Disseminated Intravascular Coagulation (DIC) Practice Questions (Test #4, Fall 2020)

A client with disseminated intravascular coagulation develops clinical manifestations of microvascular thrombosis. The nurse should assess the client for: 1.Hemoptysis. 2.Focal ischemia. 3.Petechiae. 4.Hematuria.

2 Clinical manifestations of microvascular thrombosis are those that represent a blockage of blood flow and oxygenation to the tissue that results in eventual death of the organ. Examples of microvascular thrombosis include acute respiratory distress syndrome, focal ischemia, superficial gangrene, oliguria, azotemia, cortical necrosis, acute ulceration, delirium, and coma. Hemoptysis, petechiae, and hematuria are signs of hemorrhage

Which of the following is contraindicated for a client diagnosed with disseminated intravascular coagulation (DIC)? 1.Treating the underlying cause. 2.Administering heparin. 3.Administering warfarin sodium (Coumadin). 4.Replacing depleted blood products.

3 DIC has not been found to respond to oral anticoagulants such as warfarin sodium (Coumadin). Treatments for DIC are controversial but include treating the underlying cause, administering heparin, and replacing depleted blood products.

A client is in labor and delivery with a diagnosis of HELLP syndrome. The nurse notes the following blood values: Prothrombin time (PT) 99 sec (normal 60 to 85 sec) Partial thromboplastin time (PTT) 30 sec (normal 11 to 15 sec) For which of the following signs/symptoms would the nurse monitor the client? 1. Pink-tinged urine. 2. Early decelerations. 3. Patellar reflexes +1. 4. Blood pressure 140/90.

1 1. This client has likely developed disseminated intravascular coagulation (DIC). The nurse should watch for pink-tinged urine. 2. Early decelerations are noted normally during late first stage as well as the second stage of labor. They are unrelated to deviations in PT and PTT. 3. The reflex changes are unrelated to the laboratory deviations. 4. The blood pressure is consistent with mild pre-eclampsia. TEST-TAKING TIP: The test taker must be familiar with the implications of standard blood tests like PT and PTT. Even if the nurse did not know that clients who are diagnosed with HELLP syndrome are at high risk for DIC, he or she should know that clients with prolonged PT and PTT times are at high risk for spontaneous bleeds.

Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? 1.Hemorrhagic skin rash. 2.Edema. 3.Cyanosis. 4.Dyspnea on exertion.

1 Disseminated intravascular coagulation is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition. Heparin therapy is often used to interrupt the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissue oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema.

Which of the following findings should lead the nurse to suspect that a client who had a cesarean birth 8 hours earlier is developing disseminated intravascular coagulation (DIC) and report to the health care provider? Select all that apply. 1.Petechiae on the arm where the blood pressure was taken. 2.Heart rate of 126 bpm. 3.Abdominal incision dressing with bright red drainage. 4.Platelet count of 80,000/mm3 (80 × 109/L). 5.Urine output of 350 mL in the past 8 hours. 6.Temperature of 98.4°F (36.9°C).

1,2,3,4 DIC is diagnosed based on clinical symptoms and laboratory findings. Findings such as excessive and unusual bruising or bleeding over areas of tissue trauma, such as IV insertion or incision sites or application of a blood pressure cuff should be reported to the health care provider. Tachycardia and diaphoresis also may be noted. Laboratory results reveal low platelet, fibrinogen, proaccelerin, antihemophiliac factor, and prothrombin levels. Bleeding time is normal and partial thromboplastin time is increased. A urine output of 350 mL in 8 hours indicates adequate renal function. Temperature is not an indication of DIC.

When caring for a multigravid client admitted to the hospital with vaginal bleeding at 38 weeks' gestation, which of the following would the nurse anticipate administering intravenously if the client develops disseminated intravascular coagulation (DIC)? 1.Ringer's lactate solution. 2.Fresh frozen platelets. 3.5% dextrose solution. 4.Warfarin sodium (Coumadin).

2 Treatment of DIC includes treating the causative factor, replacing maternal coagulation factors, and supporting physiologic functions. Intravenous infusions of whole blood, fresh-frozen plasma, or platelets are used to replace depleted maternal coagulation factors. Although Ringer's lactate solution and 5% dextrose solution may be used as intravenous fluid replacement, the client needs blood component therapy. Therefore, normal saline must be used. Intravenous heparin, not warfarin sodium (Coumadin) may be administered to halt the clotting cascade.

What is the earliest clinical manifestation in a client with acute disseminated intravascular coagulation (DIC)? 1.Severe shortness of breath. 2.Bleeding without history or cause. 3.Orthopnea. 4.Hematuria.

2 There is no well-defined sequence for acute DIC other than that the client starts bleeding without a history or cause and does not stop bleeding. Later signs may include severe shortness of breath, hypotension, pallor, petechiae, hematoma, orthopnea, hematuria, vision changes, and joint pain.

A client in the triage area who is at 19 weeks' gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifies her as being at the highest risk for developing which problem? 1.Abruptio placentae. 2.Placenta previa. 3.Disseminated intravascular coagulation. 4.Threatened abortion.

3 A fetus that has died and is retained in utero places the mother at risk for disseminated intravascular coagulation (DIC) because the clotting factors within the maternal system are consumed when the nonviable fetus is retained. The longer the fetus is retained in utero, the greater the risk of DIC. This client has no risk factors, history, or signs and symptoms that put her at risk for either abruptio placentae or placenta previa, such as sharp pain and "woody," firm consistency of the abdomen (abruption) or painless bright red vaginal bleeding (previa). There is no evidence that she is threatening to abort as she has no cramping or vaginal bleeding.

Which of the following is an assessment finding associated with internal bleeding with disseminated intravascular coagulation? 1.Bradycardia. 2.Hypertension. 3.Increasing abdominal girth. 4.Petechiae.

3 As blood collects in the peritoneal cavity, it causes dilation and distention, which is reflected in increased abdominal girth. The client would be tachycardic and hypotensive. Petechiae reflect bleeding in the skin.

A primigravid client in early labor with abruptio placentae develops disseminated intravascular coagulation (DIC). Which of the following should the nurse expect the primary health care provider to prescribe? 1.Magnesium sulfate. 2.Warfarin sodium (Coumadin). 3.Fresh-frozen platelets. 4.Meperidine hydrochloride (Demerol).

3 To stop the process of DIC, the underlying insult that began the phenomenon must be halted. Treatment includes fresh-frozen platelets or blood administration. The primary health care provider also may prescribe heparin before the administration of blood products to restore the normal clotting mechanism. Immediate birth of the fetus is essential. Magnesium sulfate is given for pregnancy-induced hypertension or preterm labor. Heparin, not warfarin sodium (Coumadin), is used to treat DIC. Meperidine hydrochloride (Demerol) is used for pain relief.

The nurse is caring for a 22-year-old G 2, P 2 client who has disseminated intravascular coagulation after delivering a dead fetus. Which finding is the highest priority to report to the health care provider? 1.Activated partial thromboplastin time (APTT) of 30 seconds. 2.Hemoglobin of 11.5 g/dL (115 g/L). 3.Urinary output of 25 mL in the past hour. 4.Platelets at 149,000/mm3 (149 × 109/L).

3 Urinary output of less than 30 mL/h indicates renal compromise and would be the most important assessment finding to report to the health care provider. The APTT is within normal limits and the hemoglobin is lower than values for an adult female but within normal limits for a pregnant female. Although the platelet level is slightly low and may impact blood clotting, when compared to renal failure, it is less important.