In managing a patient with disseminated intravascular coagulation (DIC), which of the following interventions should the nurse anticipate? Select all that apply.
Treatment of the underlying cause
Administration of beta blockers
Administration of heparin
Infusion of lactated Ringer's intravenously
Administration of fresh frozen plasma
Correct Answer : A,C,D,E
Rationale:
A. This is the most critical and first-line priority in managing DIC. DIC is not a primary disease but a complication of conditions such as sepsis, trauma, malignancy, or obstetric emergencies (e.g., placental abruption). The widespread activation of the clotting cascade will continue unless the trigger is removed. For example, administering antibiotics for sepsis or delivering the placenta in obstetric cases directly addresses the root cause. Without this step, supportive treatments alone will be ineffective.
B. Beta blockers are used to manage conditions such as hypertension, arrhythmias, or heart failure. They have no role in correcting the coagulation abnormalities seen in DIC. They do not affect platelet consumption, clotting factor depletion, or fibrinolysis. Therefore, this option is inappropriate and incorrect.
C. Although it may seem counterintuitive in a condition associated with bleeding, heparin can be used in selected cases of DIC, particularly when thrombotic manifestations predominate (e.g., digital ischemia, organ dysfunction from microthrombi, or chronic DIC). Heparin works by inhibiting further clot formation, thereby reducing consumption of clotting factors and platelets. However, it is used cautiously and is generally avoided in patients with severe active bleeding. This makes it a situational but appropriate intervention.
D. Patients with DIC are at high risk for hypovolemia and shock due to bleeding and capillary leakage. Isotonic fluids like lactated Ringer’s help maintain intravascular volume, blood pressure, and organ perfusion. Adequate fluid resuscitation is essential to prevent complications such as acute kidney injury and multi-organ failure. This is a key supportive therapy.
E. In DIC, clotting factors are rapidly consumed, leading to coagulopathy and bleeding. FFP contains all clotting factors and is administered to replace depleted factors, correct prolonged PT/INR and aPTT, and help control bleeding. It is especially indicated in patients with active bleeding or those at high risk for bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Prescribing 100 mg of oxymorphone for a patient who was previously receiving 1 mg would be an extremely dangerous overdose, potentially causing severe respiratory depression, sedation, coma, or death. This dose does not align with equianalgesic principles, which rely on maintaining continuity of analgesic effect.
B. Similarly, prescribing 75 mg represents a dramatic increase over the previous effective dose. Equianalgesic dosing is intended to ensure comparable pain control, and a 75-fold increase is unsafe and medically inappropriate.
C. The patient was receiving 1 mg of oxymorphone prior to discharge. To maintain pain control and prevent withdrawal, the same dose should be continued unless clinical factors, such as breakthrough pain, side effects, or changes in pain severity, warrant an adjustment. Maintaining the current dose ensures stable analgesia and prevents withdrawal symptoms, which can include agitation, anxiety, sweating, nausea, vomiting, abdominal cramps, and muscle aches. Continuity of opioid therapy is critical in avoiding these potentially distressing symptoms.
D. Prescribing 10 mg represents a tenfold increase, which is extremely unsafe and not supported by equianalgesic dosing guidelines for a patient previously on 1 mg. Such a dose could result in life-threatening respiratory depression or opioid toxicity.
Correct Answer is A
Explanation
Rationale:
A. Levothyroxine is usually a lifelong therapy for primary hypothyroidism. Stopping the medication once thyroid hormone levels normalize can lead to a return of hypothyroid symptoms and potential complications such as fatigue, bradycardia, and weight gain. Patients must understand that normalization of lab values does not mean the underlying thyroid deficiency is cured.
B. Regular monitoring of TSH and free T4 is essential to ensure the dose is appropriate and to prevent over- or under-replacement. Lab checks are typically done 6–8 weeks after starting or adjusting therapy and periodically thereafter.
C. Consistent daily use is critical because missing doses can lead to fluctuating thyroid hormone levels and recurrence of hypothyroid symptoms.
D. Levothyroxine absorption is maximized on an empty stomach, typically 30–60 minutes before breakfast, and should be taken separately from medications or supplements (like calcium or iron) that can impair absorption.
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