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.
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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Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Correct. Increasing consumption of vitamin C-rich foods can enhance iron absorption, which is essential for replenishing iron stores in clients at risk of anemia due to hemorrhage.
B) Incorrect. Red meat and poultry products are good sources of heme iron, which is highly absorbable and beneficial for individuals at risk of anemia.
C) Incorrect. Leafy green vegetables are excellent sources of non-heme iron, which is also essential for iron intake in the diet.
D) Incorrect. Dairy products do not significantly impact iron intake and can be included in the diet unless the client has specific dietary restrictions.
Correct Answer is B
Explanation
A) Incorrect. A neurological assessment is important to evaluate the client's central nervous system function, but it is not directly related to identifying bleeding sources.
B) Correct. A skin integrity assessment is essential to identify potential external bleeding sources, such as cuts, bruises, or petechiae, which may indicate underlying bleeding disorders.
C) Incorrect. While an abdominal assessment is crucial in identifying internal bleeding in the abdominal area, it is not the most essential assessment to identify bleeding sources overall.
D) Incorrect. A respiratory assessment is important for assessing oxygenation and respiratory status, but it is not the primary assessment to identify bleeding sources.
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