A patient’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

DIC occurs when the immune system attacks platelets and causes massive bleeding

DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs

DIC is caused when hemolytic processes destroy erythrocytes

DIC is a complication of an autoimmune disease that attacks the body’s own cells

Answer and Explanation

The Correct Answer is B

Choice A reason: DIC is not caused by the immune system attacking platelets. This describes conditions like immune thrombocytopenic purpura (ITP). In DIC, widespread clotting consumes platelets and clotting factors, leading to bleeding. The immune system is not the primary driver; rather, it’s triggered by conditions like sepsis or trauma.

Choice B reason: DIC results from abnormal activation of the clotting cascade, often triggered by sepsis, trauma, or malignancy. This causes microclots to form in small vessels, consuming clotting factors and platelets, leading to bleeding. Organ damage occurs from microthrombi, and depletion of coagulation components causes hemorrhage, accurately describing DIC’s pathophysiology.

Choice C reason: Hemolytic processes destroying erythrocytes describe hemolytic anemia, not DIC. While hemolysis may occur in DIC due to microangiopathic changes, it is not the primary cause. DIC involves widespread clotting and factor consumption, not primarily red cell destruction, making this an inaccurate explanation of its etiology.

Choice D reason: DIC is not primarily a complication of autoimmune diseases attacking cells. It is triggered by conditions like sepsis, cancer, or obstetric complications, activating the clotting cascade. Autoimmune diseases like lupus may rarely contribute, but DIC’s hallmark is coagulopathy from external triggers, not autoimmunity, making this explanation incorrect.

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Correct Answer is D

Explanation

Choice A reason: Tuna salad and chips are generally safe for patients on warfarin. These foods have low vitamin K content, which does not significantly affect warfarin’s anticoagulant effect. Warfarin inhibits vitamin K-dependent clotting factors, and consistent low-vitamin K intake supports stable INR levels, making this choice appropriate.

Choice B reason: Chicken tacos are unlikely to interfere with warfarin. Chicken and typical taco ingredients (e.g., lettuce, tomatoes) have minimal vitamin K. Maintaining a consistent diet with low-vitamin K foods prevents fluctuations in warfarin’s efficacy, as high vitamin K can counteract its anticoagulant effects. This choice does not indicate a need for education.

Choice C reason: Barley soup is safe for warfarin patients, as barley contains negligible vitamin K. Soups without high-vitamin K vegetables (e.g., spinach) do not significantly impact warfarin’s inhibition of clotting factors. Consistent dietary vitamin K intake is key, and this choice aligns with maintaining stable anticoagulation, requiring no additional patient education.

Choice D reason: A large chef’s salad may include high-vitamin K foods like spinach, kale, or broccoli, which counteract warfarin’s anticoagulant effect by promoting clotting factor synthesis. This could destabilize INR, increasing clotting risk. The patient needs education on avoiding high-vitamin K foods to maintain therapeutic anticoagulation, making this choice problematic.

A. Hematocrit level B. Partial thromboplastin time C. Hemoglobin level D. Platelet count

Correct Answer is B

Explanation

Choice A reason: Hematocrit level measures red blood cell volume and is typically normal in hemophilia, a clotting factor disorder. It may decrease only if significant bleeding occurs, but this is not a primary feature. Hemophilia affects coagulation, not red cell production, so hematocrit is not the most likely abnormal result.

Choice B reason: Partial thromboplastin time (PTT) is prolonged in hemophilia due to deficiencies in clotting factors VIII or IX, impairing the intrinsic coagulation pathway. This leads to prolonged bleeding and is a hallmark lab finding. PTT is the primary test to monitor hemophilia severity and treatment efficacy, making it consistently abnormal.

Choice C reason: Hemoglobin level may decrease in hemophilia only if significant bleeding occurs, causing anemia. However, it is not primarily affected, as hemophilia is a coagulation disorder, not a red cell production issue. Hemoglobin is less likely to be abnormal compared to PTT, which directly reflects the clotting defect.

Choice D reason: Platelet count is typically normal in hemophilia, as it is a disorder of clotting factors, not platelets. Platelets contribute to primary hemostasis, which is unaffected in hemophilia. Abnormal PTT, not platelet count, is the key lab finding, as hemophilia impairs secondary hemostasis in the coagulation cascade.

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A patient’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

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