DIC and Blood Administration: Nursing Quiz Performance Insights

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 1/16 Exit Performance DIC and Blood Administration Practice Quiz Due Feb 25, 2024 by 11:59 pm Final Score 86% 13 out of 15 questions answered correctly Completed on Feb 24, 2024 10:36 pm Incorrect (2) Report content error

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 2/16 Which intervention would the nurse anticipate incorporating into the plan of care for a patient newly diagnosed with disseminated intravascular coagulation (DIC)? Rationale Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Test-Taking Tip: If the question asks for an immediate action or response, then all of the answers may be correct, so base your selection on identified priorities for action. p. 738 Report content error Administer heparin. Administer whole blood. Treat the causative problem. Administer fresh frozen plasma.

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 3/16 When monitoring a patient who is receiving a transfusion of packed red blood cells (PRBCs), the nurse would perform which intervention? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Rationale During the first 15 minutes or 50 mL of blood infusion, remain with the patient. If there are any untoward reactions, they are most likely to occur at this time. Most patients not in danger of ﬂuid overload can tolerate the infusion of one unit of PRBCs over 2 hours. The transfusion should not take more than 4 hours to administer because of the increased risk of bacterial growth in the product once it is out of refrigeration. Chills, fever, lower back pain, ﬂushing, tachycardia, dyspnea, tachypnea, and hypotension are some manifestations of an acute hemolytic reaction. The nurse needs to stop the transfusion immediately if signs of a reaction are noted. The rate of infusion during this period should be no more than 2 mL/minute. p. 759 Start the infusion at a rate of 5 mL/minute. Check the patient's vital signs after the first 15 minutes. Remain with the patient during the first 15 minutes of blood infusion. Infuse the blood over 2 hours but no longer than 4 hours. Stop the infusion if the patient develops chills, fever, or lower back pain.

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3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 4/16 Correct (13) Report content error

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 5/16 The nurse would take which action to ensure patient safety when administering a unit of packed red blood cells (PRBCs)? Rationale The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. A second registered nurse should perform this check. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion. p. 757 Report content error Select a new primary IV tubing to use for the administration and piggyback with 500 mL of normal saline. Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood- bank identification bracelet.

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 6/16 Which action would the nurse take to safely infuse one unit of fresh frozen plasma (FFP) in a patient? Rationale The FFP should be administered as rapidly as possible and can be infused over 15 to 30 minutes. FFP is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the FFP is infusing unless a second IV line has been started for the transfusion. p. 759 Report content error The nurse will begin a patient’s transfusion of packed red blood cells at 1030. The nurse would plan to stay in the patient’s room until which time? Infuse the FFP over 8 hours. Infuse the FFP as rapidly as the patient will tolerate. Administer the FFP as an IV piggyback to the primary IV solution. Administer the FFP as an IV piggyback to lactated Ringer solution. 1040 1045 1050 1055

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3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 7/16 Rationale As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes. p. 759 Report content error The nurse picks up a unit of packed red blood cells from the laboratory at 1130. The nurse would initiate the patient’s transfusion no later than which time? Rationale The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank. Because the blood was picked up at 1130, 1200 is the latest it can be hung. It is okay to hang the blood at 1145. It is too late to hang the blood at 1230 or at 1530. 1145 1200 1230 1530

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 8/16 p. 759 Report content error The nurse expects which therapy will be used on a patient with chronic disseminated intravascular coagulation (DIC)? Rationale Chronic DIC does not respond to oral anticoagulants. It is controlled with long-term use of heparin. Therapy with blood products such as platelets, cryoprecipitates, and fresh frozen plasma are usually reserved for a patient with life-threatening hemorrhage. p. 741 Report content error Heparin Platelets Cryoprecipitate Fresh frozen plasma

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 9/16 Before beginning a transfusion of red blood cells (RBCs), which nursing action is the highest priority to avoid an error during the procedure? Rationale After obtaining the blood or blood components from the blood bank, make a positive identification of the blood product and recipient. Improper product-to-patient identification is the most common cause of hemolytic transfusion reactions. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, then the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer because it will cause red blood cell (RBC) hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started because this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong Check the identifying information on the unit of blood against the patient's ID bracelet. Select a new primary IV tubing primed with lactated Ringer solution to use for the transfusion. Add the blood transfusion as a secondary line to an existing IV and use the IV controller to maintain correct ﬂow. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction.

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3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 10/16 response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. p. 757 Report content error Which parameter would the nurse assess while monitoring a patient for the development of disseminated intravascular coagulation (DIC) disorder? Select all that apply. One, some, or all responses may be correct. Rationale The nurse should assess the parameters such as fibrinogen levels and PTT while monitoring a patient for the development of DIC disorder. Hemoglobin levels, RBC count, and WBC count are not altered in a patient with DIC. Therefore the nurse need not assess these parameters in a patient with DIC. p. 740 Fibrinogen levels Hemoglobin levels Red blood cell (RBC) count White blood cell (WBC) count Partial thromboplastin time (PTT)

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 11/16 Report content error Bleeding manifestations in a patient with disseminated intravascular coagulation (DIC) may be caused by which pathophysiologic factor? Select all that apply. One, some, or all responses may be correct. Rationale In DIC, the consumption of platelets decreases the platelet counts, leading to bleeding. Depletion of coagulation factors may prevent clotting and increase the risk for bleeding. The FSPs may disintegrate any clot formed, thus increasing the risk for bleeding. Fibrinolysis in the microcirculation and thrombotic occlusion of microcirculation in organs are the factors that cause thrombotic manifestations in a patient with DIC. pp. 738-739 Report content error Consumption of platelets Depletion of coagulation factors Fibrinolysis in the microcirculation Formation of fibrin split products (FSPs) Thrombotic occlusion of microcirculation in organs

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 12/16 Which factor puts a patient at risk for developing acute disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct. Rationale Risk factors associated with acute DIC include severe head injury, abruptio placentae, extensive burns, and septicemia. ARDS is not a risk factor for acute DIC. p. 739 Report content error Which assessment finding may indicate the development of disseminated intravascular coagulation (DIC) in a patient who experienced an anaphylactic reaction? Severe head trauma Abruptio placentae An extensive burn Septicemia Acute respiratory distress syndrome (ARDS) Increasing bradypnea Scattered wheezes Bradycardia and hypertension

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3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 13/16 Rationale Bleeding in a person with no previous history or obvious cause should be questioned because it may be one of the first manifestations of acute DIC. Blood oozing from venipuncture sites is a manifestation that could suggest the development of DIC. The patient will not have bradypnea or wheezing. Tachycardia and hypotension are found in patients with DIC (not bradycardia and hypertension). Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success. p. 739 Report content error The nurse would select which IV solution to prime blood tubing prior to the administration of a unit of packed red blood cells (RBCs)? Blood oozing from venipuncture sites Lactated Ringer

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 14/16 Rationale The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It also is used to ﬂush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Do not use lactated Ringer solution, dextrose solutions, or any other solution other than 0.9% sodium chloride for giving blood because they will cause RBC hemolysis. p. 757 Report content error Which sign of microvascular thrombosis observed in a patient with disseminated intravascular coagulation (DIC) disorder is associated with the integumentary system? Rationale 5% dextrose in water 0.9% sodium chloride 0.45% sodium chloride Paralytic ileus Venous distention Ischemic tissue necrosis Electrocardiogram (ECG) changes

3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 15/16 Ischemic tissue necrosis, such as gangrene, is a sign of microvascular thrombosis associated with the integumentary system. Paralytic ileus is associated with the gastrointestinal system. Venous distention and ECG changes are associated with the cardiovascular system. p. 739 Report content error

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3/20/24, 7:19 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/53114355 16/16 Which information would the nurse include when preparing to discuss the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? Rationale DIC is an abnormal response of the normal clotting cascade stimulated by a disease process or disorder. It is a disorder in which the underlying disease depletes clotting factors in blood. DIC is a disorder in which tissue factor released at the site of injury leads to overstimulation of the coagulation process in the vasculature. The coagulation pathway is not genetically altered in DIC. p. 738 DIC is due to the depletion of hemolytic factors. The coagulation pathway is overstimulated. The coagulation pathway is genetically altered. DIC is a secondary disease of clotting and hemorrhage.

Elsevier Adaptive Quizzing Quiz performance DIC and Blood Administration Practice

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