Which client would be most at risk for developing disseminated intravascular coagulation (DIC)?

A 35 year old pregnant client with placenta previa

A 42 year old client with a pulmonary embolus

A 60 year old client receiving hemodialysis 3 days a week

A 78 year old client with septicemia

Answer and Explanation

The Correct Answer is D

Rationale:
A. Placenta previa involves abnormal placental implantation and bleeding, but it is not commonly associated with DIC unless complicated by abruptio placentae or massive hemorrhage. While obstetric complications can trigger DIC, placenta previa alone is a lower risk factor.
B. Pulmonary embolus involves vascular obstruction by a clot, but it does not typically trigger the widespread activation of clotting and fibrinolysis seen in DIC. PE primarily causes localized thrombotic events rather than systemic coagulation.
C. Clients receiving hemodialysis may be at risk for bleeding or clotting issues due to anticoagulation during dialysis, but this is not a major precipitating factor for DIC.
D. Septicemia is one of the most common causes of DIC. In severe sepsis, widespread infection triggers systemic inflammation, endothelial damage, and uncontrolled activation of the coagulation cascade. This results in both microvascular clot formation and bleeding tendencies, which are hallmark features of DIC. Therefore, the 78-year-old client with septicemia is at the highest risk.

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Correct Answer is D

Explanation

Rationale:
A. Slowing the IV infusion rate would be inappropriate in this situation. The patient’s low CVP, hypotension, flat jugular veins, and clear lung sounds all indicate hypovolemia rather than fluid overload. Reducing fluids would worsen tissue perfusion and shock.
B. Administering dopamine, a vasopressor, is not the first-line intervention in this case. Vasopressors are typically considered after adequate fluid resuscitation has been attempted. Because this patient shows clear signs of volume depletion, correcting hypovolemia with fluids is the priority before initiating medications to support blood pressure.
C. No intervention is not appropriate. The patient is hypotensive (90/50 mmHg) with a low CVP (normal is approximately 2–6 mmHg), indicating inadequate circulating volume. Without intervention, the patient is at risk for worsening shock and organ hypoperfusion.
D. Increasing the IV infusion rate is the most appropriate action. Hemorrhagic pancreatitis can cause significant third-spacing and fluid loss, leading to hypovolemic shock. A low CVP, hypotension, flat neck veins, and clear lung sounds all support the need for aggressive fluid resuscitation to restore intravascular volume and improve perfusion.

A. Increase afterload B. Decrease afterload C. Increase preload D. Decrease preload

Correct Answer is A

Explanation

Rationale:
A. Increase afterload is correct because the patient is experiencing neurogenic shock, a type of distributive shock caused by spinal cord injury. Loss of sympathetic nervous system tone leads to vasodilation, hypotension, and bradycardia. Increasing afterload with vasopressors helps restore vascular tone and maintain perfusion to vital organs.

B. Decrease afterload is incorrect because the patient’s vascular tone is already too low due to vasodilation. Further decreasing afterload would worsen hypotension and tissue hypoperfusion.

C. Increase preload is incorrect because although fluids may support cardiac output, the primary problem is loss of vascular tone, not inadequate blood volume. Without restoring afterload, increasing preload alone will not effectively raise blood pressure.

D. Decrease preload is incorrect because reducing preload would lower cardiac output and further compromise tissue perfusion in an already hypotensive patient.

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Which client would be most at risk for developing disseminated intravascular coagulation (DIC)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and jugular veins are flat. Which of these actions is most appropriate for the nurse to take?

Correct Answer is D

Explanation

A 43 year old male presents to the ER following an MVC with paralysis of the arms and legs and loss of sensation below the shoulders. VS: BP 70/40; HR 48; RR 16; SpO2 81%. When anticipating treatment for this patient's condition, the nurse recognizes the priority goal of treatment is to:

Correct Answer is A

Explanation

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