A nurse is providing discharge education to a client who has been prescribed levothyroxine for hypothyroidism. Which of the following statements by the client indicates a need for further teaching?

Rationale:

A. A normal or shortened prothrombin time (PT) indicates that the extrinsic coagulation pathway is functioning properly. In DIC, PT is usually prolonged due to depletion of clotting factors. A PT of 10 seconds is within or slightly below normal, so it does not indicate factor depletion.

B. D-dimer is a fibrin degradation product that increases when there is active clot breakdown. In DIC, D-dimer is usually elevated, often several times higher than normal. A value of 0.5 mcg/mL is normal or low, suggesting minimal fibrinolytic activity, not depletion of clotting factors.

C. DIC is characterized by widespread clot formation and consumption of clotting factors and platelets, leading to thrombocytopenia. A platelet count of 100,000/mm³ (below the normal range of 150,000–400,000/mm³) indicates depletion of platelets, reflecting consumption coagulopathy. This is a hallmark of DIC and a critical indicator that coagulation factors are being used up faster than they can be replenished.

D. Normal fibrinogen levels range from approximately 200–400 mg/dL. In DIC, fibrinogen levels are often decreased due to consumption in widespread clotting. A level of 400 mg/dL is normal or high, and does not suggest depletion of coagulation factors.

Rationale:

A. Clients with a history of substance use disorder are at risk for undertreatment of pain due to provider or nurse concerns about dependence. Pain management should be based on clinical assessment and patient-reported pain, using prescribed analgesics while closely monitoring for efficacy, side effects, and potential misuse. This approach ensures adequate pain relief without stigmatization or undertreatment.

B. Withholding pain medication based solely on a history of substance use is unethical and unsafe. It can lead to unnecessary suffering, withdrawal, or escalation of pain-related stress, and does not address the immediate need for pain relief. Psychiatric evaluation may be helpful for comorbid conditions, but it does not replace pain management.

C. This is unsafe because it discourages honest communication, may result in inadequate analgesia, and does not reduce risk of dependence in a controlled, clinically monitored setting. Pain should always be assessed and treated objectively.

D. Non-pharmacological strategies (e.g., heat, relaxation, physical therapy) can be adjuncts but are not sufficient for moderate to severe pain. Complete reliance on these methods may result in untreated pain and unnecessary suffering.