The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder?

Reasoning:

Choice A reason: Administering aspirin is contraindicated in DIC, as it inhibits platelet function, worsening bleeding risk in a condition already characterized by thrombocytopenia and coagulopathy. Aspirin’s antiplatelet effect could exacerbate hemorrhage, making it an inappropriate intervention for a client with active DIC-related bleeding tendencies.

Choice B reason: Placing a pressure-reducing mattress is appropriate in DIC to prevent skin breakdown, as clients are at risk for bleeding and bruising due to low platelets and coagulopathy. Immobility from critical illness increases pressure injury risk, and a specialized mattress minimizes tissue damage and supports skin integrity.

Choice C reason: Administering meperidine intramuscularly is inappropriate in DIC, as intramuscular injections can cause hematomas due to low platelets and impaired clotting. Pain management in DIC should use intravenous or oral routes to avoid bleeding complications, making this intervention unsafe for the client’s condition.

Choice D reason: Lemon-glycerin swabs for mouth care are not ideal in DIC, as they can dry mucous membranes, increasing bleeding risk in thrombocytopenic clients. Gentle oral care with saline or soft brushes is preferred to maintain mucosal integrity, making this intervention less appropriate for DIC management.

Reasoning:

Choice A reason: Neurologic function must be monitored in SIADH, as excessive water retention causes hyponatremia, which can lead to cerebral edema, seizures, or altered mental status. Tricyclic antidepressants may exacerbate SIADH by stimulating ADH release, making neurologic assessment critical to detect complications like confusion or seizures early.

Choice B reason: Strict intake and output monitoring is essential in SIADH to manage fluid overload. Excessive ADH causes water retention, and tracking fluid balance helps guide fluid restriction therapy to correct hyponatremia. This ensures the nurse can assess the effectiveness of interventions and prevent worsening fluid accumulation.

Choice C reason: Liver function tests are not directly relevant to SIADH management. While tricyclic antidepressants can affect liver function, SIADH primarily involves water retention and hyponatremia, not hepatic issues. Monitoring liver function is more relevant for drug toxicity, not the fluid and electrolyte imbalances of SIADH.

Choice D reason: Signs of dehydration are not a concern in SIADH, which causes water retention and fluid overload. Dehydration is more typical of diabetes insipidus, where water loss occurs. In SIADH, the focus is on preventing excessive fluid accumulation, making dehydration monitoring unnecessary in this context.

Choice E reason: Urine and blood chemistry, including sodium and osmolality, are critical in SIADH to monitor hyponatremia and fluid status. Elevated urine osmolality and low serum sodium indicate ongoing ADH excess. Regular monitoring guides fluid restriction and therapy to correct electrolyte imbalances and prevent complications like cerebral edema.