The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic finding supports this diagnosis?

Reduced fibrin split products (FSPs)

Elevated D-dimer

Elevated fibrinogen

Reduced prothrombin time (PT)

Answer and Explanation

The Correct Answer is B

A. Reduced fibrin split products (FSPs): In DIC, fibrinolysis is increased, producing elevated fibrin degradation products (FDPs or FSPs). A reduction in FSPs would not support the diagnosis, as it indicates minimal fibrin breakdown, which is contrary to the hypercoagulable and consumptive process seen in DIC.

B. Elevated D-dimer: D-dimer is a specific fibrin degradation product formed when cross-linked fibrin is broken down by plasmin. In acute DIC, excessive clot formation and simultaneous fibrinolysis lead to markedly elevated D-dimer levels. This finding reflects ongoing coagulation and fibrinolytic activity and supports the diagnosis of DIC.

C. Elevated fibrinogen: Fibrinogen is consumed during DIC due to widespread clot formation, leading to low rather than elevated levels. Elevated fibrinogen would suggest an acute-phase response or inflammation, not the consumptive coagulopathy characteristic of DIC.

D. Reduced prothrombin time (PT): PT is typically prolonged in DIC because clotting factors are consumed during uncontrolled coagulation. A reduced PT is not consistent with DIC and would indicate faster coagulation than normal, which does not occur in this disorder.

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Correct Answer is A

Explanation

A. Neck swelling and stridor: Neck swelling with stridor indicates airway compromise, likely due to postoperative hemorrhage or hematoma compressing the trachea. This is a life-threatening emergency after thyroidectomy and requires immediate intervention to secure the airway and prevent respiratory arrest. Rapid assessment and notification of the surgeon are critical.

B. Oxygen saturation of 95%: An oxygen saturation of 95% is slightly below normal but not immediately life-threatening. It should be monitored closely, but it does not require the same urgent response as signs of airway obstruction.

C. Pain at the incision site: Pain is expected after thyroid surgery and is typically managed with analgesics. While important for patient comfort, it does not indicate a life-threatening complication requiring immediate action.

D. Hoarseness: Temporary hoarseness is common after thyroidectomy due to laryngeal nerve irritation. It is usually transient and not an immediate threat to airway patency, although persistent or worsening hoarseness should be monitored.

A. it decreases the risk for extravasation at the infusion site B. it reduces the incidence of systemic side effects of the medication C. It allows continuous infusion of the medication directly to the tumor D. It does not become occluded as peripherally inserted catheters can

Correct Answer is A

Explanation

A. It decreases the risk for extravasation at the infusion site: Central venous access devices (CVADs) are preferred for chemotherapy because they deliver highly vesicant or irritant medications directly into a large central vein. The rapid dilution in high-flow vessels reduces the risk of local tissue damage (extravasation), which can occur with peripheral IV administration.

B. It reduces the incidence of systemic side effects of the medication: CVADs do not inherently reduce systemic side effects, as chemotherapy affects both tumor and normal cells systemically. The method of administration mainly affects local tissue safety rather than systemic toxicity.

C. It allows continuous infusion of the medication directly to the tumor: Chemotherapy delivered via a central line enters systemic circulation, not directly to the tumor site. Tumor targeting depends on pharmacologic properties, not catheter placement.

D. It does not become occluded as peripherally inserted catheters can: While CVADs are designed for long-term use, they can still become occluded due to thrombus formation or medication precipitates. Occlusion is not entirely prevented; proper maintenance and flushing protocols are required to reduce this risk.

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The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic finding supports this diagnosis?

Nursing Test Bank

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Correct Answer is A

Explanation

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Correct Answer is A

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