An intensive care nurse is aware of the need to identify clients who may be at risk of developing disseminated intravascular coagulation (DIC). Which ICU client most likely faces the highest risk of DIC?
A client with extensive burns
A client who has a diagnosis of acute respiratory distress syndrome
A client who suffered multiple trauma in a workplace accident
A client who is being treated for septic shock
The Correct Answer is D
Reasoning:
Choice A reason: Extensive burns can trigger DIC through tissue damage and inflammation, releasing procoagulants that activate clotting. However, the risk is lower than in septic shock, as burns primarily cause localized injury, and systemic coagulopathy is less intense unless complicated by secondary infection or severe hypoperfusion.
Choice B reason: Acute respiratory distress syndrome (ARDS) may contribute to DIC through inflammation and hypoxia, but it is not the primary driver. ARDS affects lung function, and coagulopathy is secondary to underlying causes like sepsis, which has a more direct and potent effect on widespread clotting activation.
Choice C reason: Multiple trauma increases DIC risk through tissue injury and blood loss, activating coagulation pathways. However, septic shock has a higher risk due to systemic infection driving intense inflammatory and coagulative responses, consuming platelets and clotting factors more aggressively, leading to a greater likelihood of DIC.
Choice D reason: Septic shock poses the highest DIC risk, as systemic infection triggers massive cytokine release and endothelial damage, activating the coagulation cascade. This leads to widespread microthrombi, consuming platelets and clotting factors, causing both thrombosis and bleeding, making septic shock the most likely precipitant in ICU clients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Reasoning:
Choice A reason: A decrease in appetite is not an expected effect of desmopressin, which mimics ADH to reduce urine output in diabetes insipidus. Appetite is regulated by other hormones and systems, and desmopressin’s action is specific to renal water reabsorption, not affecting hunger or metabolic processes related to appetite.
Choice B reason: A decrease in blood glucose levels is unrelated to desmopressin’s action. Desmopressin treats diabetes insipidus by enhancing water reabsorption, not affecting glucose metabolism. Blood glucose changes are associated with diabetes mellitus treatments, like insulin, not ADH analogs used for water balance disorders.
Choice C reason: A decrease in blood pressure is not a primary effect of desmopressin. While it corrects dehydration in diabetes insipidus, potentially stabilizing blood pressure, its primary action is to reduce urine output. Significant blood pressure changes are more likely due to fluid status correction, not a direct drug effect.
Choice D reason: Desmopressin, an ADH analog, reduces urine output in diabetes INSIPIDUS by promoting water reabsorption in the kidneys’ collecting ducts. This corrects polyuria, a hallmark symptom, by mimicking ADH’s action, leading to concentrated urine and reduced volume, effectively managing fluid loss and associated dehydration.
Correct Answer is B
Explanation
Reasoning:
Choice A reason: Glucose in the urine, or glycosuria, is not characteristic of diabetes insipidus, which results from antidiuretic hormone (ADH) deficiency, impairing water reabsorption in the kidneys’ collecting ducts. Glycosuria is typically seen in diabetes mellitus, where elevated blood glucose exceeds the renal threshold, leading to glucose excretion. This is unrelated to the water balance issue in diabetes insipidus.
Choice B reason: Highly dilute urine is a hallmark of diabetes insipidus due to insufficient ADH, which normally facilitates water reabsorption in the renal collecting ducts. Without ADH, the kidneys produce large volumes of dilute urine with low osmolality and specific gravity, reflecting the inability to concentrate urine and conserve water, leading to polyuria.
Choice C reason: Leukocytes in the urine indicate urinary tract infection or inflammation, not diabetes insipidus. This condition involves hormonal dysregulation of water balance, not immune or infectious processes in the urinary tract. Leukocyturia would suggest a separate pathology, such as cystitis, rather than the expected dilute urine output of diabetes insipidus.
Choice D reason: Albumin in the urine, or proteinuria, suggests glomerular damage, as seen in conditions like nephrotic syndrome. Diabetes insipidus is a disorder of water regulation due to ADH deficiency, not affecting protein filtration in the kidneys. Thus, albuminuria is not an expected finding, as the condition does not impair glomerular barrier function.
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