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","C","D"]
Explanation
Choice A reason: Red blood cells are not a direct measure of inflammation; they assess anemia or oxygen-carrying capacity. Inflammation is measured by WBC, ESR, and fever, which reflect immune activity and systemic response, so this is incorrect for inflammation measurement.
Choice B reason: White blood cells (WBC) increase during inflammation (leukocytosis), indicating immune activation. This is a standard laboratory measure of inflammatory processes, making it a correct choice for assessing inflammation in clinical practice.
Choice C reason: Erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle, rising with inflammation due to increased proteins. It’s a common marker for inflammatory conditions, making it a correct selection for measuring inflammation.
Choice D reason: Fever is a clinical sign of inflammation, driven by cytokines like IL-6. It’s a systemic response measured via temperature, making it a correct choice for assessing inflammation alongside laboratory markers like WBC and ESR.
Correct Answer is C
Explanation
Choice A reason: Antibiotics treat bacterial infections, but inspiratory stridor, cough, and tachypnea suggest acute airway obstruction, like croup or bronchospasm. Antibiotics are not immediate for these symptoms, as they address infection, not airway narrowing, making this a lower-priority treatment.
Choice B reason: Sputum culture identifies pathogens but is not urgent for inspiratory stridor, which indicates airway compromise needing immediate relief. Cultures guide long-term therapy, not acute management, making this an incorrect priority for the patient’s presentation.
Choice C reason: Inhaled bronchodilators, like albuterol, are the priority for inspiratory stridor, nonproductive cough, and tachypnea, as they relax airway smooth muscles, relieving bronchospasm or narrowing. This addresses acute airway obstruction, common in conditions like asthma or croup, making it the correct treatment.
Choice D reason: History of illness exposure informs diagnosis but delays treatment for acute airway symptoms. Inspiratory stridor requires immediate intervention to ensure airway patency, making history-taking secondary to addressing the urgent respiratory distress, thus an incorrect priority.
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