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RNSG 2539 EXAM 2 LATEST ACTUAL EXAM
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RNSG 2539 EXAM 2 LATEST ACTUAL EXAM
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RNSG 2539 EXAM 2 LATEST ACTUAL EXAMWhat lab testing results are indicative of DIC? - ANSWER: -Prothrombin Time (PT)
-partial throboplastin time (PTT)
-Activated Partial Thrompoplastin Time (aPTT)
-Bleeding Time
-Thrombin Time
Decrease levels: -Fibrogen
-Platelets
-Clotine factor II, V, VIII, & X
and Antithrombin III
The nurse is reviewing the laboratory test results of a child diagnosed with
disseminated intravascular coagulation (DIC). Which of the following would the
nurse interpret as indicative of this disorder?
A) Shortened prothrombin time
B) Increased fibrinogen level
C) Positive fibrin split products
D) Increased platelets - ANSWER: C) Positive fibrin split products
The nurse is caring for a postpartum patient admitted to the intensive care unit with
a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of
choice to treat this problem?
A. Heparin
B. Urokinase
C. Aspirin
D. Warfarin - ANSWER: A.) Heparin
In the ICU, a postsurgical client has developed sepsis and is being treated with
multiple medications. During the mid-morning assessment, which finding leads the
nurse to suspect the client may be developing a complication called disseminated
intravascular coagulation (DIC)? Select all that apply.
A) Headaches associated with light sensitivity
B) Oozing from all previous puncture and intravenous sites
C) Decreased O2 saturation and diminished breath sounds in lower lobes
D) Hemorrhage from the surgical site requiring deep pressure dressings
E) Urine from the Foley catheter is bloody - ANSWER: D) Hemorrhage from the
surgical site requiring deep pressure dressings
A healthy, primiparous (first-time) mother delivered a healthy infant several hours
ago, but the mother has experienced postpartum hemorrhage. Which of the
,following disorders is most likely to underlie the client's excessive bleeding after
delivery?
A) Disseminated intravascular coagulation
B) Hemophilia A
C) Von Willebrand disease
D) Thrombotic thrombocytopenic purpura (TTP) - ANSWER: A) Disseminated
intravascular coagulation
What is the concept behind heparin for PT with DIC? - ANSWER: -It prevents the
clotting phase from being completed which inhibits the breakdown of fibrinogen.
- It also helps avoid hemorrhage by preventing the body from depleting entire stage
of coagulation factors.
What are some acute clinical manifestations of DIC? - ANSWER: -Directly related to
bleeding problems such as:
Petechia, Purpura, oozing from puncture sites or severe hemorrhaging.
How does DIC happen in postpartum hemorrhaging? - ANSWER: -Tissue factors
released from necrotic place/fetal tissue or amniotic fluid my enter the circulation,
inciting DIC.
What is a common cause of DIC? - ANSWER: -Sepsis
A patient with DIC is at a higher risk for what? - ANSWER: -Deficient fluid volume
Increased levels of ____________, _______________, __________, and
________________ will be noted in DIC: - ANSWER: -Fibrinolycin, fibrinopeptide A,
positive fibrin split products and D-dimers.
DIC can occur secondary to what type of conditions? Select all that apply: - ANSWER:
-Abrupitoplacente
-Amniotic fluid embolism
-Endotoxin sepsis
-Retained dead fetus
-Post hemorrhage shock
-Hydatidformmole
-Gynecologic Malinganries
DIC can be decreased as a loss of balance between what two activities? - ANSWER: -
Clot forming activity of thrombin
-Clot lysin activity of plasmin
What are some ways to combat DIC? Select all that apply: - ANSWER: -
Anticoagulation therapy (low-molecular weight heparin)
-Packed RBCs
-Platelet concentrate
,-Antithrombin concentrate
-Nonclotting Protein- containing volume will expand like: plasma protein fraction or
albumin
How does Heparin work in the circulatory system? - ANSWER: -Inhibits thrombus and
clot production by blocking the conversion of prothrombin to thrombin & fibrogen to
fibrin.
What are some adverse effects of Heparin? Select all that apply: - ANSWER: -Loss of
hair
-Bruising
-Chills
-Fever
-Osteoporosis
-Suppression of renal function
If a PT has an allergic reaction to Heparin, what drug would be administered as
treatment? - ANSWER: - Lepirudin (refludan)
In DIC, microemboli may obstruct blood vessels and cause tissue hypoxia/ necrotic
damage to which organ structures? Select all that apply: - ANSWER: -Kidneys
-Heart
-Lungs
-Brain
The treatment of DIC is directed toward managing what? - ANSWER: -The Primary
disease
-Replacing clotting components
-Preventing further activation of clotting mechanisms
How do you correct the clotting factor deficiency in DIC? - ANSWER: -Transition of
FFP
- " " platelets
- " " fibrinogen containing cryoprecipitate
How does DIC initiate activation of the extrinsic pathway? - ANSWER: -Occurs with
liberation of tissue factor and associated with obstetric complications, trauma,
bacterial sepsis & cancer
How does DIC initiate activation of the intrinsic pathway? - ANSWER: -Activated
through extensive endothelial damage with activation of factor XII. This results from
viruses, infections, immune mechanisms, stasis of blood or temperature extremes.
What are some potential therapies to DIC other than Heparin? - ANSWER: -Tissue
factor pathway inhibitors, antithrombin, Protein C concentrates, & anti-inflammatory
cytokines like INL-I
, What are some obstetric conditions that have been associated with DIC? - ANSWER:
-Abrupito placentratae
-Dead fetus syndrome
-Pre-eclampsia & eclampsia
-Amniotic fluid embolism
What are some Cancers that have been associated with DIC ? - ANSWER: -Metastatic
cancer
-Acute leukemia
What are some infections associations with DIC? - ANSWER: -Acute bacterial
infections (meningococal meningitis)
-Histoplasmosis, Aspergicrosis
-Ricketsial Infections (rocky mountain spotted fever)
-Parasitic infections (malaria)
-Sepsis/ Septic shock
What are some trauma signs that have been associated with DIC? - ANSWER: -Burns
-Heatstroke
-Massive traumas
-Snake bite
-Surgery including extracorpeal circulation?
What are some hematologic conditions associated with DIC? - ANSWER: -Blood
Transfusions Reactions
What clinical manifestations of DIC are primarily involved? - ANSWER: -Compromise
of organ function or failure
-PT typically develop mods
How is bleeding characterized in DIC? - ANSWER: -Decreased Platelet count
-Decreased fibrinogen levels
-Prolonged PT, ApT (thrombiotic)
-Increased Fibrinogen Degradation
-Increased D-dimers
PT with Frank DIC typically bleed from where? - ANSWER: -Mucous Membranes
-Venipuncture Sites
-GI Urinary Tracts
What is the only manifestation of DIC during its initial process? - ANSWER: -Decrease
in platelet count
What other test for DIC can be pre-determined at bedside, can better assess platelet
function? - ANSWER: -Thrombelastography
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