Chapter 32: Acute respiratory disorders and pulmonary embolism
A patient with a pulmonary embolism is being discharged home on warfarin. Which response suggests the patient requires additional teaching about warfarin therapy by the nurse prior to discharge?
"I can use a rectal suppository if I become constipated."
The nurse is teaching a patient recovering from a pulmonary embolism who will take warfarin for several weeks about long-term management of medications. Which statement by the patient indicates a need for further teaching?
"I may use enemas to help with constipation."
Which statements by the student nurse indicate effective learning about precautionary measures to be taken while a patient is on heparin sodium therapy? Select all that apply.
"I must monitor the platelet count." "I must monitor the partial thromboplastin time (PTT)." "I must have the antidote, protamine sulfate, readily available."
The nurse is teaching a patient receiving warfarin sodium about avoiding certain foods during this drug therapy. Which patient statement indicates a correct understanding of the teaching?
"I will be careful to avoid anything with vitamin K in it."
The nurse is providing teaching for a patient who will be discharged home to continue therapy with warfarin. Which statement by the patient indicates a correct understanding of the teaching?
"I'll use a soft-bristled toothbrush to brush my teeth."
A patient is refusing to allow the nurse to apply pneumatic compression stockings while in bed, stating he doesn't like how they feel and they keep him awake. What is the nurse's best response?
"It is important to wear them in bed so you don't develop a blood clot in your legs."
A patient is receiving mechanical ventilation after developing acute respiratory distress syndrome (ARDS) from aspiration pneumonia. The patient's spouse asks the nurse how long it will take the patient to recover. Which response by the nurse shows an understanding of the disease process?
"Recovery time depends on the severity and progression of symptoms."
A patient receiving 100% oxygen for treatment of pneumonitis after inhaling an irritant has worsening hypoxemia confirmed with arterial blood gases and has increasing dyspnea and work of breathing. A chest x-ray reveals a ground-glass appearance in both lungs. Which condition does the nurse suspect this patient has developed?
Acute respiratory distress syndrome
Which risk factors increase a patient's risk for venous thromboembolism that may progress to a pulmonary embolism? Select all that apply.
Age 72 years Presence of a central venous catheter Admission weight of 290 lb (131.8 kg)
The nurse notifies the Rapid Response Team for a patient who develops distended neck veins, severe dyspnea, cyanosis, and syncope. The patient is hypoxic and hypotensive and has an abnormal electrocardiogram. Which medication does the nurse anticipate will be ordered immediately?
Alteplase
Which components belong to the ventilator bundle approach to prevent ventilator-associated pneumonia (VAP)? Select all that apply.
Continuous removal of subglottic secretions Handwashing before and after contact with the patient Elevating the head of the bed at least 30 degrees whenever possible
A patient is receiving mechanical ventilation with FiO 2 of 85%. The provider has ordered the positive end-expiratory pressure (PEEP) to be increased from 10 cm of H 2O to 15 cm of H 2O after the patient's oxygen saturation levels have remained less than 92%. The nurse will know this intervention is successful when the patient's condition allows the nurse to make which additional change?
Decrease the oxygen flow rate.
A patient who is taking warfarin after an acute pulmonary embolism is transferred from the ICU after 5 days of heparin therapy. The nurse reviews the patient's electronic medical record and notes an international normalized ratio (INR) of 3.4. After notifying the provider of this result, which order does the nurse expect for this patient?
Give phytonadione.
The patient with a pulmonary embolism who is experiencing anxiety asks the nurse for a sedative. The nurse teaches that sedatives increase the risk for which complication?
Hypoventilation
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation, and the nurse has an order to turn the patient every 2 hours. This action is performed to achieve which outcome?
Increase gas exchange
A patient who is a lifetime smoker, obese, and has a previous history of thromboembolism is preparing to have major surgery that will require prolonged immobility. Past treatments with anticoagulant medications caused serious bleeding. Which management strategy will be best for this patient?
Inferior vena cava filtration
The nurse is assessing a patient with possible pulmonary embolism (PE). For which symptoms should the nurse assess? Select all that apply.
Inspiratory chest pain Dizziness and fainting
A patient has been admitted for a pulmonary embolism and is receiving heparin infusion. What safety priority does the nurse include in the plan of care?
Monitor the platelet count daily.
A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The provider has ordered 10 cm H 2O of positive end-expiratory pressure (PEEP) to be used with mechanical ventilation. What assessment will inform the nurse that the PEEP was effective in supporting the patient's respiratory needs?
Oxygen saturation increases from 85% to 92%.
A patient has a PaO 2 of 55 mm Hg, an arterial oxygen saturation of 85%, and a hemoglobin of 9.2 g/dL. The patient also has normal lung function and clear breath sounds but has exertional dyspnea. What does the nurse suspect the patient is experiencing?
Oxygenation failure
A patient has developed a pulmonary embolism. The nurse anticipates orders for which lab values before beginning heparin therapy for this condition?
Partial thromboplastin time (PTT)
Which critically ill patient has the greatest risk for developing acute respiratory distress syndrome (ARDS)?
Patient with aspiration pneumonia
The nurse hears the ventilator alarm come from the room of a patient who is receiving mechanical ventilation. When arriving in the patient's room, which assessment does the nurse perform first?
Patient's color, perfusion, and chest rise
The nurse has extubated a patient who was receiving mechanical ventilation for several days. A few hours after extubation, the patient reports a sore throat and cough and the nurse notes a hoarse voice. Which action by the nurse is correct?
Provide extra fluids and throat lozenges.
A patient who had knee replacement surgery 2 days ago has a sudden onset of dyspnea and cough and reports a sharp, stabbing pain in the chest. The nurse notes a heart rate of 110 beats/min, bilateral crackles in lung fields, and an oxygen saturation of 97% on room air. Which postoperative complication does the nurse suspect the patient has developed?
Pulmonary embolism
The nurse assesses extreme shortness of breath, agitation, and apprehension in a patient who had knee surgery. A heart rate of 119 beats/min and a respiratory rate of 24 breaths/min with an oxygen saturation of 84% are also noted. The nurse suspects which postoperative complication?
Pulmonary embolism
The nurse assesses a patient with pneumonia and notes a productive cough, dyspnea with ambulation, and increased work of breathing. The patient's oxygen saturation is 96%, and an arterial blood gas reveals a PaO 2 of 93%. The nurse contacts the provider to report which condition based on these findings?
Respiratory distress
