While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

Reasoning:

Choice A reason: Platelet count and WBC count are relevant, but blood glucose levels are not specific to DIC. DIC involves widespread clotting and bleeding, depleting platelets and coagulation factors, affecting clotting times. Glucose levels are unrelated to the coagulopathy central to DIC’s pathophysiology, making this set less comprehensive.

Choice B reason: Thrombin time is relevant to DIC, but calcium and potassium levels are not primary indicators. Calcium may affect clotting in specific contexts, but DIC primarily involves consumption of platelets and clotting factors, prolonging prothrombin and partial thromboplastin times, making these more critical parameters.

Choice C reason: Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT) are key in DIC monitoring. DIC causes widespread microthrombi, consuming platelets and clotting factors, leading to low platelets and prolonged PT/PTT. These parameters directly reflect the coagulopathy and bleeding risk, making them essential for diagnosis and management.

Choice D reason: Fibrinogen level and platelet count are important in DIC, as both are consumed in widespread clotting. However, WBC count is less specific, as it reflects infection or inflammation, not coagulopathy. PT and PTT better capture the clotting factor depletion central to DIC’s pathophysiology.

Reasoning:

Choice A reason: Weight loss is not a typical side effect of corticosteroid therapy for Addison’s disease. Corticosteroids mimic cortisol, promoting weight gain through increased appetite and fat redistribution. Weight loss is more common in untreated Addison’s disease due to cortisol deficiency and reduced appetite.

Choice B reason: Poor wound healing is a side effect of corticosteroids, as they suppress immune responses and inhibit collagen synthesis. This impairs fibroblast activity and tissue repair, increasing infection risk and delaying wound closure, a significant concern for patients on long-term therapy for Addison’s disease.

Choice C reason: Hypertension is a common side effect of corticosteroids due to their mineralocorticoid effects, which increase sodium and water retention, elevating blood volume and pressure. This is particularly relevant in Addison’s disease treatment, where corticosteroids restore deficient aldosterone and cortisol, potentially causing fluid overload.

Choice D reason: Hypotension is not a side effect of corticosteroid therapy but a symptom of untreated Addison’s disease due to aldosterone deficiency, causing sodium loss and hypovolemia. Corticosteroid therapy corrects this, so hypotension is unlikely unless under-dosed or during acute crisis.

Choice E reason: Alterations in glucose metabolism are a side effect of corticosteroids, which induce insulin resistance and increase gluconeogenesis, leading to hyperglycemia. In Addison’s disease, corticosteroids replace deficient cortisol, but excess dosing can mimic Cushing’s syndrome, causing elevated blood glucose and requiring careful monitoring.