FA Davis Chapter27 Pulmonary Embolism

Which of the following is the primary risk factor for pulmonary embolism? Smoking Heart disease Deep vein thrombosis Malignancy

Deep vein thrombosis

Diagnostic Testing for PE

Electrocardiogram (ECG) Pulmonary angiography Ventilation/perfusion scan (V/Q scan) Plasma D-dimer level INCORRECT. Diagnostic testing for PE includes imaging and laboratory studies. Diagnostic studies include an ECG, a chest CT with contrast (not without), a V/Q scan, and pulmonary angiography. Laboratory studies include arterial blood gas analysis (not venous) and a plasma D-dimer level.

A patient treated for a pulmonary embolism is being discharged from the hospital. Which patient teaching should the nurse include in the teaching plan? Select all that apply. Lab tests to check oral heparin effectiveness Exercise regimen recommended by provider Smoking cessation therapies or support group Diet rich in saturated fat Take prescribed medication at appropriate time

Exercise regimen recommended by the provider Smoking cessation therapies or support group Take prescribed medication at the appropriate time

The nurse suspects a patient to have a pulmonary embolism. Which of the following common signs and symptoms would support the nurse's belief? Select all that apply. Hemoptysis Decreased heart rate Dyspnea with accessory muscle use Unilateral lower extremity edema Cough

Hemoptysis Dyspnea with accessory muscle use Unilateral lower extremity edema Cough

Drug Therapy to Treat PE

Heparin drip Altapase Warfarin CORRECT. Drug therapy prescribed to treat PE includes heparin (single dose followed by a continuous infusion). Anticoagulation will continue after discharge with warfarin. Thrombolytic therapy with altaplase may be prescribed for patients who are hemodynamically unstable as thrombolysis actively reduces the clot. Protamine sulfate should be on standby to treat active bleeding; however, this is not prescribed to treat the PE itself but a complication associated with heparin therapy. Vitamin K is used to treat active bleeding for a patient who has transitioned to warfarin. Vitamin K, like protamine sulfate, is not prescribed to treat the PE but to treat complications associated with warfarin therapy.

Which assessment findings would the nurse most likely expect in a patient diagnosed with a pulmonary embolism? Select all that apply. High ventilation/low perfusion Increased cardiac output Decreased pulmonary vascular resistance Pulmonary hypertension Reduced left ventricular preload

High ventilation/low perfusion Pulmonary hypertension Reduced left ventricular preload

The nurse is caring for a hospitalized patient being treated with heparin for a pulmonary embolism. The most recent activated partial thromboplastin time (aPTT) is 3.0 times the normal value. What is the nurse's best action? Administer an additional heparin bolus Increase the rate of infusion Continue the current rate of infusion Decrease the rate of infusion

Increase the rate of infusion

Risk Factors for PE

Obesity Deep vein thrombosis (DVT) Cigarette smoking CORRECT. Risk factors for PE include DVT, obesity, and cigarette smoking. A hip or leg, not wrist, fracture is a risk factor for PE. Chronic heart disease is also a risk factor for PE, but transient heart disease is not.

A patient diagnosed with a pulmonary embolism is receiving a heparin infusion. Which lab should the nurse monitor in order to adjust the rate of infusion? Prothrombin time Partial thromboplastin time Platelet count Hemoglobin and hematocrit

Partial thromboplastin time

The nurse should review which lab study to indicate the presence of a thrombus in the body? Arterial blood gas Prothrombin time B-type natriuretic peptide Plasma d-dimer

Plasma d-dimer

The nurse should closely monitor for signs and symptoms of a pulmonary embolism in a patient with which risk factors? Select all that apply. Post-knee surgery Underweight Smoker Chronic heart disease Hypertension

Post-knee surgery Smoker Chronic heart disease

The nurse should ensure that which reversal agent is readily available in case of active bleeding while a patient is receiving a heparin infusion? Vitamin K Protamine sulfate Flumazenil Naloxone

Protamine sulfate

A patient presents to the emergency department with symptoms of a pulmonary embolism. What is the nurse's first action? Obtain 12-lead ECG. Administer IV saline. Provide oxygen. Start heparin infusion.

Provide oxygen.

Patient Education to Prevent Recurrence of PE

Smoking cessation Exercise regimen to include aerobic exercise Take prescribed medication, such as warfarin Adequate fluid intake CORRECT. Patient teaching to prevent the recurrence of PE includes implementation of an exercise regimen to include aerobic exercise. The exercise will strengthen the patient's heart and cardiovascular system, improve venous return to the heart, and assist with weight loss. Smoking cessation is encouraged during hospitalization and at every subsequent visit to the patient's primary care provider. Teaching to prevent recurrence of PE should also include the importance of taking all prescribed medication, such as warfarin, at the appropriate time. Follow-up visits to monitor laboratory values are required for patients who are prescribed warfarin therapy. While a cardiac prudent diet is important and should be encouraged, it is important to minimize saturated, not unsaturated, fat.

Client Education for Anticoagulant Therapy

Use of a soft toothbrush No floss Need for coagulation studies Action of the medication The nurse should explain the mechanism of action of anticoagulants and thrombolytics and that the client will be required to have follow-up laboratory samples drawn if on warfarin to determine effective dosing of anticoagulants. Bleeding precautions should be initiated that include encouraging the use of electric razors (not blades), use of soft toothbrushes, and no flossing. The diet should limit foods high in vitamin K, as these foods interfere with the efficacy of warfarin