Pulmonary Embolism

A client scheduled for surgery is being instructed in leg exercises and the pneumatic compression device. The nurse includes these instructions to decrease which postoperative complication? A) Infection B) Delayed wound healing C) Contractures D) Deep vein thrombosis

D) Deep vein thrombosis Rationale: The best care for a pulmonary embolism (PE) is prevention. Since surgical clients have an increased risk of developing a PE postoperatively, instructions should include ways to encourage movement, such as leg exercises, and the need for pneumatic compression devices to maintain lower extremity circulation and prevent the development of a deep vein thrombosis. Exercises and pneumatic compression devices do not prevent infection, encourage wound healing, or prevent contractures.

The nurse is caring for a child with a fractured femur who complains of sudden chest pain and difficulty breathing. Which test would the nurse question if it was ordered by the physician? A) D-dimer test B) V/Q scans C) Computerized tomography pulmonary angiography D) Magnetic resonance pulmonary angiography

A) D-dimer test Rationale: Although V/Q scans, computerized tomography pulmonary angiography, and magnetic resonance pulmonary angiography are useful in diagnosing children with PE, the D-dimer test is not. Therefore, if the physician ordered a D-dimer test, the nurse may need to question this order.

A client is diagnosed with a thrombotic pulmonary embolus (PE). Which manifestation is least likely to be consistent with this diagnosis? A) Difficulty breathing and decreased level of consciousness B) Heightened sense of apprehension and anxiety C) Presence of rapid breathing and heart rates D) Difficulty breathing and increasing shortness of breath

A) Difficulty breathing and decreased level of consciousness. ​Rationale: Decreased level of consciousness is not expected with a thrombotic PE. Expected findings include rapid breathing and heart​ rate, sense of apprehension and​ anxiety, difficulty​ breathing, and shortness of breath.

A client had a vena cava filter inserted. Which condition most likely indicates a complication? A) Edema in bilateral lower extremities B) Shortness of breath C) Productive cough D) Chest pain

A) Edema in bilateral lower extremities Rationale: Edema in bilateral lower extremities may indicate the filter has become clogged with emboli from the legs. Chest​ pain, productive​ cough, and shortness of breath are expected due to the diagnosis of a pulmonary embolism.

The nurse is planning to assess a client with PE. Which factor should the nurse assess during the health history portion of the assessment? SATA A) Recent surgeries B) Quality of apical pulse C) Current medications D) History of clots E) Degree of edema

A, C, D Rationale: Current​ medications, history of deep vein thrombosis​ (DVT), and recent surgical history are factors assessed during the health history portion of the nursing assessment. The degree of edema and apical pulse quality are assessed during the physical exam portion of the nursing assessment.

The nurse is preparing to discharge a client diagnosed with a PE. Which instruction should the nurse include in the teaching? SATA A) Not using aspirin or other OTC meds unless approved by the healthcare provider B) Strategies for smoking reduction C) Using a soft bristled toothbrush D) Wearing a medic alert bracelet for anticoagulant use. E) Maintaining scheduled lab testing to ensure effective anticoagulant therapy.

A, C, D, E Rationale: Smoking should be​ stopped, not reduced. A​ soft-bristled toothbrush will reduce the risk of bleeding. A medic alert bracelet is essential in case of an emergency when the client cannot inform healthcare personnel. Scheduled laboratory testing is essential to avoiding complications and ensuring the anticoagulant therapy is effective. Aspirin and other​ over-the-counter medications can increase the risk of bleeding and should be approved by the healthcare provider.

The nurse is planning to teach a client about a pulmonary angiogram. Which statement should the nurse include in the teaching? SATA A) "This procedure uses radioisotopes to help diagnose PE." B) "This procedure involves the use of x-ray." C) "This procedure involves contrast injected into the pulmonary arteries." D) "This procedure involves inhaling a gas that measures ventilation." E) "This procedure involves the placement of an IV"

B, C, E ​Rationale: A pulmonary angiography involves an IV injection of contrast​ dye, which is injected into the pulmonary arteries and is illuminated on an​ x-ray. The ventilation part of the​ ventilation-perfusion (V/Q) lung scan involves the inhalation of a​ radio-tagged gas that measures ventilation.

The nurse is reviewing the lab results of a client diagnosed with a PE and notes that the D-dimer is elevated. Which shold the nurse identify as the cause of this elevation? A) D-dimer indicates inflammation in the vessel that contains a blood clot. B) D-dimer indicates increased coagulation associated with a blood clot C) D-dimer is a portion of fibrin formed during lysis of a blood clot. D) D-dimer is a portion of protein synthesized during the formation of a blood clot.

C) D-dimer is a portion of fibrin formed during lysis of a blood clot. Rationale: D-dimer is a portion of fibrin formed during lysis of a blood clot and is elevated in a client with a pulmonary embolism. The other answer choices are incorrect.

The nurse is planning care for a newly admitted client diagnosed with PE. The nurse anticipates the client will need anticoagulant therapy. What is true regarding this therapy for the treatment of this condition? A) It's considered second-line treatment B) Major hemorrhage is common C) Heparin and warfarin are usually initiated at the same time. D) Heparin alters the synthesis of Vitamin K-dependent clotting factors, preventing further clots.

C) Heparin and warfarin are usually initiated at the same time. Rationale: Heparin and warfarin are usually initiated at the same time for the treatment of PE. Anticoagulant therapy is the standard first-line treatment of PE. While major hemorrhage is uncommon, bleeding may occur. Warfarin (Coumadin), not heparin, alters the synthesis of vitamin K-dependent clotting factors.

The nurse is caring for a woman at 28 weeks of gestation who has increasing edema in the bilateral lower extremities, shortness of breath, and tachycardia. Which treatment should the nurse expect? A) Admitting the client for bedrest due to venous thrombosis. B) Beginning fibrinolytic therapy. C) Performing a bilateral venous compression ultrasound of the lower extremities. D) Continuing to monitor the client.

C) Performing a bilateral venous compression ultrasound of the lower extremities. Rationale: The symptoms are common in normal pregnancies. There is no reason to begin therapy or place the client on bedrest.​ However, because the edema has been​ progressing, a bilateral venous compression ultrasound of the lower extremities will be performed to rule out venous thrombosis and possible pulmonary embolism.

The nurse is preparing to discharge a client recovering from a PE. Which topics should the nurse include in the learning session? SATA A) Limit the use of OTC meds B) Diet to include green leafy vegetables C) Symptoms of recurrence D) Anticoagulant administration schedule E) Resume normal activity level

C, D C) Symptoms of recurrence D) Anticoagulant administration schedule Rationale: The nurse should instruct the client in symptoms of bleeding or recurrence of a PE and the schedule for anticoagulation administration. The client being discharged after treatment for a PE needs to be instructed in avoiding all over-the-counter medications, avoiding green leafy vegetables because of vitamin K, and adhering to the physician's prescribed activity level.

The nurse provided discharge instructions to the parents of a 10-year-old child diagnosed with a PE. Which parent statement requires the nurse to intervene? A) "I will monitor my child for shortness of breath." B) "I will monitor my child for chest pain." C) "I will monitor my child for sudden cough." D) "I will monitor my child for signs of blood when coughing."

D) "I will monitor my child for signs of blood when coughing." Rationale: Hemoptysis is not a common symptom for children with pulmonary embolism. Children more often present with chest​ pain, cough, and shortness of breath.

The nurse is caring for a client who had an internal fixation of the right femur. Which clinical manifestation indicates a complication? A) A rash of small red bumps on the chest B) Discomfort in the right lower extremity when repositioning C) Slight swelling of the right toes D) Slight pain at the pin site

A) A rash of small red bumps on the chest Rationale: Petechiae on the chest and arms are a characteristic manifestation of a fat​ emboli, a risk with long bone​ fractures, especially the femur. Slight pain at the pin​ site, slight swelling of the toes on the affected​ side, and discomfort with repositioning are expected.

The nurse is providing discharge instructions to an older adult client who is going home after having a total knee replacement. Which should the nurse include in the discharge teaching to decrease the client's risk for developing a thrombosis or PE? SATA A) Place pillows under the knees when in bed B) Use compression stockings C) Limit ambulation D) Limit fluids E) Continue with leg exercises

B) Use compression stockings E) Continue with leg exercises Rationale: A client being discharged after having orthopedic surgery is at increased risk for PE. The nurse should instruct the client to use compression stockings and continue with leg exercises to reduce the risk of deep vein thrombosis formation. The client should avoid placing pillows under the knees, be encouraged to ambulate, and be well hydrated unless another physiological condition exists that would necessitate a fluid restriction.

A client is diagnosed with PE but has no hx of blood clots. Which should the nurse identify as a likely source of the PE? SATA A) Water B) Fat C) Amniotic Fluid D) Tumors E) Air

B, C, D, E Fat Tumors amniotic fluid Air ​Rationale: Additional sources of PE include​ fat, tumors, amniotic​ fluid, and air. Water is not considered a source of pulmonary emboli.

The nurse is planning care for a client diagnosed with a PE and being treated with anticoagulation therapy. Which intervention should the nurse include? A) Administering a stool softener as ordered B) Auscultating heart sounds q 12 hrs C) Applying 15 minutes of pressure to arterial puncture sites. D) Keeping vitamin K available as an antidote for heparin

A) Administering a stool softener as ordered Rationale: The nurse will administer a stool softener as ordered to prevent client​ straining, which increases the risk of bleeding of hemorrhoids in a client with a pulmonary embolism who has been treated with anticoagulants. The nurse should assess heart sounds every 2-4 ​hours, not every 12 hours. The nurse should apply at least 30 minutes of pressure to arterial puncture sites in a client who has been treated with anticoagulant therapy. Vitamin K is the antidote for warfarin​ (Coumadin), not heparin.

The nurse is concerned that a client admitted for a total hip replacement is at risk for thrombus formation. Which assessment finding caused the nurse to draw this conclusion? A) BMI of 35.8 B) Former smoker C) BP 132/88 D) Age: 45

A) BMI of 35.8 Rationale: Risk factors for the development of thrombus formation that could lead to a pulmonary embolism include obesity, orthopedic surgery, myocardial infarction, heart failure, and advancing age. The BMI of 35.8 falls into the category of obese, which would increase the client's risk of developing a thrombus and possible pulmonary embolism. The client's age, status as a former smoker, and blood pressure would not have as significant an impact on the development of a thrombus as the client's weight.

A client with a hx of venous thrombosis is suspected of having a PE. Which diagnostic test to confirm the diagnosis should the nurse question? A) Cardiac enzymes B) Chest CT with contrast C) D-dimer D) Lung scan

A) Cardiac enzymes ​Rationale: Cardiac enzymes are used to detect damage to cardiac tissue. A​ D-dimer is elevated in the presence of a thrombus. A lung scan or chest CT with contrast will enable visualization of the embolism.

Which is the principle test to confirm the diagnosis of pulmonary embolism? A) Chest CT w/contrast B) Pulmonary angiography C) Lung scan D) D-dimer

A) Chest CT with contrast ​Rationale: Chest CT with contrast is considered the primary diagnostic test in clients suspected of having a pulmonary embolism​ (PE). The other answer choices may be used in the collaborative care of the client with​ PE; however, they are not considered the primary diagnostic tests for this condition.

The nurse is caring for a client with a suspected PE. Which diagnostic test should the nurse expect to be ordered? A) D-dimer B) CBC C) White blood cell count D) Arterial blood gas

A) D-dimer ​Rationale: The​ D-dimer laboratory test is used primarily to help diagnose pulmonary embolism​ (PE). D-dimer is a portion of fibrin formed during lysis of a blood clot. While complete blood​ count, white blood cell​ count, and arterial blood gas may be used in the collaborative treatment of a client with​ PE, these are not used primarily to help in the diagnosis of the condition.

The nurse is caring for a pregnant woman with a suspected PE without DVT. With regard to diagnostic tests to confirm the diagnosis what should the nurse anticipate being ordered for the client? SATA A) V/Q Scan B) Computerized tomography pulmonary angiography C) Chest X-ray D) Non-stress test

A, B, C Rationale: For pregnant women who have a suspected pulmonary embolism without DVT, a chest x-ray should be performed. If the chest x-ray is normal, a V/Q scan should be performed, followed by computerized tomography pulmonary angiography if the V/Q scan is inconclusive. If the chest x-ray is abnormal, the computerized tomography pulmonary angiography should be performed first rather than the V/Q scan. A Doppler ultrasound and non-stress test may provide information of fetal wellbeing, but are not used to diagnose a PE.

Which client shold the nurse recognize as having the greatest risk of DVT or PE? SATA A) a 24 year old male in a traction device after femur fracture B) A 55 year old female scheduled for a hysterectomy C) A 32 year old female with an asthma exacerbation D) A 65 year old male recovering from myocardial infarction E) A 19 year old pregnant female with gestational diabetes.

A, B, D, E Rationale: Pregnancy, fracture of long bones​ (especially the​ femur), reproductive​ surgery, and myocardial infarction are all factors that increase the risk of the development of DVT or PE. Asthma alone is not a risk factor for these conditions.

The nurse is caring for a client who is receiving heparin therapy. Which intervention is most important to promote safety? SATA A) Avoiding invasive procedures B) Maintaining adequate fluid intake C) Keeping Vitamin K available D) Assessing the client frequently for signs of bleeding E) Keeping protamine sulfate available.

A, B, D, E ​Rationale: Vitamin K is needed to reverse the effects of​ warfarin, not heparin. Avoiding invasive procedures reduces the risk of bleeding. Maintaining adequate fluid intake will reduce constipation and the risk of bleeding from hemorrhoids. Protamine sulfate should be kept available to reverse the effects of heparin in case of bleeding. The client should be assessed frequently for overt or covert signs of bleeding.

A client who is diagnosed with a PE is preparing for discharge. Which instruction should the nurse include in the teaching? A) "You should stop warfarin therapy at least 1 week prior to going to the dentist." B) "Warfarin therapy will not be fully effective for 5 to 7 days from when it was started." C) "Heparin therapy will need to be continued for at least 3 weeks while taking warfarin." D) "Fibrinolytic therapy will be started by the home care nurse."

B) "Warfarin therapy will not be fully effective for 5 to 7 days from when it was started." ​Rationale: Warfarin takes 5-7 days to become fully effective. The client will remain on heparin until that time. Fibrinolytic therapy is given in the hospital to break up large pulmonary emboli. The dentist should be advised that the client is on​ warfarin, but the medication should not be stopped. Heparin will not be continued for 3​ weeks, only 5-7 days until the warfarin is fully effective.

The nurse is caring for a client with suspected PE. The client's clinical manifestations include hypoxia, dyspnea, productive cough, and chest pain. Which clinical therapy should the nurse question? A) Repositioning the client into high-Fowler position B) Encouraging the client to ambulate 100 yards with assistance C) Administering O2 D) Encouraging the use of an incentive spirometer.

B) Encouraging the client to ambulate 100 yards with assistance. ​Rationale: Bedrest, rather than​ ambulation, is recommended for suspected PE. Administering​ oxygen, encouraging the use of an incentive​ spirometer, and placing the client in​ high-Fowler position will facilitate air exchange

The nurse is providing care to several client on a medical-surgical unit. Which client is at highest risk for a non-thrombotic PE? A) The client who is receiving IV pain meds B) The client who is post-op from a femur fracture repair C) The client with a primary abdominal tumor D) The client who uses IV illicit drugs

B) The client who is post-op from a femur fracture repair. Rationale: Fat emboli are the most common nonthrombotic pulmonary emboli. A fat embolism usually occurs after fracture of long bone (typically the femur) releases bone marrow fat into the circulation. The other clients may be at risk for PE; however, they are incorrect choices for the most common cause of nonthrombotic pulmonary emboli.

The nurse is providing teaching about a long-term anticoagulant therapy to a client recovering from a PE. Which client statement indicates that the instruction has been effective? A) "I will expect bloody sputum when I brush my teeth." B) "I need to use a soft toothbrush and an electric razor to avoid injuries." C) "I need to eat a well balanced diet with green salads." D) "I can expect to be bruised, since this is normal."

B)" I need to use a soft toothbrush and an electric razor to avoid injuries." Rationale: Instruction on anticoagulant therapy should include the need to avoid injury, use a soft toothbrush, and use an electric razor. The client should avoid green salads because of the vitamin K content. The statements about bruising being normal and expecting bloody sputum mean the client is in need of additional instruction on anticoagulant therapy

The nurse assessed a client who is recovering from a PE. Which finding requires the nurse to follow up? A) Slight pain when coughing B) Capillary refill less than 3 seconds bilaterally C) Anxiety and apprehension D) A productive cough

C) Anxiety and apprehension ​Rationale: Goals for care of the client with pulmonary embolism include maintaining adequate oxygenation for tissue​ perfusion, pain controlled to facilitate rest and​ recovery, and ability to maintain and clear airway. Continued anxiety and apprehension does not meet these goals and should be followed up on.

What increases after an embolus has become trapped in the pulmonary microvasculature? A) Perfusion B) Ventilation C) Dead space D) Alveolar surfactant

C) Dead space Rationale: Dead space, or areas of the lung that are ventilated but not perfused, increases. Both perfusion and ventilation are decreased after a pulmonary embolism. Alveolar surfactant also decreases, increasing the risk for atelectasis (collapsed lung).

The nurse is caring for a client who is recovering from a hysterectomy. Which clinical manifestation supports that the client is experiencing a PE? A) Nausea B) Decreased urine output C) Dyspnea and chest pain D) Activity intolerance

C) Dyspnea and chest pain Rationale: The most common symptoms of PE are dyspnea and pleuritic chest pain. Other manifestations include anxiety, cough, diaphoresis, hemoptysis, tachycardia, tachypnea, crackles, and a low-grade fever. Nausea, decreased urine output, and activity intolerance are not clinical manifestations of a PE

A client diagnosed with a PE has a reduction in arterial oxygen saturation level and dyspnea. Which is the priority nursing diagnosis for this client? A) Ineffective tissue perfusion B) Anxiety C) Impaired gas exchange D) Impaired physical mobility

C) Impaired gas exchange Rationale: A reduction in arterial oxygen saturation level and dyspnea indicate the client is experiencing impaired gas exchange. This would be the priority for the client at this time. The client may have ineffective tissue perfusion; however, this is not the priority. The client may be experiencing anxiety; however, this is not the priority at this time either. There is not enough information to determine whether the client is at risk for impaired mobility.

The nurse is planning care for a client with a PE. Which nursing action would assist with the client's decrease in cardiac output? A) Provide oxygen B) Keep protamine sulfate at the bedside C) Monitor pulmonary arterial pressures D) Assess for bleeding

C) Monitor pulmonary arterial pressures Rationale: The client with a pulmonary embolism and decreased cardiac output is at risk for developing right heart failure. The nurse should monitor pulmonary arterial pressures. Oxygen would be appropriate for the client with impaired gas exchange. Assessing for bleeding and keeping protamine sulfate at the bedside would be appropriate for the client who is taking heparin.

The nurse assesses a client diagnosed with a PE and finds a HR of 118/BPM, RR of 24/BPM, Temp of 104 F, dehydration, and a cough. Which cause should the nurse attribute to these clinical manifestations? A) Blockage of alveoli by thrombus B) Arterial congestion C) Tissue necrosis D) Inflammatory process

D) Inflammatory process Rationale: The inflammatory process is the only cause of all the​ client's clinical manifestations. Blockage of the alveoli by thrombus results in hypoxia that leads to​ restlessness, chest​ pain, dyspnea,​ cyanosis, use of accessory​ muscles, respiratory​ acidosis, tachycardia,​ tachypnea, and a feeling of impending doom. Arterial congestion causes rupture of small​ arterioles, which leads to coarse​ crackles, cough​ (with or without​ blood), and dyspnea. Alveolar collapse related to tissue necrosis and the inflammatory process cause​ hypoxia, dyspnea, productive​ cough, and chest pain.

The nurse is caring for a client who develops dyspnea and chest pain. Which diagnostic finding is consistent with a PE? A) Lack of infiltrates on chest x-ray B) Metabolic alkalosis on arterial blood gas C) Elevated CO2 level found on end-tidal carbon dioxide monitor. D) Tachycardia and nonspecific T-wave changes on EKG

D) Tachycardia and non-specific T-wave changes on EKG Rationale: With PE, tachycardia and nonspecific T-wave changes occur on EKG. Pulmonary infiltration is common on a chest x-ray. The client with a PE will likely have respiratory alkalosis from rapid breathing, not metabolic alkalosis. The end-tidal CO2 (EtCO2) monitor will be decreased, not increased, due to rapid breathing.