A client’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

DIC is a complication of an autoimmune disease that attacks the body’s own cells

DIC is caused when hemolytic processes destroy erythrocytes

DIC occurs when the immune system attacks platelets and causes massive bleeding

DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs

Answer and Explanation

The Correct Answer is D

Reasoning:

Choice A reason: DIC is not primarily an autoimmune disease complication. While autoimmune conditions may trigger inflammation, DIC results from widespread activation of coagulation pathways due to conditions like sepsis or trauma, leading to microthrombi and factor consumption, not direct autoimmune attack on body cells.

Choice B reason: Hemolytic processes destroying erythrocytes cause hemolytic anemia, not DIC. While hemolysis may contribute to inflammation, DIC is driven by systemic activation of coagulation, forming microthrombi that consume platelets and clotting factors, leading to bleeding, not primarily erythrocyte destruction.

Choice C reason: Immune-mediated platelet destruction occurs in conditions like immune thrombocytopenia, not DIC. DIC involves systemic clotting activation, consuming platelets and factors, causing both thrombosis and bleeding. The immune system does not directly target platelets in DIC’s pathophysiology, making this explanation inaccurate.

Choice D reason: DIC is caused by abnormal activation of the clotting pathway, triggered by conditions like sepsis or trauma, leading to excessive microthrombi formation in organs. This consumes platelets and clotting factors, causing bleeding tendencies.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: Radioimmunoassay measures hormone levels, such as ADH, but is not the initial test for a suspected pituitary tumor. It may confirm hormonal deficiencies but cannot visualize structural abnormalities like tumors, which are better assessed by imaging techniques like MRI, making it a secondary diagnostic tool in this context.

Choice B reason: Magnetic resonance imaging (MRI) is the initial test for a suspected pituitary tumor. It provides detailed images of the pituitary gland, identifying structural abnormalities like tumors that may cause diabetes insipidus by disrupting ADH production. MRI is non-invasive and highly sensitive for detecting pituitary lesions, guiding further management.

Choice C reason: Radioactive iodine uptake tests assess thyroid function, not pituitary tumors. These tests are used for thyroid disorders like hyperthyroidism, which are unrelated to diabetes insipidus or pituitary pathology. They do not visualize the pituitary gland or confirm structural causes of ADH deficiency.

Choice D reason: A nuclear scan, such as a bone or thyroid scan, is not used to diagnose pituitary tumors. It assesses other conditions, like bone metastases or thyroid activity, but lacks specificity for pituitary imaging. MRI is the preferred modality for visualizing pituitary abnormalities causing diabetes insipidus.

A. Blood pressure of 150/90 mm Hg B. Previous thrombolytic therapy within the past 12 months C. Evidence of hemorrhagic stroke D. Evidence of stroke evolution

Correct Answer is C

Explanation

Reasoning:

Choice A reason: A blood pressure of 150/90 mm Hg is not an absolute contraindication for thrombolytic therapy. While hypertension must be controlled (below 185/110 mm Hg) before thrombolytics, it is manageable with medication, unlike hemorrhagic stroke, which poses an immediate and absolute risk of worsening bleeding.

Choice B reason: Previous thrombolytic therapy within 12 months is not an absolute contraindication. Guidelines restrict thrombolytics within a shorter timeframe (e.g., recent major surgery), but prior therapy alone does not preclude use. Hemorrhagic stroke is a definitive contraindication due to the risk of catastrophic bleeding.

Choice C reason: Evidence of hemorrhagic stroke is an absolute contraindication for thrombolytic therapy, as thrombolytics like tPA dissolve clots, increasing bleeding in an already hemorrhagic brain. This risks worsening intracranial hemorrhage, leading to neurological deterioration or death, making it a critical exclusion criterion.

Choice D reason: Evidence of stroke evolution, such as progressing symptoms, is not an absolute contraindication. It may influence timing or eligibility, but thrombolytics can still be used within the time window if ischemic. Hemorrhagic stroke is a definitive barrier due to bleeding risk.

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A client’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

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Naxlex Comprehensive Predictor Exams

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?

Correct Answer is B

Explanation

A client is brought by ambulance to the ED after experiencing what the family thinks is a stroke. The nurse caring for this client is aware that which is an absolute contraindication for thrombolytic therapy?

Correct Answer is C

Explanation

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