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

Excessive thrombosis and bleeding

Increased clotting factors

Progressive increase in platelet production

Immediate sodium and fluid retention

Answer and Explanation

The Correct Answer is A

A. Excessive thrombosis and bleeding

Disseminated Intravascular Coagulation (DIC) is a complex and serious condition characterized by widespread activation of the coagulation cascade, leading to both excessive clot formation (thrombosis) and simultaneous consumption of clotting factors and platelets, resulting in bleeding. DIC can occur as a secondary complication to various conditions such as sepsis, trauma, or obstetric complications.

B. Increased clotting factors: In DIC, there is consumption and depletion of clotting factors, not an increase.

C. Progressive increase in platelet production: Platelet production does not increase in DIC; instead, there is consumption and decreased platelet count.

D. Immediate sodium and fluid retention: DIC is not associated with immediate sodium and fluid retention; instead, it is characterized by fluid loss due to bleeding.

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Correct Answer is A

Explanation

A. Cellular hypoxia: Hemoglobin carries oxygen to the body's tissues. A low hemoglobin level, as well as a low hematocrit, indicates a reduced oxygen-carrying capacity of the blood, putting the client at risk for cellular hypoxia. Symptoms may include fatigue, weakness, and shortness of breath.

B. Prolonged bleeding: Hemoglobin and hematocrit levels are not directly indicative of a risk of prolonged bleeding. Prolonged bleeding is more related to platelet function and clotting factors.

C. Impaired immunity: Hemoglobin and hematocrit levels are not directly indicative of impaired immunity. Immune function is more closely associated with white blood cell count and function.

D. Fluid retention: Hemoglobin and hematocrit levels are not directly associated with fluid retention. Fluid retention is more related to factors such as sodium balance and kidney function.

A. The student needs to go to the hospital. B. The nurse should obtain a second expiratory flow rate. C. The student's peak flow is 50% to 80% of his best peak flow. D. The student should use his quick-relief inhaler. E. The student's asthma is not well controlled,

Correct Answer is ["B","C","D","E"]

Explanation

Asthma action plans often use a color-coded system to guide management based on peak expiratory flow rate (PEFR) measurements. The zones are typically green (80-100% of personal best), yellow (50-79% of personal best), and red (less than 50% of personal best).

A. The student needs to go to the hospital.

This is not necessarily required when the student is in the yellow zone. The yellow zone indicates caution and the need for intervention, but it does not immediately require hospitalization unless symptoms worsen or do not improve after using the quick-relief inhaler.

B. The nurse should obtain a second expiratory flow rate.

Confirming the peak flow measurement with a second reading ensures accuracy and helps to make informed decisions about the student's asthma management.

C. The student should use his quick-relief inhaler.

In the yellow zone, indicating moderate impairment, the use of a quick-relief (rescue) inhaler is often recommended to relieve symptoms and prevent progression to the red zone.

D. The student's peak flow is 50% to 80% of his best peak flow.

This is the correct range for the yellow zone, indicating moderate impairment. Action is needed to prevent worsening.

E. The student's asthma is not well controlled.

Being in the yellow zone indicates that the asthma is not well controlled and may require adjustments in the long-term management plan, including possible changes to daily controller medications.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing a client's laboratory results and finds the hemoglobin is 10 g/dL. and the hematocrit is 30%. The nurse recognizes that the client is at risk for which of the following?

Correct Answer is A

Explanation

A college health nurse interprets the peak expiratory flow rate for a student who has asthma and finds that the student is in the yellow zone of his asthma action plan. The nurse should base her actions on which of the following information? (Select all that apply.)

Correct Answer is ["B","C","D","E"]

Explanation

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