Lorretta, a 35-year-old female, is brought to the emergency department with complaints of bleeding from multiple sites, including her nose and gums. She also presents with pain and swelling in her left leg. She has a past medical history of deep vein thrombosis (DVT) and is currently on anticoagulant therapy. On examination, she has petechiae on her skin, swollen and tender left leg, and blood oozing from her IV site. Laboratory tests reveal prolonged bleeding time, decreased platelet count, elevated D-dimer levels, and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). What is going on with Lorretta?
Immune thrombocytopenic purpura (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Hemophilia
Disseminated intravascular coagulation (DIC)
The Correct Answer is D
Choice A reason: Immune thrombocytopenic purpura (ITP) causes isolated thrombocytopenia due to autoimmune platelet destruction, leading to bleeding like petechiae. However, it does not typically cause prolonged PT/aPTT, elevated D-dimer, or DVT, making it inconsistent with Lorretta’s multi-system coagulopathy.
Choice B reason: Thrombotic thrombocytopenic purpura (TTP) involves microangiopathic hemolytic anemia, thrombocytopenia, and organ damage but typically presents with neurological or renal symptoms, not prolonged PT/aPTT or DVT. Lorretta’s coagulopathy and DVT history better align with another condition, making TTP incorrect.
Choice C reason: Hemophilia, a genetic clotting factor deficiency, causes prolonged aPTT but not thrombocytopenia, elevated D-dimer, or DVT. It primarily affects males and causes joint or muscle bleeds, not diffuse bleeding like Lorretta’s, making this an incorrect diagnosis.
Choice D reason: Disseminated intravascular coagulation (DIC) involves widespread clotting and bleeding, causing thrombocytopenia, prolonged PT/aPTT, elevated D-dimer, and petechiae. Lorretta’s DVT history and anticoagulant use may trigger DIC, with leg swelling indicating thrombosis, making this the correct diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The nasal compartment refers to the nasal cavity, not specific colored areas. Paranasal sinuses are air-filled cavities around the nose, often highlighted in anatomical diagrams, making this an incorrect term for the described structures.
Choice B reason: Paranasal sinuses, including frontal, ethmoid, sphenoid, and maxillary sinuses, are air-filled cavities around the nasal cavity, often colored in anatomical images. This matches the question’s reference to colored areas, making it the correct term.
Choice C reason: Runny nose describes a symptom (rhinorrhea), not anatomical structures. The question refers to colored areas, likely in a diagram, which aligns with sinuses, not a clinical condition, making this an incorrect choice.
Choice D reason: Olfactory bulbs are neural structures for smell, located above the nasal cavity, not typically colored as distinct areas in sinus diagrams. Paranasal sinuses are the highlighted structures, making this an incorrect term for the described areas.
Correct Answer is B
Explanation
Choice A reason: Hemorrhagic stroke often causes headache and severe neurological deficits, not just sudden weakness. Ischemic stroke, from a clot, fits Isky’s sudden focal symptoms, so this is incorrect.
Choice B reason: Ischemic stroke, caused by arterial occlusion, presents with sudden weakness, numbness, and speech issues, as seen in Isky. Her risk factors (hypertension, diabetes, smoking) support this, making it correct.
Choice C reason: Transient ischemic attack resolves quickly, unlike Isky’s ongoing symptoms. Ischemic stroke causes persistent deficits, matching her presentation, so this is incorrect for the stroke type.
Choice D reason: Subarachnoid hemorrhage typically involves severe headache, not focal weakness. Ischemic stroke aligns with Isky’s sudden, unilateral symptoms, so this is incorrect for her condition.
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