Question 1
A 65-year-old male with a history of deep vein thrombosis is admitted to the emergency department with sudden onset of dyspnea, tachypnea, and chest pain that worsens with deep breathing. His oxygen saturation is 92% on room air. A CT angiogram of the chest reveals a pulmonary embolism. What is the priority nursing intervention for this patient? A. Administer a beta-blocker. B. Initiate oxygen therapy. C. Start an IV infusion of normal saline. D. Encourage coughing and deep breathing exercises. E. Administer oral aspirin.
Rationale: Oxygen therapy is the priority intervention for a patient with pulmonary embolism (PE) to address hypoxemia and improve oxygen saturation levels. Administering a beta-blocker is not appropriate as it doesn’t address the immediate concern of hypoxemia and may worsen the patient’s condition by reducing cardiac output. IV infusion of normal saline and coughing and deep breathing exercises are supportive but not the primary interventions for acute PE. Aspirin is not the first-line treatment for PE, which requires anticoagulation or thrombolytic therapy.
Question 2
A nurse is caring for a patient diagnosed with a pulmonary embolism. The patient is stable, on anticoagulation therapy, and asks when they will be able to resume normal activities. What is the best response by the nurse? A. “You should avoid all physical activity for the next few months.” B. “Normal activities can be resumed within a few days as long as you feel up to it.” C. “Activity levels should be gradually increased under the guidance of your healthcare provider.” D. “You will not be able to resume normal activities but can live a full life with modifications.” E. “It is safe to resume high-intensity exercises immediately.”
Rationale: After a pulmonary embolism, it’s crucial to gradually increase activity levels under the supervision of a healthcare provider to monitor for any complications or worsening of symptoms. Immediate resumption of normal or high-intensity activities could be harmful and increase the risk of another PE. Avoiding all physical activity is also not recommended as it can lead to deconditioning and worsen overall health. The statement encourages a balanced approach to recovery and emphasizes the importance of medical guidance.
Question 3
Which of the following assessments is most critical for a nurse to monitor in a patient with a recent diagnosis of pulmonary embolism? A. Urine output B. Skin turgor C. Respiratory rate and effort D. Capillary refill time E. Bowel sounds
Rationale: Monitoring respiratory rate and effort is critical in patients with pulmonary embolism (PE) because PE can cause respiratory distress, hypoxemia, and increased work of breathing. Urine output, skin turgor, capillary refill time, and bowel sounds are important assessments but do not directly reflect the acute respiratory compromise that can occur with PE. Focusing on respiratory assessments helps in identifying deterioration or improvement in the patient’s condition and guides the need for interventions such as oxygen therapy or escalation of care.
Question 4
A nurse is providing discharge instructions to a patient who has been treated for pulmonary embolism. Which statement by the patient indicates a need for further teaching? A. “I will need to wear compression stockings daily.” B. “I should avoid long periods of sitting during my flight next week.” C. “I will monitor for any signs of bleeding while taking anticoagulants.” D. “I can stop taking my anticoagulation medication if I start feeling better.” E. “I will follow up with my healthcare provider as scheduled.”
Rationale: This statement indicates a misunderstanding about anticoagulation therapy, which is crucial for preventing further clots after a pulmonary embolism. Patients should never stop taking anticoagulant medication without consulting their healthcare provider, even if they feel better, as the risk of another PE or deep vein thrombosis remains. Wearing compression stockings, avoiding prolonged immobility, monitoring for signs of bleeding, and regular follow-up with healthcare providers are all appropriate and important parts of post-PE care and management.
Understanding the Pulmonary Embolism: NCLEX Priority Questions
Question 5
A nurse is reviewing the laboratory test results for a patient with a suspected pulmonary embolism. Which diagnostic test is most specific in confirming the presence of a pulmonary embolism? A. D-dimer B. Complete blood count (CBC) C. Arterial blood gas (ABG) D. CT pulmonary angiography (CTPA) E. Chest X-ray
Rationale: CT pulmonary angiography (CTPA) is the most specific diagnostic test for confirming the presence of a pulmonary embolism. It provides detailed images of the blood vessels in the lungs and can directly visualize a clot. While a D-dimer test can suggest the presence of a clot, it is not specific to pulmonary embolism and can be elevated in many other conditions. A Complete Blood Count (CBC) and Arterial Blood Gas (ABG) analysis provide supportive information but do not confirm PE. A Chest X-ray is often normal in cases of PE and is not diagnostic for the condition but can help rule out other causes of symptoms.
Understanding Pulmonary Embolism: NCLEX Delegation Questions
Question 6
During a health education session for a patient who has recovered from a pulmonary embolism, the nurse discusses lifestyle modifications to prevent future events. Which of the following recommendations is the most appropriate? A. “Limit fluid intake to avoid fluid overload.” B. “Increase protein intake to enhance blood clotting.” C. “Maintain a sedentary lifestyle to conserve energy.” D. “Avoid smoking and perform regular exercise.” E. “Take over-the-counter cough medications regularly.”
Rationale: Avoiding smoking and engaging in regular exercise are key lifestyle modifications that can help prevent future pulmonary embolism events by improving cardiovascular health and circulation. Smoking is a major risk factor for blood clot formation, and regular exercise helps prevent deep vein thrombosis by promoting blood flow. Limiting fluid intake, increasing protein intake specifically to enhance clotting, maintaining a sedentary lifestyle, and regular use of over-the-counter cough medications are not recommended strategies for preventing pulmonary embolism and can be harmful or unrelated to the condition.
Understanding Pulmonary Embolism: Causes and Symptoms
Question 7
A patient with a known history of pulmonary embolism is scheduled for elective surgery. What is the most important information for the nurse to communicate to the surgical team prior to the procedure? A. The patient’s preference for post-operative pain management. B. The patient’s history of pulmonary embolism. C. The patient’s dietary restrictions. D. The patient’s daily routine activities. E. The patient’s favorite relaxation techniques.
Rationale: Communicating the patient’s history of pulmonary embolism to the surgical team is critical because it significantly increases the risk of perioperative venous thromboembolism. This information will influence the choice of prophylactic measures, such as the use of anticoagulants or mechanical devices to prevent deep vein thrombosis, and the monitoring strategy during and after the procedure. While the patient’s preferences for pain management, dietary restrictions, routine activities, and relaxation techniques are important for holistic care, they do not directly impact the risk of thromboembolic events in the context of surgery as significantly as the history of PE does.
NCLEX Practice Questions: Understanding Pulmonary Embolism Causes and Symptoms
Question 8
A nurse is assessing a patient who was recently admitted with a pulmonary embolism. Which symptom would indicate that the patient’s condition is worsening? A. Decreased appetite. B. Sudden onset of sharp, stabbing chest pain. C. Improvement in dyspnea after starting anticoagulation therapy. D. A decrease in heart rate from 100 bpm to 85 bpm. E. An increase in urinary frequency.
Rationale: A sudden onset of sharp, stabbing chest pain in a patient with a pulmonary embolism may indicate an increase in the size of the embolus or the development of another embolus, leading to further obstruction of pulmonary blood flow and increased strain on the heart. This is a sign of worsening condition and requires immediate medical attention.
NCLEX Questions: Focus on Medications for Pulmonary Embolism
Question 9
During a shift assessment, a nurse notes that a patient with a pulmonary embolism has suddenly developed tachypnea, hypoxemia, and a new onset of right ventricular dilation on echocardiography. What does this indicate? A. Expected progression of the disease. B. Improvement in the patient’s condition. C. Risk of developing deep vein thrombosis. D. Massive pulmonary embolism requiring immediate intervention. E. Need for initiation of anticoagulant therapy.
Rationale: The sudden development of tachypnea, hypoxemia, and new onset of right ventricular dilation in a patient with pulmonary embolism indicates a massive PE, which is a life-threatening emergency requiring immediate intervention. These signs suggest significant obstruction of pulmonary blood flow leading to acute right ventricular strain. This condition can rapidly deteriorate and lead to cardiac arrest if not promptly treated. Anticoagulant therapy is necessary for PE management but, in this scenario, more aggressive measures such as thrombolysis or surgical embolectomy may be needed urgently.
NCLEX Focus Exploring Pulmonary Embolism: Causes and Diagnosis
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NCLEX Review: Basic Metabolic Panel Disease Treatments
Question 10
A nurse is teaching a group of nursing students about the prevention of pulmonary embolism. Which of the following is the most effective strategy for prevention? A. Use of incentive spirometry B. Early mobilization after surgery C. Regular administration of aspirin D. Application of heat to lower extremities E. Maintaining a sedentary lifestyle
Rationale: Early mobilization after surgery is recognized as one of the most effective strategies for the prevention of pulmonary embolism (PE) and deep vein thrombosis (DVT). It helps in promoting venous return and reducing the risk of blood clot formation. While incentive spirometry is beneficial for lung expansion and preventing atelectasis, it does not directly prevent PE. Aspirin may be used for cardiovascular prevention but is not the primary prophylaxis for PE. Application of heat to the lower extremities and maintaining a sedentary lifestyle are not recommended strategies for PE prevention and, in the case of a sedentary lifestyle, can actually increase the risk of clot formation.