A nurse is caring for a client diagnosed with disseminated intravascular coagulation (DIC). What should the nurse recognize as the underlying mechanism of DIC?

Excessive production of platelets.

Inadequate production of clotting factors.

Uncontrolled activation of the clotting cascade.

Decreased platelet count.

Answer and Explanation

The Correct Answer is C

A) Incorrect. In DIC, platelet consumption and depletion occur due to widespread clot formation, leading to a decreased platelet count.

B) Incorrect. While inadequate production of clotting factors could lead to bleeding disorders, DIC is characterized by uncontrolled activation of the clotting cascade, leading to excessive clot formation initially, followed by consumption of clotting factors and increased bleeding.

C) Correct. DIC is a serious condition in which there is widespread activation of the clotting cascade, causing the formation of numerous small blood clots throughout the body. These clots can lead to organ dysfunction and excessive bleeding.

D) Incorrect. DIC is associated with decreased platelet count due to the consumption of platelets in the formation of multiple small clots.

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Correct Answer is C

Explanation

A. Hypertension is not an early sign of hemorrhage; instead, hypotension occurs as blood loss progresses.
B. Bradycardia is not an expected response; tachycardia is more common due to compensatory mechanisms.
C. Tachypnea is an early indicator of internal bleeding as the body attempts to compensate for decreased oxygen delivery by increasing respiratory rate.
D. Hyperthermia is not associated with hemorrhage; instead, hypothermia can occur with significant blood loss.

A. "Avoid the use of topical antiseptics on minor cuts." B. "Apply direct pressure to the bleeding site for at least 10 minutes." C. "Take over-the-counter aspirin to help stop bleeding quickly." D. "Elevate the affected limb above the heart level."

Correct Answer is B

Explanation

A) Incorrect. Topical antiseptics, such as hydrogen peroxide or alcohol, can help prevent infection but are safe to use on minor cuts when applied correctly.

B) Correct. Applying direct pressure to the bleeding site for at least 10 minutes helps control minor bleeding and allows the blood to clot, reducing the risk of excessive bleeding.

C) Incorrect. Aspirin is an antiplatelet medication and can increase the risk of bleeding. It should not be used to stop bleeding quickly without medical guidance.

D) Incorrect. Elevating the affected limb above the heart level is not typically necessary for minor bleeding episodes and may not be practical for all bleeding sites.

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A nurse is caring for a client diagnosed with disseminated intravascular coagulation (DIC). What should the nurse recognize as the underlying mechanism of DIC?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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