RNSG 2539 Exam 2 with complete solutions
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-Prothrombin Time (PT)
-partial throboplastin time (PTT)
-Activated Partial Thrompoplastin Time (aPTT)
-Bleeding Time
-Thrombin Time
What lab testing results are indicative of DIC?
Decrease levels: -Fibrogen
-Platelets
-Clotine factor II, V, VIII, & X
and Antithrombin III
The nurse is reviewing the laboratory test results of a child diag-
nosed with disseminated intravascular coagulation (DIC). Which
of the following would the nurse interpret as indicative of this
disorder?
C) Positive fibrin split products
A) Shortened prothrombin time
B) Increased fibrinogen level
C) Positive fibrin split products
D) Increased platelets
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
A. Heparin
B. Urokinase
C. Aspirin
D. Warfarin
In the ICU, a postsurgical client has developed sepsis and is being
treated with multiple medications. During the mid-morning as-
sessment, which finding leads the nurse to suspect the client may
be developing a complication called disseminated intravascular
coagulation (DIC)? Select all that apply.
D) Hemorrhage from the surgical site requiring deep pressure
A) Headaches associated with light sensitivity
dressings
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
A healthy, primiparous (first-time) mother delivered a healthy in-
fant several hours ago, but the mother has experienced postpar-
tum hemorrhage. Which of the following disorders is most likely to
underlie the client's excessive bleeding after delivery?
A) Disseminated intravascular coagulation
A) Disseminated intravascular coagulation
B) Hemophilia A
C) Von Willebrand disease
D) Thrombotic thrombocytopenic purpura (TTP)
-It prevents the clotting phase from being completed which inhibits
the breakdown of fibrinogen.
What is the concept behind heparin for PT with DIC?
- It also helps avoid hemorrhage by preventing the body from
depleting entire stage of coagulation factors.
-Directly related to bleeding problems such as:
What are some acute clinical manifestations of DIC? Petechia, Purpura, oozing from puncture sites or severe hemor-
rhaging.
-Tissue factors released from necrotic place/fetal tissue or amni-
How does DIC happen in postpartum hemorrhaging?
otic fluid my enter the circulation, inciting DIC.
What is a common cause of DIC? -Sepsis
, RNSG 2539 Exam 2 with complete solutions
Study online at https://quizlet.com/_h5dhd7
A patient with DIC is at a higher risk for what? -Deficient fluid volume
Increased levels of ____________, _______________, -Fibrinolycin, fibrinopeptide A, positive fibrin split products and
__________, and ________________ will be noted in DIC: D-dimers.
-Abrupitoplacente
-Amniotic fluid embolism
-Endotoxin sepsis
DIC can occur secondary to what type of conditions? Select all
-Retained dead fetus
that apply:
-Post hemorrhage shock
-Hydatidformmole
-Gynecologic Malinganries
DIC can be decreased as a loss of balance between what two -Clot forming activity of thrombin
activities? -Clot lysin activity of plasmin
-Anticoagulation therapy (low-molecular weight heparin)
-Packed RBCs
-Platelet concentrate
What are some ways to combat DIC? Select all that apply:
-Antithrombin concentrate
-Nonclotting Protein- containing volume will expand like: plasma
protein fraction or albumin
-Inhibits thrombus and clot production by blocking the conversion
How does Heparin work in the circulatory system?
of prothrombin to thrombin & fibrogen to fibrin.
-Loss of hair
-Bruising
-Chills
What are some adverse effects of Heparin? Select all that apply:
-Fever
-Osteoporosis
-Suppression of renal function
If a PT has an allergic reaction to Heparin, what drug would be
- Lepirudin (refludan)
administered as treatment?
-Kidneys
In DIC, microemboli may obstruct blood vessels and cause tissue
-Heart
hypoxia/ necrotic damage to which organ structures? Select all
-Lungs
that apply:
-Brain
-The Primary disease
The treatment of DIC is directed toward managing what? -Replacing clotting components
-Preventing further activation of clotting mechanisms
-Transition of FFP
How do you correct the clotting factor deficiency in DIC? - " " platelets
- " " fibrinogen containing cryoprecipitate
-Occurs with liberation of tissue factor and associated with obstet-
How does DIC initiate activation of the extrinsic pathway?
ric complications, trauma, bacterial sepsis & cancer
-Activated through extensive endothelial damage with activation
How does DIC initiate activation of the intrinsic pathway? of factor XII. This results from viruses, infections, immune mech-
anisms, stasis of blood or temperature extremes.
-Tissue factor pathway inhibitors, antithrombin, Protein C concen-
What are some potential therapies to DIC other than Heparin?
trates, & anti-inflammatory cytokines like INL-I
-Abrupito placentratae
What are some obstetric conditions that have been associated -Dead fetus syndrome
with DIC? -Pre-eclampsia & eclampsia
-Amniotic fluid embolism
-Metastatic cancer
What are some Cancers that have been associated with DIC ?
-Acute leukemia
-Acute bacterial infections (meningococal meningitis)
-Histoplasmosis, Aspergicrosis
What are some infections associations with DIC? -Ricketsial Infections (rocky mountain spotted fever)
-Parasitic infections (malaria)
-Sepsis/ Septic shock
, RNSG 2539 Exam 2 with complete solutions
Study online at https://quizlet.com/_h5dhd7
-Burns
-Heatstroke
What are some trauma signs that have been associated with DIC? -Massive traumas
-Snake bite
-Surgery including extracorpeal circulation?
What are some hematologic conditions associated with DIC? -Blood Transfusions Reactions
-Compromise of organ function or failure
What clinical manifestations of DIC are primarily involved?
-PT typically develop mods
-Decreased Platelet count
-Decreased fibrinogen levels
How is bleeding characterized in DIC? -Prolonged PT, ApT (thrombiotic)
-Increased Fibrinogen Degradation
-Increased D-dimers
-Mucous Membranes
PT with Frank DIC typically bleed from where? -Venipuncture Sites
-GI Urinary Tracts
What is the only manifestation of DIC during its initial process? -Decrease in platelet count
What other test for DIC can be pre-determined at bedside, can
-Thrombelastography
better assess platelet function?
What is the normal range for platelet count? -150,000-450,000/ mm^3 (decrease w/ DIC)
What is the normal range for PT? -11 - 12.5 seconds (extrinsic pathway) think (PET)
What is the normal range for aPTT? -23-35 seconds (intrinsic pathway) think PItt?
What is normal range for thrombin time (TT)? - 8-11 seconds (clot formation)
What is normal range of Fibrinogen? - 170-340 mg/ dL (decreases in DIC)
What is the normal range of fibrin degradation products (FDPs)? - 0-5 mcg/ mL
Why might cryotrecipitate be given? -To replace fibrinogen & factors V & VII
What is examples of a fibrinolytic inhibitor? - Aminocaproic Acid
-Excess thrombin converts fibrinogen to fibrin, producing fibrin
What is the pathophysiology of DIC?
clots in the microcirculation
-Burns
What are 3 main causes of DIC? -Sepsis
-Abrupito placentae
-Sepsis
-Cardiac Arrest
-ARDs
What is risk factor associated with DIC? -DKA
-PE
-Sickle Cell Anemia
-Liver failure
-Cardiac tamponade
-Hemothorax
What are some complications associated with DIC?
-Stroke
-MODs
The increase with DiC is unknown but it occurs in 1%-2% of PT
1- 30%, 2-50%, 3-Sepsis
with 3.
-Hematoria
-Purpura, Jaundice
-Taghycardia
-Hemoptysic (coughing up blood)
What are some pysical finding for DIC?
-XXXXXX (low urine output)
-Dyspnea or tachypnea
-Pleural friction rub
-Confusion
What results are indicative of DIC?
Study online at https://quizlet.com/_h5dhd7
-Prothrombin Time (PT)
-partial throboplastin time (PTT)
-Activated Partial Thrompoplastin Time (aPTT)
-Bleeding Time
-Thrombin Time
What lab testing results are indicative of DIC?
Decrease levels: -Fibrogen
-Platelets
-Clotine factor II, V, VIII, & X
and Antithrombin III
The nurse is reviewing the laboratory test results of a child diag-
nosed with disseminated intravascular coagulation (DIC). Which
of the following would the nurse interpret as indicative of this
disorder?
C) Positive fibrin split products
A) Shortened prothrombin time
B) Increased fibrinogen level
C) Positive fibrin split products
D) Increased platelets
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
A. Heparin
B. Urokinase
C. Aspirin
D. Warfarin
In the ICU, a postsurgical client has developed sepsis and is being
treated with multiple medications. During the mid-morning as-
sessment, which finding leads the nurse to suspect the client may
be developing a complication called disseminated intravascular
coagulation (DIC)? Select all that apply.
D) Hemorrhage from the surgical site requiring deep pressure
A) Headaches associated with light sensitivity
dressings
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
A healthy, primiparous (first-time) mother delivered a healthy in-
fant several hours ago, but the mother has experienced postpar-
tum hemorrhage. Which of the following disorders is most likely to
underlie the client's excessive bleeding after delivery?
A) Disseminated intravascular coagulation
A) Disseminated intravascular coagulation
B) Hemophilia A
C) Von Willebrand disease
D) Thrombotic thrombocytopenic purpura (TTP)
-It prevents the clotting phase from being completed which inhibits
the breakdown of fibrinogen.
What is the concept behind heparin for PT with DIC?
- It also helps avoid hemorrhage by preventing the body from
depleting entire stage of coagulation factors.
-Directly related to bleeding problems such as:
What are some acute clinical manifestations of DIC? Petechia, Purpura, oozing from puncture sites or severe hemor-
rhaging.
-Tissue factors released from necrotic place/fetal tissue or amni-
How does DIC happen in postpartum hemorrhaging?
otic fluid my enter the circulation, inciting DIC.
What is a common cause of DIC? -Sepsis
, RNSG 2539 Exam 2 with complete solutions
Study online at https://quizlet.com/_h5dhd7
A patient with DIC is at a higher risk for what? -Deficient fluid volume
Increased levels of ____________, _______________, -Fibrinolycin, fibrinopeptide A, positive fibrin split products and
__________, and ________________ will be noted in DIC: D-dimers.
-Abrupitoplacente
-Amniotic fluid embolism
-Endotoxin sepsis
DIC can occur secondary to what type of conditions? Select all
-Retained dead fetus
that apply:
-Post hemorrhage shock
-Hydatidformmole
-Gynecologic Malinganries
DIC can be decreased as a loss of balance between what two -Clot forming activity of thrombin
activities? -Clot lysin activity of plasmin
-Anticoagulation therapy (low-molecular weight heparin)
-Packed RBCs
-Platelet concentrate
What are some ways to combat DIC? Select all that apply:
-Antithrombin concentrate
-Nonclotting Protein- containing volume will expand like: plasma
protein fraction or albumin
-Inhibits thrombus and clot production by blocking the conversion
How does Heparin work in the circulatory system?
of prothrombin to thrombin & fibrogen to fibrin.
-Loss of hair
-Bruising
-Chills
What are some adverse effects of Heparin? Select all that apply:
-Fever
-Osteoporosis
-Suppression of renal function
If a PT has an allergic reaction to Heparin, what drug would be
- Lepirudin (refludan)
administered as treatment?
-Kidneys
In DIC, microemboli may obstruct blood vessels and cause tissue
-Heart
hypoxia/ necrotic damage to which organ structures? Select all
-Lungs
that apply:
-Brain
-The Primary disease
The treatment of DIC is directed toward managing what? -Replacing clotting components
-Preventing further activation of clotting mechanisms
-Transition of FFP
How do you correct the clotting factor deficiency in DIC? - " " platelets
- " " fibrinogen containing cryoprecipitate
-Occurs with liberation of tissue factor and associated with obstet-
How does DIC initiate activation of the extrinsic pathway?
ric complications, trauma, bacterial sepsis & cancer
-Activated through extensive endothelial damage with activation
How does DIC initiate activation of the intrinsic pathway? of factor XII. This results from viruses, infections, immune mech-
anisms, stasis of blood or temperature extremes.
-Tissue factor pathway inhibitors, antithrombin, Protein C concen-
What are some potential therapies to DIC other than Heparin?
trates, & anti-inflammatory cytokines like INL-I
-Abrupito placentratae
What are some obstetric conditions that have been associated -Dead fetus syndrome
with DIC? -Pre-eclampsia & eclampsia
-Amniotic fluid embolism
-Metastatic cancer
What are some Cancers that have been associated with DIC ?
-Acute leukemia
-Acute bacterial infections (meningococal meningitis)
-Histoplasmosis, Aspergicrosis
What are some infections associations with DIC? -Ricketsial Infections (rocky mountain spotted fever)
-Parasitic infections (malaria)
-Sepsis/ Septic shock
, RNSG 2539 Exam 2 with complete solutions
Study online at https://quizlet.com/_h5dhd7
-Burns
-Heatstroke
What are some trauma signs that have been associated with DIC? -Massive traumas
-Snake bite
-Surgery including extracorpeal circulation?
What are some hematologic conditions associated with DIC? -Blood Transfusions Reactions
-Compromise of organ function or failure
What clinical manifestations of DIC are primarily involved?
-PT typically develop mods
-Decreased Platelet count
-Decreased fibrinogen levels
How is bleeding characterized in DIC? -Prolonged PT, ApT (thrombiotic)
-Increased Fibrinogen Degradation
-Increased D-dimers
-Mucous Membranes
PT with Frank DIC typically bleed from where? -Venipuncture Sites
-GI Urinary Tracts
What is the only manifestation of DIC during its initial process? -Decrease in platelet count
What other test for DIC can be pre-determined at bedside, can
-Thrombelastography
better assess platelet function?
What is the normal range for platelet count? -150,000-450,000/ mm^3 (decrease w/ DIC)
What is the normal range for PT? -11 - 12.5 seconds (extrinsic pathway) think (PET)
What is the normal range for aPTT? -23-35 seconds (intrinsic pathway) think PItt?
What is normal range for thrombin time (TT)? - 8-11 seconds (clot formation)
What is normal range of Fibrinogen? - 170-340 mg/ dL (decreases in DIC)
What is the normal range of fibrin degradation products (FDPs)? - 0-5 mcg/ mL
Why might cryotrecipitate be given? -To replace fibrinogen & factors V & VII
What is examples of a fibrinolytic inhibitor? - Aminocaproic Acid
-Excess thrombin converts fibrinogen to fibrin, producing fibrin
What is the pathophysiology of DIC?
clots in the microcirculation
-Burns
What are 3 main causes of DIC? -Sepsis
-Abrupito placentae
-Sepsis
-Cardiac Arrest
-ARDs
What is risk factor associated with DIC? -DKA
-PE
-Sickle Cell Anemia
-Liver failure
-Cardiac tamponade
-Hemothorax
What are some complications associated with DIC?
-Stroke
-MODs
The increase with DiC is unknown but it occurs in 1%-2% of PT
1- 30%, 2-50%, 3-Sepsis
with 3.
-Hematoria
-Purpura, Jaundice
-Taghycardia
-Hemoptysic (coughing up blood)
What are some pysical finding for DIC?
-XXXXXX (low urine output)
-Dyspnea or tachypnea
-Pleural friction rub
-Confusion
What results are indicative of DIC?
