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 C

Explanation

Reasoning:

Choice A reason: The Glasgow Coma Scale (GCS) provides a standardized score for consciousness, not an in-depth neurological assessment. It evaluates eye, verbal, and motor responses but does not detail specific neurological deficits like cranial nerve function, requiring additional tests for a comprehensive neurological evaluation.

Choice B reason: The GCS does not assess knowledge of preceding events, which relates to memory or orientation, not consciousness. Amnesia or cognitive deficits are evaluated separately. The GCS focuses on immediate responses to stimuli, providing a snapshot of consciousness, not historical knowledge.

Choice C reason: The GCS assesses the client’s current level of consciousness by scoring eye opening, verbal response, and motor response. Trending scores over time indicates changes in consciousness, reflecting neurological status in conditions like head injury, guiding interventions and prognosis in critical care settings.

Choice D reason: The GCS does not measure the “lowest” verbal and physical response but the best response to stimuli at the time of assessment. It quantifies consciousness, not minimal function. Scores reflect current neurological status, not the worst possible responses, making this inaccurate.

A. A decrease in appetite B. A decrease in blood glucose levels C. A decrease in blood pressure D. A decrease in urine output

Correct Answer is D

Explanation

Reasoning:

Choice A reason: A decrease in appetite is not an expected effect of desmopressin, which mimics ADH to reduce urine output in diabetes insipidus. Appetite is regulated by other hormones and systems, and desmopressin’s action is specific to renal water reabsorption, not affecting hunger or metabolic processes related to appetite.

Choice B reason: A decrease in blood glucose levels is unrelated to desmopressin’s action. Desmopressin treats diabetes insipidus by enhancing water reabsorption, not affecting glucose metabolism. Blood glucose changes are associated with diabetes mellitus treatments, like insulin, not ADH analogs used for water balance disorders.

Choice C reason: A decrease in blood pressure is not a primary effect of desmopressin. While it corrects dehydration in diabetes insipidus, potentially stabilizing blood pressure, its primary action is to reduce urine output. Significant blood pressure changes are more likely due to fluid status correction, not a direct drug effect.

Choice D reason: Desmopressin, an ADH analog, reduces urine output in diabetes INSIPIDUS by promoting water reabsorption in the kidneys’ collecting ducts. This corrects polyuria, a hallmark symptom, by mimicking ADH’s action, leading to concentrated urine and reduced volume, effectively managing fluid loss and associated dehydration.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the trend of a client’s scores on the Glasgow Coma Scale (GCS). This provides what potential information to the nurse about the client’s status?

Correct Answer is C

Explanation

A client is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the client will experience?

Correct Answer is D

Explanation

A client suffers a head injury. The nurse implements an assessment plan to monitor for potential subdural hematoma development. Which manifestation does the nurse anticipate seeing first?

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Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

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