TERM 4 CH. 32 Care of Critically Ill Patients with Respiratory Problems

- Shock - Trauma - Blood transfusions - Aspiration Several factors place this client at increased risk for acute lung injury, including shock, trauma, multiple blood transfusions, and aspiration. The nurse should be aware of these risk factors and continually monitor the client for early signs of respiratory distress. Age is not a risk factor for this client

A 17-year-old client was ejected from a car after hitting a tree at a fast speed. The client was believed to have aspirated at the scene and a nasogastric tube was placed. The client underwent emergent surgery to control bleeding from a lacerated liver and several long bone fractures. Four units of packed red blood cells were given during the surgery. The nurse monitors the client for the development of acute lung injury based on which risk factors? Select all that apply. 1 Shock 2 Trauma 3 Blood transfusions 4 Age 5 Aspiration 6 Antibiotic administration

Oxygenation failure Clients with normal lung function who are hypoxic most likely have ventilatory failure. This client is anemic, which results in decreased oxygen-carrying capability due to a deficiency in red blood cells and hemoglobin. Clients with pulmonary embolism have changes in lung function. Respiratory distress occurs when there is increased work of breathing, but without hypercapnea or hypoxia. Ventilatory failure occurs when there is lung dysfunction with normal perfusion.

A client has a Pao2 of 55 mm Hg, an arterial oxygen saturation of 85%, and a hemoglobin of 9.2 g/dL. The client also has normal lung function and clear breath sounds, but has exertional dyspnea. What does the nurse suspect the client is experiencing? 1 Oxygenation failure 2 Pulmonary embolism 3 Respiratory distress 4 Ventilatory failure

Intercostal nerve block Clients with severe pain often do not take deep breaths and thus do not maintain adequate ventilation. An intercostal nerve block is used for severe pain. Opioid analgesics suppress respiration and should be avoided. Splinting with tape is not done unless the fracture is complex, when seven or more ribs are involved, or if a flail chest is present. Mechanical ventilation is used as a last intervention after others have been attempted.

A client has severe pain from three rib fractures after a workplace accident. To facilitate adequate respiration, the nurse discusses which intervention with the provider? 1 Administering opioid analgesics 2 Intercostal nerve block 3 Mechanical ventilation 4 Splinting the ribs with tape

Protamine sulfate Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin. Antihemophilic factor and aminocaproic acid are both antidotes for fibrinolytic therapy that attempts to break up established clots.

A client is receiving heparin sodium (Hepalean) therapy for a pulmonary embolism. Which antidote does the nurse confirm is available on the unit? 1 Vitamin K 2 Protamine sulfate 3 Antihemophilic factor 4 Aminocaproic acid

A tracheostomy will be performed to minimize complications Clients who require an artificial airway longer than 10-14 days will often need a tracheostomy to help minimize tracheal and vocal cord damage and to continue to remove secretions and provide ventilation and oxygenation. BiPAP is not used to wean clients from ventilators. Nasotracheal tubes carry the same risks as endotracheal tubes and are less comfortable. It is too early to tell whether the client will be ventilator-dependent for a prolonged period of time.

A client is receiving mechanical ventilation via an endotracheal tube. Despite several attempts to extubate the client, the client remains ventilator-dependent for 2 weeks after the initial intubation. What does the nurse plan to tell the client's family about the plan of care? 1 "A tracheostomy will be performed to minimize complications." 2 "The provider will order bilevel positive airway pressure (BiPAP) to help wean the client from the ventilator." 3 "We will insert a nasotracheal tube to make the client more comfortable." 4 "Your loved one may be ventilator-dependent indefinitely."

Decrease the oxygen flow rate PEEP is added when clients cannot maintain adequate gas exchange even with high-flow oxygen. The effect of preventing atelectasis should increase arterial blood oxygenation and allow the oxygen flow rate to be decreased. Adding PEEP does not have a direct effect on tidal volume, which is determined by the client's weight and lung capacity.

A client is receiving mechanical ventilation with FiO2 of 85%. The provider has ordered the positive end-expiratory pressure (PEEP) to be increased from 10 cm of H2O to 15 cm of H2O after the client's oxygen saturation levels have remained less than 92%. As a result of this increase, which adjustment does the nurse plan to make? 1 Decrease the oxygen flow rate. 2 Increase the oxygen flow rate. 3 Decrease the tidal volume. 4 Increase the tidal volume.

It is important to wear them in bed so you dont develop a blood clot in your legs The continuous use of antiembolism and pneumatic compression stockings is an essential intervention in the prevention of venous thromboembolism. Providing education to clients may help with their refusal to wear compression stockings.

A client 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? 1 "I'll give you a break from them for an hour, but then I'll need to put them back on." 2 "It is important to wear them in bed so you don't develop a blood clot in your legs." 3 "Let me talk to the provider about discontinuing them." 4 "Would you like me to give you medication to help you sleep?

Aminocaproic acid (Amicar) The antidote for excessive bleeding for clients receiving alteplase is aminocaproic acid. Packed red blood cells may be given if blood loss is excessive to treat anemia, but they are not used as an antidote. Phytonadione is the antidote for warfarin. Protamine sulfate is the antidote for heparin.

A client receiving intravenous alteplase (tPA) after developing a pulmonary embolism develops bloody stools and bleeding gums. The nurse notifies the provider and obtains an order for which antidote? 1 Aminocaproic acid (Amicar) 2 Packed red blood cells 3 Phytonadione (AquaMEPHYTON) 4 Protamine sulfate

Discontinue the heparin and continue the warfarin The client will typically take both drugs until the INR is between 2.0 and 3.0, then will stop taking the heparin. Clients may take warfarin for 3-6 weeks or indefinitely. There is no need to administer protamine sulfate or phytonadione, which are antidotes for heparin and warfarin, since the INR is within normal limits.

A client recovering from a pulmonary embolism after surgery is receiving low-molecular-weight heparin (Lovenox) and warfarin (Coumadin). The client's international normalized ratio (INR) is 2.4 today. After reporting this lab value to the provider, which order does the nurse anticipate? 1 Continue the heparin and warfarin, and repeat the INR in one day. 2 Discontinue the heparin and administer protamine sulfate. 3 Discontinue the warfarin and administer phytonadione (AquaMEPHYTON) 4 Discontinue the heparin and continue the warfarin.

Pulmonary Embolism Difficulty breathing, tachycardia, chest pain, fainting, and cyanosis are some of the common clinical manifestations of a pulmonary embolism. The client also has experienced two of the major risk factors—bone fracture and surgery. A pulmonary infection and edema can cause breathing difficulties and possible cyanosis, but usually not fainting or chest pain. Respiratory difficulties and chest pain are not usual reactions to anesthesia.

A client recovering from an osteotomy and pin fixation for a femur fracture suddenly experiences shortness of breath, chest pain, and tachycardia. What does the nurse suspect is causing the client's symptoms? 1 Pulmonary infection 2 Reaction to anesthesia 3 Pulmonary embolism 4 Pulmonary edema

Administer the medications as prescribed Although both heparin and warfarin are anticoagulants, they have different mechanisms and onsets of action. Because warfarin has a slow onset, it must be started while the client is still receiving heparin in order to maintain a safe level of anticoagulation for effective treatment of the venous thromboembolism. It is not necessary to clarify the order because the client must take warfarin while on the heparin because the warfarin is slow-onset. Warfarin should not be held to wait for PTT because PTT is used to measure effectiveness of heparin, not warfarin. Although the nurse may implement use of a bed alarm, it is not a priority.

A client who has a venous thromboembolism in the upper arm is to be started on oral warfarin (Coumadin) while still receiving an intravenous heparin infusion. What is the nurse's best action? 1 Administer the medications as prescribed. 2 Clarify the warfarin and heparin orders with the provider. 3 Hold the dose of warfarin until the client's partial thromboplastin time (PTT) is within normal range. 4 Place the client on a bed alarm as a safety precaution.

Fibroproliferative In the fibroproliferative phase increased lung damage leads to pulmonary hypertension and fibrosis. The body attempts to repair the damage, and increasing lung involvement reduces gas exchange and oxygenation. In the exudative phase clients experience dyspnea and tachypnea and require oxygen via mask or nasal cannula. The resolution phase usually occurs after 14 days. Resolution of the injury can occur; if not, the patient either dies or has chronic disease. Fibrosis may or may not occur.

A client who has been on a ventilator for the past week has become increasingly hypoxemic and has not been responding well to the increasing oxygen settings. The nurse suspects the client is in which phase of acute respiratory distress syndrome (ARDS)? 1 Exudative 2 Resolution 3 Fibroproliferative 4 Fibrosis

Remove the client from the ventilator and ventilate using a bag-valve-mask device The priority is to provide ventilation using a bag-valve-mask device to determine if the problem is with the client or the ventilator. This information is necessary before calling the health care provider or the Rapid Response Team. Changing the ventilator settings does not provide immediate information about the cause of the distress (client or machine).

A client who is intubated and on mechanical ventilation begins to develop respiratory distress. What is the next priority action for the nurse? 1 Immediately notify the health care provider and monitor the client's Sao2. 2 Activate the hospital's Rapid Response Team and stay with the client. 3 Increase the ventilator rate and monitor the client's respiratory effort. 4 Remove the client from the ventilator and ventilate using a bag-valve-mask device.

"I can use a rectal suppository if I become constipated." Several safety precautions important for the client to understand about bleeding when being discharged on warfarin. The client should take stool softeners to prevent hard stools or straining but should not insert a rectal suppository (unless they are prescribed and well-lubricated) or enema, as they can cause bleeding. Avoiding contact sports, contacting the provider before going to the dentist, and using an electric shaver demonstrate appropriate knowledge about warfarin safety upon discharge.

A client with a pulmonary embolism is being discharged home on warfarin (Coumadin). Which response suggests the client requires additional teaching about warfarin therapy by the nurse prior to discharge? 1 "I will not participate in my soccer club games until I'm off the warfarin." 2 "I can use a rectal suppository if I become constipated." 3 "I will have to buy myself an electric shaver." 4 "I will call my provider before I go to the dentist.

Oxygen saturation increases from 85% to 92% The client with ARDS often requires intubation and mechanical ventilation with PEEP. PEEP improves oxygenation by enhancing gas exchange and preventing atelectasis. An improvement in oxygen saturation would be used to evaluate the effectiveness of adding PEEP to the client's mechanical ventilation mode.

A client with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The provider has ordered 10 cm H2O 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 client's respiratory needs? 1 Blood pressure decreases from 120/80 mm Hg to 92/65 mm Hg. 2 Oxygen saturation increases from 85% to 92%. 3 Urine output increases to 45 mL/hour. 4 Heart rate increases from 96 to 110 beats/min

Increase gas exchange Positioning may be important in promoting gas exchange in clients with ARDS, but the exact position is controversial. Manually turning the client every 2 hours has been shown to improve perfusion. Turning the client does not affect lung compliance or reduce lung fibrosis. It does help prevent pressure ulcers, but in this client's case, the order is given specifically to improve lung perfusion.

A client with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation, and the nurse has an order to turn the client every 2 hours. This action is performed to achieve which outcome? 1 Improve lung compliance 2 Increase gas exchange 3 Prevent pressure ulcers 4 Reduce lung fibrosis

Pneumothorax Clients with COPD may have a spontaneous pneumothorax. Assessment findings frequently include reduced breath sounds on auscultation over the collapsed lung region, hyperresonance on percussion, deviation of the trachea, pleuritic pain, tachypnea, and subcutaneous emphysema. The provider or Rapid Response Team must be contacted immediately to evaluate the need for a chest tube to reexpand the lung.

A client with chronic obstructive pulmonary disease (COPD) reports acute difficulty breathing and right-side pleuritic pain. Auscultation reveals decreased breath sounds in the right lung field compared to the left lung field. Which possible condition does the nurse contact the provider for based on these assessment data? 1 Tension pneumothorax 2 Flail chest 3 Pneumothorax 4 Pulmonary embolism

Obtain an order for arterial blood gases The client has developed respiratory distress. Even though the oxygen saturation level is within normal limits, a more accurate assessment of hypoxemia is with arterial blood gases. Giving high-flow oxygen with a Venturi mask may increase anxiety and cause oxygen-induced hypercapnea in clients with COPD. Unless the client exhibits signs of respiratory failure with hypoxemia and cyanosis, notifying the Rapid Response Team is not necessary. A chest x-ray may be indicated after the client is stabilized to help determine the cause of the respiratory distress.

A client with chronic obstructive pulmonary disease (COPD) suddenly becomes dyspneic with a respiratory rate of 32 breaths/min and an oxygen saturation of 94%. The client appears pale and anxious and is using accessory muscles to breathe. What is the nurse's priority action? 1 Apply high-flow oxygen with a Venturi mask 2 Notify the Rapid Response Team 3 Obtain an order for arterial blood gases 4 Request an order for a chest x-ray

Assess for adequate oxygenation Restlessness, agitation, anxiety, and tachycardia are early symptoms of hypoxemia. Increasing sedation is not indicated for this client and may mask symptoms like hypoxemia or worsening respiratory failure. Although the nurse may explain to the client that he or she is intubated, it does not take priority over assessing for hypoxemia. The presence of family members may decrease the chances of "ICU psychosis" and anxiety, but it does not take priority over assessing for hypoxemia.

A ventilated client in the intensive care unit begins to pick at the bedcovers. Which action should the nurse take next? 1 Increase the sedation. 2 Assess for adequate oxygenation. 3 Explain to the client that he has a tube in his throat to help him breathe. 4 Request that the family leave to decrease the client's agitation

Keep the head of the bed elevated Positioning of clients is included in UAP education and scope of practice and can be delegated. Client teaching is an activity performed by the professional nurse. Although taking vital signs is an activity of the UAP, monitoring a potentially unstable client is done by the professional nurse. Adjusting oxygen flow rates requires complex decision making and should be done by the RN.

All of these nursing actions are included in the plan of care for a client who has just been extubated. Which action should the nurse delegate to unlicensed assistive personnel (UAP)? 1 Keep the head of the bed elevated. 2 Teach about incentive spirometer use. 3 Monitor vital signs every 5 minutes. 4 Adjust the nasal oxygen flow rate

Client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright-red hemoptysis The client with a diagnosed pulmonary embolism is showing signs of possible pulmonary infarction or bleeding abnormality secondary to heparin; this indicates a significant decline in status and warrants activation of the Rapid Response Team. The client with deep vein thrombosis requires ongoing monitoring and is receiving appropriate treatment; calf pain is expected in this situation. The client with a right pneumothorax requires ongoing monitoring but has normal oxygen saturation. The client who was extubated 3 days ago requires ongoing monitoring or nursing intervention, but does not have evidence of acute deterioration or severe complications.

The medical-surgical unit nurse should call the Rapid Response Team to assess which client? 1 Client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright-red hemoptysis 2 Client with deep vein thrombosis who is receiving low-molecular-weight heparin and has ongoing calf pain 3 Client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry of 94% 4 Client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs

Respiratory distress Respiratory failure, oxygenation failure, and ventilatory failure are all characterized by hypoxemia, which is any Pao2 less than 90%. This client has increased work of breathing and dyspnea characteristic of respiratory distress, but is still compensating to maintain oxygenation.

The nurse assesses a client with pneumonia and notes a productive cough, dyspnea with ambulation, and increased work of breathing. The client's oxygen saturation is 96% and an arterial blood gas reveals a Pao2 of 93%. The nurse contacts the provider to report which condition based on these findings? 1 Respiratory distress 2 Respiratory failure 3 Oxygenation failure 4 Ventilatory failure

PEEP pressure between 5 and 15 cm H2O Clients receiving PEEP ventilation should have pressure settings between 5 and 15 cm H2O. Because prolonged use of high Fio2 can damage lungs, the Fio2 should be lowered to the lowest possible amount. The oxygen flow rate should be 40 L/min. The client's tidal volume should be 7-10 mL/kg; for this client, the range would be 560-800 mL.

The nurse assists with the intubation of an 80-kg client who will receive mechanical ventilation with positive end-expiratory pressure (PEEP) ventilation. When monitoring the client, the nurse ensures that which settings are maintained? 1 Fio2 as high as possible 2 Oxygen flow rate of 20 L/min 3 PEEP pressure between 5 and 15 cm H2O 4 Tidal volume of 400 mL

-Assess the client's color and respirations. - Confirm alarms and ventilator settings -Ensure that the tube cuff is inflated and is in the proper position. - Listen for bilateral breath sounds. The first priority when caring for a critically ill client is to assess airway and breathing. Alarm settings should be confirmed each shift, more frequently if necessary. Confirming that the client cannot speak ensures that air is going through the endotracheal tube and not around it. Auscultating for equal bilateral breath sounds assists in confirming that the tube is above the carina. Having visitors remain with the client may promote comfort and prevent confusion. Routine tracheostomy care is performed according to schedule, not necessarily as part of an initial assessment.

The nurse coming on shift prepares to perform an initial assessment of a sedated ventilated client. Which are priorities for the nurse to carry out? Select all that apply. 1 Ask visitors to leave. 2 Assess the client's color and respirations. 3 Confirm alarms and ventilator settings. 4 Ensure that the tube cuff is inflated and is in the proper position. 5 Listen for bilateral breath sounds. 6 Provide routine tracheotomy and endotracheotomy and mouth care.

- Dizziness and fainting - Inspiratory chest pain Syncope, hypotension, and fainting are symptoms associated with PE. Sharp, pleuritic, inspiratory chest pain is also characteristic of PE. Sudden, not gradual, SOB occurs with PE. Productive cough is associated with infection; PE typically causes a dry cough. Pink, frothy sputum is characteristic of pulmonary edema; PE may cause hemoptysis.

The nurse is assessing a client with possible pulmonary embolism (PE). For which symptoms should the nurse assess? Select all that apply. 1 Dizziness and fainting 2 Shortness of breath (SOB) worsening over the last 2 weeks 3 Inspiratory chest pain 4 Productive cough 5 Pink, frothy sputum

Position the client in a semi-Fowler's position and continue to monitor symptoms Coughing and difficulty clearing secretions are early signs of possible obstruction; the nurse should monitor the client closely and position the client in a semi-Fowler's position. Stridor is a late sign and signifies an emergency requiring racemic epinephrine and possible reintubation. Suctioning the client may increase irritation and cause increased swelling of the airway.

The nurse is caring for a client who has recently been extubated following ventilatory support. The nurse notes that the client is hoarse, has a cough, and has difficulty clearing secretions. Which action is correct? 1 Notify the Rapid Response Team that the client may need to be reintubated. 2 Notify the provider and request an order to administer racemic epinephrine. 3 Position the client in a semi-Fowler's position and continue to monitor symptoms. 4 Suction the client to remove secretions and encourage deep-breathing

Listen to the client's breath sounds A typical reason for the high pressure alarm to sound is the need for suctioning or tension pneumothorax. The nurse should begin the assessment with the client, not with the ventilator. Although an excessively high tidal volume could contribute to sounding of the high-pressure alarm, assessment always begins with the client. The professional nurse possesses the skill to assess ventilator alarms; waiting for the respiratory therapist delays intervention.

The nurse is caring for a client who is receiving mechanical ventilation and hears the high-pressure alarm. Which action should the nurse take first? 1 Check the ventilator alarm settings. 2 Assess the set tidal volume. 3 Listen to the client's breath sounds. 4 Call the respiratory therapist.

Hypoxemia related to ventilation-perfusion mismatch Restoring adequate oxygenation and tissue perfusion takes priority when a client presents with a PE. Although nutrition must be addressed, priorities include airway, breathing, and circulation. The client has a leukocytosis related to lung inflammation; leukopenia places clients at risk for infection, but this is not the priority at this time. Education as to the cause of PE must be postponed until oxygenation and hemodynamic stability occur.

The nurse is developing a plan of care for a client with pulmonary embolism (PE). Which client problem does the nurse establish as the priority? 1 Inadequate nutrition related to food-drug interactions and anticoagulant therapy 2 Potential for infection related to leukocytosis 3 Hypoxemia related to ventilation-perfusion mismatch 4 Insufficient knowledge related to the cause of PE

Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3. The international normalized ratio (INR), a measurement of anticoagulation with warfarin, is in the therapeutic range between 2 and 3. Enoxaparin (Lovenox) is a low-molecular-weight heparin that is usually given by the subcutaneous route. Heparin and warfarin are overlapped until the INR is in the therapeutic range, then the heparin can be discontinued. Fresh frozen plasma is used as an antidote for anticoagulant therapy, not platelets.

The nurse is overseeing a nursing student who is administering medications to a group of clients with pulmonary disorders. Which statement by the student nurse indicates a correct understanding about thrombolytic therapy? 1 "You will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days." 2 "Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3." 3 "Once the health care provider orders warfarin (Coumadin), we will discontinue the intravenous heparin." 4 "If bleeding develops, we will give you platelets to reverse the anticoagulant."

Paralysis and sedatives help decrease the demand for oxygen Paralytics and sedation decrease oxygen demand. Sedation is needed more for its effects on oxygenation than to prevent the client from ripping out the endotracheal tube. Suctioning is performed to maintain airway patency. Minimizing fluids while administering diuretics leads to better outcomes.

The nurse is teaching the family of a client who is receiving mechanical ventilation. Which statement reflects appropriate information that the nurse should communicate? 1 "Sedation is needed so your loved one does not rip the breathing tube out." 2 "Suctioning is important to remove organisms from the lower airway." 3 "Paralysis and sedatives help decrease the demand for oxygen." 4 "We are encouraging oral and IV fluids to keep your loved one hydrated."

25 year old woman who frequently flies to different countries People who engage in prolonged and frequent air travel are at higher risk for PE. A 67-year-old man who works on a farm is not at high risk because he has an active lifestyle. A heart attack is usually caused by a thrombus or occlusion of the coronary arteries, not of the legs; if on prolonged bedrest, the client's risk is increased. PE is a clotting disorder, not a bleeding disorder.

Which client has the highest risk for developing a pulmonary embolism (PE)? 1 25-year-old woman who frequently flies to different countries 2 67-year-old man who works on a farm 3 45-year-old man admitted for a heart attack 4 23-year-old woman with a bleeding disorder

54-year-old who is mechanically ventilated and has tracheal deviation The 54-year-old client is showing signs of a tension pneumothorax that could lead to decreased cardiac output and shock if not addressed promptly. The 40-year-old client has intermittent adventitious breath sounds, but is not in immediate danger or distress. The 57-year-old client has mild discomfort, but is not in danger of a life-threatening situation. The 60-year-old client has mild tachypnea, but is not in immediate distress or danger.

Which client needs immediate attention by the nurse? 1 40-year-old who is receiving continuous positive airway pressure (CPAP) and has intermittent wheezing 2 54-year-old who is mechanically ventilated and has tracheal deviation 3 57-year-old who was recently extubated and is reporting a sore throat 4 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24

Client with aspiration pneumonia Aspiration of acidic gastric contents is a risk for ARDS. Clients with DKA may develop metabolic acidosis, but not ARDS, which develops in lung injury. Atrial fibrillation does not cause lung injury unless embolization occurs. Acute kidney failure results in metabolic acidosis, not in acute lung injury.

Which critically ill client has the greatest risk for developing acute respiratory distress syndrome (ARDS)? 1 Client with diabetic ketoacidosis (DKA) 2 Client with atrial fibrillation 3 Client with aspiration pneumonia 4 Client with acute kidney failure

Tension pneumothorax PEEP is used to prevent the alveoli from collapsing at the end of expiration. The most serious side effect of PEEP is tension pneumothorax, in which the alveoli rupture and air accumulates in the pleura. Infection is not associated with application of PEEP. PEEP is used for prevention of ventilatory failure. PEEP does not affect the clotting mechanism of the body; pulmonary embolism is not a side effect associated with PEEP.

Which is a serious side effect associated with positive end-expiratory pressure (PEEP)? 1 Lung infection 2 Ventilatory failure 3 Pulmonary embolism 4 Tension pneumothorax

- Age 72 years -Admission weight of 290 - Presence of a central venous catheter

Which risk factors increase a client's risk for venous thromboembolism that may progress to a pulmonary embolism? Select all that apply. 1 Age 72 years 2 Admission weight of 290 lb (131.8 kg) 3 Ability to ambulate with assistance of one person 4 Presence of a central venous catheter 5 Nonsmoker