Med Surg Exam Pulmonary Embolism

Pulmonary Embolism 1. The nurse is caring for a group of clients on a Telemetry unit. When providing client education, which client will the nurse determine most needs information regarding preventing pulmonary embolism (PE)? a. A woman who frequently flies to Europe (prolonged travel) b. A man who works on a farm c. A man admitted for a myocardial infarction d. A woman with a bleeding disorder 2. The nurse is caring for a group of clients on a medical surgical unit. For which of these individuals does the nurse provide immediate interventions to reduce the risk for pulmonary embolism (PE)? a. A client with diabetes and cellulitis of the leg b. A client receiving IV fluids through a peripheral line c. A client returning from an open reduction and internal fixation of the tibia (orthopedic, GI surgery, gynecology surgery have high risk of DVT and PE due to immobility) d. A client with fluid volume deficit and hypokalemia receiving potassium supplements 3. The nurse is assessing a client with possible pulmonary embolism (PE). For which symptoms consistent with PE will the nurse assess? a. Dizziness and syncope b. Shortness of breath (SOB) worsening over the last 2 weeks c. Inspiratory chest pain d. Productive cough e. Pink, frothy sputum f. Tachycardia (dizziness, syncope, hypotension, and fainting, sharp, pleuritic, inspiratory chest pain, hemoptysis, and tachycardia are characteristic of PE) 4. A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? Select all that apply a. Vomiting b. Cyanosis c. Rapid heart rate d. Dyspnea e. Paradoxical chest movement f. Crackles in the lung fields 5. 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? a. Inadequate nutrition related to food–drug interactions with anticoagulant therapy b. Risk for infection related to leukocytosis c. Hypoxemia related to ventilation–perfusion mismatch d. Insufficient knowledge related to the cause of PE 6. The nurse is caring for a patient with a postoperative complication of pulmonary embolism (PE). The nurse determines the patient has adequate perfusion by which data? Select all that apply a. b. c. d. e. f. Pulse oximetry of 95% Patient’s subjective desire to go home Arterial blood gas, pH of 7.28 Absence of pallor or cyanosis Mental status at patient’s baseline Palpable peripheral pulses 7. When caring for a client with a pulmonary embolism, which priority intervention will the nurse use to reduce anxiety? a. Remain with the client and provide oxygen in a calm manner. b. Have the client breathe into a brown paper bag using pursed lips. c. Offer the client a mild sedative. d. Allow a family member to remain in the room. 8. What are the nursing interventions to decrease risk for pulmonary embolism of postoperative patients? a. Start passive and active ROM exercises for the extremities b. Ambulate postoperative patients soon after surgery c. Use anti embolism devices postoperatively d. Elevate legs in an extended position e. Change patient position every 4-5hrs (change position every 2 hours) 9. A client has been admitted with a diagnosis of pulmonary embolism and is receiving heparin infusion. What safety priority does the nurse include in the plan of care? a. Teach the client to avoid using dental floss. b. Monitor the platelet count daily. c. Ensure adequate staffing for the unit. d. Notify radiology of an impending scan. 10. The nurse is reviewing the medical record of a client with pulmonary embolism (PE). What priority does the nurse set after reviewing the blood gas result below? pH 7.46, PaCO2 30 mm Hg, HCO3– 26 mEq/L (26 mmol/L), PaO2 62 mm Hg a. Have the client breathe rapidly and deeply b. Apply oxygen c. Administer sodium bicarbonate d. Collaborate with the provider to increase the pH 11. Take anticoagulation therapy as prescribed and keep appointments for follow-up laboratory test sustained a pulmonary contusion in a motor vehicle crash develops a pulmonary embolism. What is the priority nursing concern with this client? a. Excess fluid volume b. Acute pain c. Ineffective breathing pattern d. Activity intolerance 12. The perioperative nurse is writing a care plan for a client who has returned from surgery 2 hours ago. Which measure should the nurse implement to most decrease the client’s risk of developing pulmonary emboli (PE)? a. b. c. d. Early ambulation Increased dietary intake of protein Maintaining the client in a supine position Administering aspirin with warfarin 13. The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements? a. “The client will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days.” b. “Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3.” c. “Once the health care provider orders warfarin (Coumadin), the intravenous heparin can be discontinued.” d. “If bleeding develops, we will give platelets to reverse the anticoagulant.”