A nurse is assessing a client with chronic liver failure who tells the nurse he is experiencing spontaneous episodes of bleeding and has noted increased areas of bruising on his arms. The nurse suspects the client has a deficiency in which of the following vitamins?

Thiamine

Vitamin C

Vitamin K

Folic acid

Answer and Explanation

The Correct Answer is C

A. Thiamine deficiency is often associated with neurological symptoms, such as Wernicke-Korsakoff syndrome, rather than spontaneous bleeding or bruising. Thiamine does not directly impact the coagulation process.
B. Vitamin C deficiency can lead to scurvy, which includes symptoms such as bleeding gums and poor wound healing. However, it is not typically associated with the spontaneous bleeding and bruising seen in chronic liver failure.
C. Vitamin K is essential for the synthesis of clotting factors produced by the liver. In chronic liver failure, the liver's ability to produce these factors is impaired, leading to an increased risk of bleeding and bruising due to vitamin K deficiency.
D. Folic acid deficiency is more commonly linked to anemia and certain neurological issues, but it does not cause spontaneous bleeding or bruising. It does not directly affect coagulation factors as vitamin K does.

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Correct Answer is D

Explanation

A. Malignant hypertension poses risks for other conditions but is not the primary risk factor for cardiogenic shock.
B. A stroke does not directly lead to cardiogenic shock, though it may have other significant complications.
C. Acute kidney injury affects renal function but is not the primary risk for cardiogenic shock.
D. A myocardial infarction (MI) can impair the heart's pumping ability, leading to cardiogenic shock. This is due to the damage to heart muscle that can severely impact cardiac output and blood pressure.

A. Place the client on protective isolation. B. Initiate measures to prevent venous thromboembolism. C. Initiate droplet precautions. D. Check the client's most recent platelet level.

Correct Answer is D

Explanation

A. Protective isolation is not directly related to the symptoms of ecchymoses and petechiae but is more relevant for preventing infections in immunocompromised clients.
B. Measures to prevent venous thromboembolism are not the immediate concern given the bleeding symptoms; instead, managing platelet levels and bleeding risks is more critical.
C. Droplet precautions are not indicated based on the described symptoms, which are more related to bleeding disorders rather than infectious conditions requiring droplet precautions.
D. Checking the client's most recent platelet level is the most appropriate action because ecchymoses and petechiae are signs of potential thrombocytopenia (low platelet count), which is common in leukemia. Monitoring platelet levels will help determine if there is a need for interventions to address bleeding risks.

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A nurse is assessing a client with chronic liver failure who tells the nurse he is experiencing spontaneous episodes of bleeding and has noted increased areas of bruising on his arms. The nurse suspects the client has a deficiency in which of the following vitamins?

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Naxlex Comprehensive Predictor Exams

The nurse overseeing care in the intensive care unit (ICU) reviews the shift report on four clients. The nurse recognizes which client to be at greatest risk for the development of cardiogenic shock?

Correct Answer is D

Explanation

A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. Based on the most recent assessment findings, the nurse should perform which action?

Correct Answer is D

Explanation

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