DIC

Question 1

Scenario-Based Exam for Understanding DIC
Clinical Scenario
Jenna, a 45-year-old
Jenna, a 45-year-old female with a history of ovarian cancer, has been admitted to your ward with a diagnosis of sepsis. Upon examination, she presents with signs of systemic inflammation and is found to have a blood pressure of 90/58 mmHg, a heart rate of 120 bpm, and a respiratory rate of 22 breaths/min. Her skin is warm and flushed, and petechiae are noted on her lower extremities. Laboratory tests are pending, but there is a high suspicion for Disseminated Intravascular Coagulation (DIC).
Questions
Based on the scenario provided, which of the identified triggers for DIC is most likely present in Jenna’s case?
A. Trauma
B. Shock
C. Cancer
D. Abruptio placentae

Jenna’s symptoms suggest she might be in the early stages of DIC. Which systemic response should the nurse monitor for that indicates the progression to overt DIC?
A. Hypotension
B. Fever
C. Exaggerated inflammatory response
D. All of the above
Imagine that Jenna’s laboratory results show a low platelet count, increased D-dimer level, and decreased fibrinogen level. How would this support the suspicion of DIC?
A. It indicates an isolated thrombocytopenia unrelated to DIC.
B. It suggests that Jenna has an isolated infection with no impact on coagulation.
C. It shows a pattern of pathological clotting and consumption of clotting factors, which is characteristic of DIC.
D. It signifies that Jenna might be experiencing a severe allergic reaction with no coagulopathy.
While waiting for the full coagulation profile, Jenna begins to show signs of bleeding from her IV sites and has blood in her urine. What immediate nursing intervention should be prioritized?
A. Administer an antihistamine.
B. Begin transfusion of fresh frozen plasma (FFP).
C. Apply warm compresses to her IV sites.
D. Increase the rate of IV fluids for volume resuscitation.
The medical team decides to initiate treatment for DIC. What is the main focus of this management approach?
A. To cure the DIC directly through medications.
B. To induce hypocoagulation with long-term anticoagulant therapy.
C. To treat the underlying cause of sepsis and manage the symptoms and consequences of DIC.
D. To provide supportive care only with no active interventions for coagulopathy.
If Jenna’s blood pressure continues to drop and her lactate levels rise, what would be the most appropriate step in managing her condition?
A. Start inotropic support to maintain organ perfusion.
B. Discontinue all antibiotics as they might be causing an allergic reaction.
C. Immediately begin heparin infusion to interrupt the DIC process.
D. Perform a transfusion of platelets only, disregarding other blood product needs.
As Jenna’s nurse, you note that her capillary refill time is prolonged, and she has developed cold extremities. What does this finding most likely signify?
A. The onset of diabetic neuropathy.
B. Worsening tissue ischemia that may be related to microvascular clots.
C. A side effect of the anticoagulation therapy she is receiving.
D. That she is recovering from the septic state.
In educating Jenna and her family about the complexity of DIC, which aspect is critical to convey?
A. DIC is a long-term chronic disease that she will have to manage for the rest of her life.
B. DIC is a condition that is corrected solely by administering blood products.
C. DIC is a reversible condition once the underlying trigger is effectively treated.
D. The only symptom of concern in DIC is the presence of bleeding or bruising.

If Jenna’s DIC is a result of her cancer, what ongoing monitoring might she need even after the current episode is resolved?
A. Regular assessments for heart disease.
B. Periodic coagulation profiles to monitor for recurrent DIC.
C. Continuous antibiotic therapy to prevent future infection.
D. No further monitoring, as the risk of DIC recurrence is minimal once it has been resolved.

Answer 1

The relationships in the context of Disseminated Intravascular Coagulation (DIC), which is not a disease in itself but rather a secondary complication that can arise from a variety of conditions, can be identified as follows:

1. Triggers:
   
   • Various conditions can trigger DIC, including sepsis, trauma, shock, cancer, abruptio placentae (premature detachment of the placenta), exposure to toxins, and severe allergic reactions.
2. Pathophysiology:
   
   • DIC involves an altered hemostasis mechanism that leads to massive, widespread clotting within the microcirculation throughout the body. This pathological clotting process can block small blood vessels, leading to tissue ischemia (reduced blood flow).
3. Consumption of Clotting Factors:
   
   • The widespread clotting results in the consumption of large amounts of platelets and clotting factors. As these elements are used up, the body’s ability to form clots where needed is compromised, leading to a paradoxical situation where there can be extensive bleeding elsewhere.
4. Cycle of Clotting and Bleeding:
   
   • Massive clot formation depletes the body’s clotting resources, which in turn leads to coagulation failure and bleeding, often from multiple sites. This cycle can exacerbate tissue ischemia and further the systemic response.
5. Symptoms:
   
   • Symptoms of DIC are related to the two major consequences of the condition: tissue ischemia resulting from clots impeding blood flow, and bleeding due to the exhaustion of clotting factors and platelets.
6. Coagulation Tests:
   
   • Laboratory findings in DIC often show elevated markers of clot formation (like D-dimers, which are products of clot breakdown) and decreased levels of platelets and clotting factors (such as fibrinogen), indicating their consumption in the clotting process.

Identifying these relationships is crucial for understanding the complexity of DIC and the balance between clot formation and bleeding. It is important for healthcare providers to recognize the underlying triggers and to manage both the primary cause and the secondary coagulopathic consequences of DIC.

Correct Answers
C. Cancer
D. All of the above
C. It shows a pattern of pathological clotting and consumption of clotting factors, which is characteristic of DIC.
B. Begin transfusion of fresh frozen plasma (FFP).
C. To treat the underlying cause of sepsis and manage the symptoms and consequences of DIC.
A. Start inotropic support to maintain organ perfusion.
B. Worsening tissue ischemia that may be related to microvascular clots.
C. DIC is a reversible condition once the underlying trigger is effectively treated.
B. Periodic coagulation profiles to monitor for recurrent DIC.

Question 2

Scenario-Based Exam for Understanding DIC

Clinical Scenario

John, a 60-year-old male with a past medical history of chronic pancreatitis, presents to the emergency room with acute abdominal pain and hypotension. Initial labs show an elevated white blood cell count, and imaging confirms the presence of pancreatic necrosis. Within hours, John develops purpuric skin lesions and begins to ooze blood from his IV sites. The clinical team suspects he may have developed Disseminated Intravascular Coagulation (DIC) as a complication of his acute pancreatitis.

Questions

1. What is the most likely trigger for John’s suspected DIC?
   A. Chronic pancreatitis
   B. Acute pancreatic necrosis
   C. Purpuric skin lesions
   D. Oozing from IV sites
2. John’s lab results return with thrombocytopenia, low fibrinogen levels, and elevated D-dimer. What do these lab findings collectively suggest?
   A. Hepatic impairment
   B. Primary hematologic disorder
   C. The presence of a hypercoagulable state followed by consumption coagulopathy characteristic of DIC
   D. Renal dysfunction
3. John’s PT and aPTT are found to be prolonged. What does this indicate in the context of DIC?
   A. Specific factor deficiencies
   B. Inhibition of anticoagulation pathways
   C. Depletion of clotting factors and disruption of the coagulation cascade
   D. Primary fibrinolysis
4. Given the high mortality rate associated with severe DIC, what aspect of John’s management should be prioritized to potentially lower this risk?
   A. Immediate surgical intervention
   B. Aggressive fluid resuscitation
   C. Identification and treatment of the underlying cause of DIC
   D. Palliative care consultation
5. As part of the early recognition of DIC, why is it essential for the nursing staff to monitor John’s skin and mucous membranes?
   A. To assess for jaundice associated with liver dysfunction
   B. To identify early signs of pressure ulcers
   C. To detect signs of bleeding indicative of DIC
   D. To ensure adequate hydration
6. A decision to transfuse John with fresh frozen plasma (FFP) and platelets is made. What is the purpose of this intervention?
   A. To replenish coagulation factors and platelets consumed in the DIC process
   B. To increase John’s blood volume and improve renal function
   C. To rebuild John’s immune system to fight pancreatic infection
   D. To alleviate pain and provide comfort
7. The medical team is concerned about the potential for organ failure due to ischemia from microvascular thrombi. Which organs should they closely monitor for dysfunction in John’s case?
   A. Pancreas and lungs
   B. Kidneys and liver
   C. Heart and brain
   D. All of the above
8. How should the nurse assess for potential hypovolemic shock in John, who is experiencing bleeding as a part of DIC?
   A. By monitoring daily weights to assess fluid loss
   B. By ensuring that John’s diet is high in iron
   C. By regularly checking vital signs and observing for signs of organ perfusion compromise
   D. By providing supplemental oxygen continuously
9. As John’s condition evolves, the importance of educating his family about DIC is clear. What is the most appropriate information to share with them?
   A. DIC is an inherited condition that John’s children may also develop.
   B. DIC is primarily a clotting disorder, and bleeding is a rare complication.
   C. DIC is managed by directly treating the coagulation pathways with medications.
   D. DIC is a complication that has developed secondary to John’s acute condition, and managing the underlying cause is crucial.

Answer 2

In the context of Disseminated Intravascular Coagulation (DIC), the relationships between various clinical presentations, laboratory findings, outcomes, and the importance of early recognition can be identified as follows:
Clinical Presentations of
Clinical Presentations of DIC:
Bleeding from mucous membranes, venipuncture sites, and the gastrointestinal (GI) and urinary tracts is common due to widespread coagulation and subsequent consumption of clotting factors leading to bleeding.
A decline in organ function can occur as a result of ischemia from microvascular thrombi obstructing blood flow to vital organs.
Laboratory Findings in DIC:
Thrombocytopenia (low platelet count) is indicative of platelet consumption in the process of forming clots in the microcirculation.
Low fibrinogen levels occur due to its conversion to fibrin to form clots, depleting its availability in the bloodstream.
Prolonged Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and thrombin time are reflective of the depletion of clotting factors.
Elevated D-dimer levels signal that there is active breakdown of fibrin, indicative of both clot formation and breakdown occurring simultaneously.
Prognosis and Mortality:
The mortality rate in clients with severe DIC is high, reaching up to 80%, largely due to the complications associated with widespread thrombosis and hemorrhage, and subsequent organ failure.
Importance of Early Recognition:
Early recognition and treatment are essential to improve the prognosis. Prompt identification of the underlying cause and initiation of appropriate therapy to control the DIC process can be life-saving.
Reference to Educational Resource:
Details and protocols for managing DIC may be referenced in medical texts or resources, such as the mentioned “Chart 33-10 pg. 957,” which likely outlines management guidelines and considerations for clinicians.
The relationship between these elements underscores the complexity of diagnosing and managing DIC. The interplay between the clinical signs of bleeding and ischemia, correlated with lab findings, presents a challenging scenario for medical intervention. Hence, clinicians must use a nuanced and comprehensive approach in managing patients with suspected or diagnosed DIC, as early and effective management can be critical in reducing high mortality rates associated with this condition.

CBC- Low platelets d/t consumption. Clotting times- PT, aPTT may be normal or prolonged. Coagulation factors: Fibrinogen- decreased

Correct Answers

1. B. Acute pancreatic necrosis
2. C. The presence of a hypercoagulable state followed by consumption coagulopathy characteristic of DIC
3. C. Depletion of clotting factors and disruption of the coagulation cascade
4. C. Identification and treatment of the underlying cause of DIC
5. C. To detect signs of bleeding indicative of DIC
6. A. To replenish coagulation factors and platelets consumed in the DIC process
7. D. All of the above
8. C. By regularly checking vital signs and observing for signs of organ perfusion compromise
9. D. DIC is a complication that has developed secondary to John’s acute condition, and managing the underlying cause is crucial.

Question 3

Scenario-Based Exam: Managing Disseminated Intravascular Coagulation (DIC)

Clinical Scenario

Maria, a 33-year-old woman with a history of lupus, has been admitted to the ICU with a severe bacterial infection. Over the last few hours, she has developed signs of systemic instability, including labile blood pressure, altered mental status, and spontaneous bleeding from her gums and IV sites. Her initial workup has raised concerns for the development of Disseminated Intravascular Coagulation (DIC). Maria is receiving IV antibiotics for her infection, but her blood pressure is steadily dropping despite fluid resuscitation.

Questions

1. What is the primary goal in Maria’s medical management with regards to her suspected DIC?
   A. To aggressively correct her low blood pressure with fluids
   B. To identify and treat the underlying bacterial infection causing the DIC
   C. To administer cryoprecipitate immediately
   D. To stabilize her mental status with neuroleptics
2. Maria’s hypotension persists despite fluid resuscitation. Which class of medication should be considered next according to the treatment elements for DIC?
   A. Vasopressors
   B. Antipsychotics
   C. Antipyretics
   D. Diuretics
3. The lab results show that Maria has a significant drop in fibrinogen level. Which blood product is most appropriate to administer in this situation?
   A. Whole blood
   B. Fresh Frozen Plasma (FFP)
   C. Cryoprecipitate
   D. Packed Red Blood Cells (PRBCs)
4. While correcting Maria’s hypotension, it’s also noted that her potassium levels are elevated. What is the significance of correcting this finding?
   A. Elevated potassium levels may indicate renal failure
   B. Hyperkalemia can affect cardiac rhythm and function
   C. Potassium is not a concern in the setting of DIC
   D. Lowering potassium is cosmetic and has no real benefit
5. During Maria’s treatment, her platelet count is found to be critically low. What is the most likely outcome of transfusing platelets in Maria’s case?
   A. Increased risk of thrombus formation
   B. Improvement in clotting and decrease in bleeding risk
   C. Worsening of her underlying lupus
   D. Significant improvement in her infection status
6. Maria’s team decides to initiate heparin therapy to prevent further clot formation. What must be monitored closely during this therapy to balance the risks and benefits?
   A. Maria’s cholesterol levels
   B. Maria’s coagulation parameters, like PT, aPTT, and platelet count
   C. The bacterial load in Maria’s blood cultures
   D. Maria’s blood glucose levels
7. The ICU nurses are monitoring Maria’s intake and output to assess fluid balance. This is especially important when administering blood products because of the risk of:
   A. Allergic reactions
   B. Fluid overload
   C. Hypernatremia
   D. Nutrient malabsorption
8. If Maria shows signs of improvement with her bleeding symptoms but still requires ongoing anticoagulation, which medication may be preferred for its ease of use and more predictable dosing?
   A. Warfarin
   B. Enoxaparin
   C. Aspirin
   D. Vitamin K
9. Given the complex interplay of treatments, which healthcare professional’s role is critical in coordinating Maria’s care to address both the immediate and long-term needs?
   A. The pharmacist
   B. The primary care physician
   C. The intensivist
   D. All of the above
10. Finally, to improve oxygenation and reduce the risk of tissue hypoxia in Maria, which of the following interventions is appropriate?
    A. Administration of a bronchodilator
    B. Initiation of mechanical ventilation if she cannot maintain adequate oxygen levels
    C. Immediately beginning chest physiotherapy
    D. Increasing room air concentration to 100%

Answer 3

In the context of managing Disseminated Intravascular Coagulation (DIC) or similar serious medical conditions, the relationships between various aspects of medical management can often be complex, but they generally aim to stabilize the patient and address the root causes and effects of the condition. Here’s how these treatment elements relate to each other:
Aggressively Treat Underlying Cause:
Fundamental to managing DIC or any other condition characterized by systemic instability is identifying and treating the underlying cause (e.g., infection, trauma, malignancy) to halt the progression of the disorder.
Improve Oxygenation:
Ensuring adequate oxygen delivery to tissues to prevent hypoxia, which can exacerbate organ dysfunction and the systemic inflammatory response.
Replacing Fluids:
Addressing hypovolemia that can occur due to hemorrhage or fluid shifts, helping to maintain blood pressure and perfusion to vital organs.
Correcting Electrolyte Imbalances:
Restoring electrolyte balance is essential for normal cellular function and to prevent complications that can arise from abnormalities like hyperkalemia or hyponatremia.
Vasopressors:
Used to stabilize blood pressure if hypotension is present, which can help improve perfusion to organs that might be at risk due to the systemic effects of DIC.
Cryoprecipitate:
Contains concentrated clotting factors, including fibrinogen, Factor VIII, and von Willebrand factor, to help mitigate the effects of clotting factor depletion in DIC.
Fresh Frozen Plasma (FFP):
Provides all clotting factors; used to correct coagulopathies by replenishing depleted clotting factors in patients with active bleeding or significant clotting factor reduction.
Platelets:
Transfused to address thrombocytopenia (a critical component of DIC) and reduce bleeding risk when platelet counts drop dangerously low.
Heparin:
An anticoagulant used in some cases of DIC to inhibit further thrombin generation and clot formation, especially in the chronic or compensated phases of DIC. The use of heparin is complex due to the risk of bleeding and must be balanced against its potential benefits.
Enoxaparin:
A low molecular weight heparin may be used similarly to heparin for its anticoagulant effects, often with a more predictable effect and easier dosing requirements. It may be preferred in certain clinical situations or when managing the chronic phase of DIC.
The objective in managing DIC is to balance the need to control excessive clotting while simultaneously avoiding or treating bleeding. These therapeutic strategies support the body’s hemostatic balance, organ function, and the resolution of the underlying pathology that initiated the DIC.
Each treatment option brings a different mechanism of action to address specific aspects of the condition and to stabilize the patient:
Blood products (like cryoprecipitate, fresh frozen plasma, and platelets) are focused on replacing consumed factors to help control bleeding.
Vasopressors support blood pressure and thus perfusion.
Electrolyte correction and fluid replacement stabilize the patient’s internal environment, ensuring that cells function properly.
Oxygenation addresses the cellular needs for metabolism and healing.
Anticoagulation therapy (heparin, enoxaparin) aims to prevent new clot formation in the already taxed circulatory system.
The therapeutic approach’s overall aim is to address the immediate life-threatening aspects of DIC while laying the groundwork for a long-term solution to the causative disease or injury. This requires a dynamic and responsive treatment plan that is tailored to the individual patient’s evolving needs.

Correct Answers

1. B. To identify and treat the underlying bacterial infection causing the DIC
2. A. Vasopressors
3. C. Cryoprecipitate
4. B. Hyperkalemia can affect cardiac rhythm and function
5. B. Improvement in clotting and decrease in bleeding risk
6. B. Maria’s coagulation parameters, like PT, aPTT, and platelet count
7. B. Fluid overload
8. B. Enoxaparin
9. D. All of the above
10. B. Initiation of mechanical ventilation if she cannot maintain adequate oxygen levels

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Question 4

Scenario-Based Exam: Nursing Management in DIC

Clinical Scenario

Carlos, a 52-year-old male, has been admitted to the hospital with a confirmed diagnosis of severe pancreatitis. Over the past few days, his condition has deteriorated, and he is exhibiting signs and symptoms that are concerning for the development of Disseminated Intravascular Coagulation (DIC). He is currently in the Intensive Care Unit (ICU) under constant observation.

Questions

1. Carlos’s heart rate has increased from 88 to 110 bpm within the last hour, and his blood pressure has dropped to 100/65 mmHg from a baseline of 130/80 mmHg. What should the nurse’s initial action be based on the nursing management principles?
   A. Document the findings and continue to monitor.
   B. Administer an anti-arrhythmic medication.
   C. Perform a detailed assessment of his vital functions and notify the physician.
   D. Increase the IV fluid rate to boost blood pressure.
2. Upon assessing Carlos, the nurse notes the presence of petechiae on his arms and blood oozing from a recent blood draw site. Which immediate nursing action is warranted?
   A. Apply a topical antibiotic to the oozing site.
   B. Apply pressure to the site and inform the treating team.
   C. Prepare for immediate surgery to stop potential internal bleeding.
   D. Cover the petechiae with sterile dressings to prevent infection.
3. Carlos’s complete blood count (CBC) returns indicating thrombocytopenia. Which blood product should be prepared for transfusion if ordered by the physician?
   A. Whole blood
   B. Packed Red Blood Cells (PRBCs)
   C. Platelets
   D. Fresh Frozen Plasma (FFP)
4. During his episode of hypotension, Carlos has developed labored breathing and crackles are noted in the lung bases. What concern does this raise for the nurse?
   A. Early signs of pneumonia
   B. Potential development of fluid overload or ARDS
   C. Carlos might be experiencing an asthma attack
   D. The presence of a pulmonary embolism
5. The nurse monitors Carlos’s intake and output closely. What complication can arise if transfusion of blood products leads to fluid overload in the context of DIC?
   A. Cerebral edema
   B. Hypertension crisis
   C. Decompensated heart failure or pulmonary edema D. Decompensated heart failure or pulmonary edema
6. If Carlos were to develop signs of hypovolemic shock, which findings would the nurse expect to observe?
   A. An increase in blood pressure due to systemic vasoconstriction
   B. Warm, flushed skin due to peripheral vasodilation
   C. Prolonged capillary refill time and cool, clammy skin
   D. Bradycardia as a compensatory mechanism to preserve blood flow
7. Considering the risk for thrombi leading to ischemia, which diagnostic results would the nurse need to monitor to evaluate for potential organ dysfunction in Carlos’s case?
   A. Serum creatinine and blood urea nitrogen (BUN) for kidney function
   B. Serum albumin levels for nutritional status
   C. Spirometry readings for pulmonary function
   D. Blood glucose levels for diabetic status
8. Carlos is receiving fresh frozen plasma (FFP) based on lab findings of coagulopathy. What is the primary nursing concern related to this intervention?
   A. Ensuring that Carlos receives the FFP at room temperature
   B. Monitoring for signs of transfusion reactions such as hives or wheezing
   C. Ensuring the FFP is infused as quickly as possible
   D. Verifying that Carlos has signed the informed consent for blood products every time
9. As part of interdisciplinary care, the nurse should collaborate with which team to optimize fluid management and prevent complications such as electrolyte imbalances in Carlos?
   A. The dietary team for nutritional support
   B. The pharmacy for medication reconciliation
   C. The physical therapy team for mobility support
   D. The palliative care team for overall comfort measures
10. At one point, Carlos’s central line needs to be removed. What is the most crucial aspect for the nurse to remember about removing a central line in a patient with a potential or confirmed diagnosis of DIC?
    A. Remove the line quickly to minimize discomfort
    B. Use minimal sterile barrier precautions to prevent infection
    C. Apply pressure for an extended period after line removal to prevent bleeding
    D. Ensure the patient is in a sitting position to reduce the risk of air embolism

Answer 4

The relationships between the various elements of nursing management for a patient who may be experiencing a condition like Disseminated Intravascular Coagulation (DIC), severe sepsis, or similar critical conditions include:

1. Close Monitoring of Vital Functions:
   
   • This includes tracking cardiac, respiratory, and neurologic status at least every 30 minutes initially to identify and respond quickly to any changes.
   • Vital signs and cardiac rhythm provide clues to the patient’s hemodynamic stability and cardiac output.
   • Breath sounds assessment helps in detecting respiratory complications like fluid overload or acute respiratory distress syndrome (ARDS).
2. Assessment for Hemorrhage and Shock:
   
   • Watching for signs of hemorrhage is critical given the bleeding tendency in conditions like DIC.
   • Hypovolemic shock is a concern if significant bleeding occurs, thus assessing skin color, peripheral circulation, and capillary refill is important for detecting poor circulation and shock early.
3. Skin and Mucous Membranes:
   
   • Inspecting these areas for signs of bleeding, such as petechiae, ecchymosis, or purpura, which can indicate blood clotting issues and inform interventions.
4. Management of IV and Venipuncture Sites:
   
   • Frequent checks to prevent bleeding. Applying pressure for extended periods post-procedure reduces bleeding risks.
5. Laboratory Value Monitoring:
   
   • This is essential to keep abreast of the patient’s coagulation status and guide the administration of blood products. Laboratory values can signal the severity of the condition and provide guidance on the need for transfusion or other interventions.
6. Administration of Blood Products:
   
   • Blood, fresh frozen plasma, and platelets may be given to address anemia, coagulopathy, and thrombocytopenia, respectively. Careful administration is required to avoid transfusion reactions or volume overload.
7. Fluid Balance Monitoring:
   
   • Observing intake and output hourly is key when administering fluid and blood products to prevent volume overload, which can exacerbate respiratory and cardiac issues.
   • Considering that transfusion reactions can present with fever, chills, hemolysis, or an allergic response, it’s crucial to monitor for these and act promptly if they occur.
8. Identification and Management of Ischemia and Organ Dysfunction:
   
   • Thrombi formation due to the hypercoagulable state in DIC can lead to ischemia and subsequent organ dysfunction. Monitoring for signs of these complications involves vigilance for changes in organ function and localizing pain or dysfunction.

In summary, nursing management is centered around meticulous monitoring and support, ensuring that interventions like transfusions are performed safely while preventing and managing potential complications. Nurses act as the frontline responders, identifying subtle changes that may indicate worsening or improving conditions. This active monitoring and intervention can significantly affect the patient’s prognosis in the acute phase of critical conditions like DIC.

Correct Answers

1. C. Perform a detailed assessment of his vital functions and notify the physician.
2. B. Apply pressure to the site and inform the treating team.
3. C. Platelets
4. B. Potential development of fluid overload or ARDS
5. C. Decompensated heart failure or pulmonary edema
6. C. Prolonged capillary refill time and cool, clammy skin
7. A. Serum creatinine and blood urea nitrogen (BUN) for kidney function
8. B. Monitoring for signs of transfusion reactions such as hives or wheezing
9. B. The pharmacy for medication reconciliation
10. C. Apply pressure for an extended period after line removal to prevent bleeding