC causes both widespread clotting and bleeding. DIC does not affect the number of white blood cells (WBCs). It is not a deficiency or dysfunction of clotting factor VIII specifically. Platelets are consumed faster than they can be replaced, leading to decreased platelet levels. DIC is not caused by an autoimmune disorder.

Which therapy should the nurse expect to be prescribed first by the healthcare provider for a patient who is bleeding from acute disseminated intravascular coagulation (DIC)? A.Whole blood B.Aspirin C.Fresh frozen plasma D.Low molecular weight heparin

C.Fresh frozen plasma When DIC manifests with bleeding, fresh frozen plasma and platelet concentrates are given to restore platelets and clotting factors. Whole blood is not administered for the patient with DIC who presents with bleeding. Low molecular weight heparin (LMWH) and aspirin may cause bleeding.

The nurse is assessing a patient diagnosed with disseminated intravascular coagulation (DIC). Which finding indicates a possible acute complication from DIC? A.Increased platelet levels B.Normal platelet levels C.Oozing of blood around the IV site D.A medical diagnosis of chronic DIC

C.Oozing of blood around the IV site The assessment finding that supports possible acute complication from DIC is oozing of blood around the IV site. Chronic DIC is associated with a clotting disorder. Patients with DIC with the potential for shock will have decreased platelet levels.

The nurse is caring for a patient with suspected disseminated intravascular coagulation (DIC). Which diagnostic test result supports this suspicion? A.Increased fibrinogen levels B.Increased platelets C.Presence of schistocytes in CBC D.Shortened prothrombin time

C.Presence of schistocytes in CBC Schistocytes, or fragmented red blood cells (RBCs), in the complete blood count (CBC) are an indication of DIC. Other indications include decreased platelets and lengthened prothrombin (PT) time. Fibrinogen levels may be normal or decreased.

The nurse is reviewing the laboratory results for a patient diagnosed with disseminated intravascular coagulation (DIC). Which finding supports the diagnosis of DIC for this patient? A.Increased platelet count B.High fibrinogen level C.Prolonged prothrombin time D.Decreased fibrin split products

C.Prolonged prothrombin time A prolonged prothrombin time supports the diagnosis of DIC. Other lab findings that would support this diagnosis include: Low (not high) fibrinogen level. Decreased (not increased) platelet count. Increase (not decrease) in the fibrin split products.

The nurse is planning care for a patient diagnosed with disseminated intravascular coagulation (DIC). Which goal requires revision? A.The patient's bleeding is controlled. B.The patient's body systems will effectively meet oxygenation and perfusion needs. C.The patient will have no side effects from DIC upon discharge. D.The patient and family demonstrate effective coping strategies.

C.The patient will have no side effects from DIC upon discharge. It is not realistic to believe the patient will be completely free of side effects upon discharge. Some effects may continue after discharge and require follow up by the primary healthcare provider and possibly home care nursing. Appropriate goals of treatment include supporting the patient's body systems to meet perfusion needs and prevent tissue destruction, controlling bleeding, and effective coping for the patient and family.

The nurse assesses a client who is diagnosed with chronic disseminated intravascular coagulation​ (DIC). Which finding should the nurse suspect as the probable cause of the​ client's diagnosis? A. Diminished bowel sounds B. Chronic constipation C. History of nosebleeds D. History of a cancerous tumor

D ​Rationale: Chronic DIC develops​ slowly, over weeks or months. It lasts longer and typically is not diagnosed as quickly as acute DIC. Chronic DIC causes excessive blood​ clotting, but usually does not lead to bleeding. Nosebleeds would be unlikely with chronic DIC. Cancer is the most common cause of chronic DIC. Constipation and diminished bowel sounds are not generally associated with chronic DIC.

A client with a diagnosis of chronic disseminated intravascular coagulation​ (DIC) is being discharged home. Which statement by the client requires the nurse to follow​ up? A. ​"I should call my healthcare provider if I have excessive​ bleeding." B. ​"I understand home healthcare will visit me to monitor the​ infusion." C. ​"I will need to be on a portable infusion pump of​ heparin." D. ​"The effects of the disorder will resolve​ completely."

D ​Rationale: Even though the immediate crisis is​ resolved, the client may continue to have effects from​ DIC, such as impaired tissue integrity. Subcutaneous injections of heparin or a portable infusion pump may be required. The healthcare provider should be called for excessive bleeding or recurrent clotting. A referral should be made to home healthcare for IV maintenance assistance.

Which therapy will the healthcare provider prescribe for the client with chronic disseminated intravascular coagulation​ (DIC)? A. Fresh frozen plasma B. Whole blood C. Aspirin regimen D. Heparin

D ​Rationale: Heparin may be administered by continuous infusion using a portable pump if needed for​ long-term therapy, as in the client with chronic DIC.

The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation​ (DIC). Which statement correctly explains why this client is at risk for​ DIC? A. Onset of infection. B. Amniotic fluid embolism. C. Septic shock due to blood loss. D. Leaked fluid is similar to a coagulation factor.

D ​Rationale: Leakage of fluid similar to a coagulation factor from a placental abruption can trigger DIC. Onset of infection and amniotic fluid embolism are not the greatest risk. Hemorrhagic shock is caused by blood​ loss, not septic shock.

The nurse is caring for a patient with disseminated intravascular coagulation (DIC). The patient asks, "How did this happen?" Which response by the nurse is accurate? A."DIC may be caused by bacterial or viral infections, but not fungal or parasitic infections." B."The most common cause of DIC is trauma." C."DIC is caused by activation of the extrinsic pathway of clotting, but not by activation of the intrinsic pathway." D."DIC occurs as a complication of another illness."

D."DIC occurs as a complication of another illness." DIC occurs secondary to or as a complication of another illness. It is most common in severe sepsis or septic shock but not trauma. DIC is more often associated with a bacterial infection, but can also be caused by viruses, fungi, and parasites. DIC can occur due to activation of either the intrinsic or extrinsic pathway.

The nurse is teaching a patient and the spouse about home care for acute disseminated intravascular coagulation (DIC). Which statement by the patient's spouse indicates understanding? A."I should not be concerned if there is a little residual bright red blood in the stool." B."Due to the risk of bleeding, my spouse should not get a flu shot." C."Circulation to the feet has returned so my spouse does not need to see the healthcare provider." D."I will call my spouse's healthcare provider if there is any blood in my spouse's urine."

D."I will call my spouse's healthcare provider if there is any blood in my spouse's urine." Patients and family should be taught to report any signs and symptoms of bleeding; this includes blood in the urine or stool. Foot checkups may be required to ensure healing and adequate perfusion. The flu shot will protect against infection, which could trigger DIC.

Which patient should the nurse consider to be at most risk for the development of disseminated intravascular coagulation (DIC)? A.A 47-year-old man with influenza B.A 16-year-old patient with a minor laceration from a pocket knife C.A 4-year-old child with closed fracture of the radius D.A 27-year-old pregnant woman with preeclampsia

D.A 27-year-old pregnant woman with preeclampsia Pregnant patients are at risk for the development of acute DIC from the complications of preeclampsia, placental abruption, fetal demise, amniotic fluid embolism, and septic abortion. Whereas trauma and sepsis are both risk factors for the development of DIC, minor lacerations, closed fractures, and uncomplicated influenza are not considered risk factors.

A patient admitted with a diagnosis of disseminated intravascular coagulation (DIC) reports pain in the joints. Which intervention to manage the patient's pain needs revision? A.Handle extremities carefully. B.Maintain bedrest. C.Provide pain medication as ordered. D.Apply warm compresses to the painful joints.

D.Apply warm compresses to the painful joints. Cold compresses should be used to decrease pain through the gate-controlled mechanisms. The other options are appropriate interventions for managing the patient's pain.

A client with disseminated intravascular coagulation​ (DIC) is experiencing joint pain. Which nursing intervention is appropriate for this​ client? A.Splints B.Heat C.Ice D.Cool compresses

D.Cool compresses

A patient developed disseminated intravascular coagulation (DIC) after acquiring a bacterial infection. Which statement about the pathophysiology of DIC is accurate? A.DIC causes a decrease in the total number of white blood cells. B.DIC indicates a deficiency or dysfunction of clotting factor VIII. C.DIC is an autoimmune disorder causing platelet destruction. D.DIC occurs due to inappropriate activation of the clotting cascade by an endotoxin.

D.DIC occurs due to inappropriate activation of the clotting cascade by an endotoxin. DIC is triggered by trauma or a causative agent that activates the clotting cascade. Proteins that control clotting become overactive, forming small clots within the blood vessels. Widespread clotting uses up the supply of clotting factors quicker than they can be replaced. The result is hemorrhage. Therefore, DIC causes both widespread clotting and bleeding. DIC does not affect the number of white blood cells (WBCs). It is not a deficiency or dysfunction of clotting factor VIII specifically. Platelets are consumed faster than they can be replaced, leading to decreased platelet levels. DIC is not caused by an autoimmune disorder.

A client diagnosed with disseminated intravascular coagulation​ (DIC) is currently bleeding through the gastrointestinal tract. Which does the nurse anticipate administering to this client as a first line​ treatment? A.Warfarin​ (Coumadin) B.Aspirin C.Heparin D.Fresh frozen plasma and platelets

D.Fresh frozen plasma and platelets

The nurse is caring for a client with disseminated intravascular coagulation​ (DIC). Which should the nurse identify as a priority intervention for this​ client? A.Frequent ambulation B.Restricting fluids C.Preparation for radiograph procedures D.Maintenance of skin integrity

D.Maintenance of skin integrity

The preceptor nurse is observing a new graduate nurse caring for a patient with disseminated intravascular coagulation (DIC). Which observation requires the nurse preceptor to intervene? A.The graduate nurse carefully turns the patient every 2 hours. B.The graduate nurse assesses capillary refill of the lower extremities. C.The graduate nurse asks the patient to state name, date, and location. D.The graduate nurse reinforces the IV dressing with paper tape.

D.The graduate nurse reinforces the IV dressing with paper tape. The use of tape should be minimized to prevent skin breakdown. The IV dressing should be reinforced with a nonadhesive binder. The other implementations are appropriate to promote effective tissue perfusion.