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Exemplar 16.1: Pulmonary Embolism

Olivia McRitchie 10 preguntas

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Preguntas del test (10)

  1. 1You are tasked with teaching a fellow nursing student about pulmonary embolisms as part of an in class activity.

    Select the information that is correct.
    1. A"The most common thrombi to embolize to pulmonary circulation are thrombi of the deep veins of the calf."
    2. B"Pulmonary embolisms can cause sudden death."
    3. C"More often than not, pulmonary embolisms cause lung tissue infarction."
    4. D"Pulmonary embolisms can lead to systemic hypertension and right ventricular heart failure."
    5. E"The body is usually unable to dissolve the clot."
    6. F"Fat emboli are nonthrombotic. They usually occur after any sort of bone fracture."
  2. 2You are taking care of a 40-year-old female patient following a knee replacement. She is complaining of chest pain, coughing, nervousness, and inability to breathe. You are incredibly concerned because her MAR shows that her first dose of enoxaparin was not administered.

    What might you be looking for when you assess this patient?
    1. ATachycardia
    2. BTachypnea
    3. CCrackles upon auscultation of lungs.
    4. DLow-grade fever
    5. EAn S3 and/or S4 gallop
    6. FDiaphoresis
    7. GCyanosis in fingers, toes, and lips
  3. 3Which of the following is NOT an intervention for a patient experiencing hypoxia due to blockage of alveoli by thrombus?
    1. AAdminister oxygen.
    2. BPlace the patient in high Folwer's position
    3. CPrepare for intubation and mechanical ventilation.
    4. DProcure prescription for 5,000 U of heparin, IV bolus.
    5. EMonitor ABGs and aPTT (or PTT)
    6. FMaintain an environment with minimal sound and minimal light.
    7. GSuction PRN
  4. 4Select the interventions that would be appropriate for a patient whose small arterioles are rupturing due to arterial congestion.
    1. AEducate patient and family about hemoptysis.
    2. BProcure an order for oxygen at a flow rate of 2 mL via nasal cannula.
    3. CPerform suctioning when airway becomes too occluded.
    4. DPosition patient in a high Fowler's position.
    5. EAdminister prescribed antibiotics.
  5. 5You have a patient with alveolar collapse r/t tissue necroses and inflammation and pyrexia r/t the inflammatory process. You've administered oxygen, placed the patient in a high-Fowler's position, and procured sputum for laboratory testing. What other interventions can you enact?
    1. AEncourage the patient to blow into the incentive spirometer 10 times every hour.
    2. BProcure an order for a 5,000 U IV bolus of heparin.
    3. CAdminister 600 mg of acetaminophen.
    4. DAdminister prescribed antibiotics.
    5. EPrepare for possibility of intubation.
  6. 6Drag and drop the correct diagnostic test for the description.

    -[blank_start]Arterial blood gas[blank_end]: Shows hypoxemia (PaO2 <80 mmHg) and respiratory alkalosis (pH >7.45, PaCO2 <38 mmHg) caused by tachypnea and hyperventilation.

    -[blank_start]Perfusion lung scan[blank_end]: Radiotagged albumin is injected IV and distributed in the lungs by pulmonary blood flow. The lungs are then scanned for distribution of isotope; an area of the lung where it cannot be detected is suggestive of occluded blood flow and pulmonary embolism.

    -[blank_start]Chest x-ray[blank_end]: Shows pulmonary infiltration and, sometimes, pleural effusion.

    -[blank_start]Ventilation lung scan[blank_end]: A radiotagged gas is inhaled and the lungs are scanned for gas distribution. When in combination with a perfusion lung scan, it can identify areas of the lung that are ventilated but not perfused.

    -[blank_start]Chest CT with contrast[blank_end]: The PRINCIPAL test used to diagnose PE. Effectively shows large, central pulmonary emboli.

    -[blank_start]Pulmonary angiography[blank_end]: The DEFINITIVE test for PE when other less invasive tests aren't conclusive. A contrast medium is injected into pulmonary arteries so the pulmonary vascular system can be seen on X-ray. Makes it possible to detect very small emboli.

    -[blank_start]Electrocardiography[blank_end]: Ordered to rule out acute MI. Tachycardia and nonspecific T-wave changes are generally associated with PE.

    -[blank_start]ETCO2[blank_end]: Evaluates alveolar perfusion. The normal reading is 35-45 mmHg, but it is decreased when pulmonary perfusion is impaired.

    -[blank_start]Plasma D-dimer levels[blank_end]: Highly specific to presence of a thrombus. Tests for a fragment of fibrin formed during lysis of a blood clot. If elevated, it indicates thrombus formation and lysis.
    1. AArterial blood gas
    2. BPerfusion lung scan
    3. CLung scan
    4. DChest x-ray
    5. EVentilation lung scan
    6. FChest CT with contrast
    7. GPulmonary angiography
    8. HElectrocardiography
    9. IETCO2
    10. JPlasma D-dimer levels
  7. 7You are caring an elderly patient admitted to the ER with a pulmonary embolism. Her daughter is her primary caretaker at home. The elderly patient had a hip replacement just 4 days prior, and was sent home with a prescription for warfarin. You ask her if she took her warfarin and she explained to you that she didn't because her daughter refused to pick up the prescription, stating that it was "dangerous and unnecessary".

    You speak to the daughter and she cries and states the following: "A close, trusted friend told me that warfarin is dangerous because it could cause my mother to bleed out. I looked at a couple websites that she sent me... I honestly didn't know that this would happen!" You assess that the daughter did not have malicious intent, but was uninformed about her mother's medications.

    You decide to educate the daughter. Which of the following statements, made by the daughter, shows that she still needs more teaching?
    1. A"My mother is at risk for pulmonary embolism because she had hip surgery."
    2. B"My mother is now being given an IV of heparin to prevent new clots from forming."
    3. C"My mother was given Coumadin to take for 3 months because it can prevent blood clotting."
    4. D"Major hemorrhage is common with anticoagulant therapy, but it's a necessary risk."
  8. 8Which of the following is NOT a preventative measure that a nurse can enact to prevent DVT and pulmonary embolisms?
    1. AEncouraging ambulation after surgery.
    2. BCompression stocking and/or pneumatic compression devices.
    3. CActive range of motion leg exercises.
    4. DEncouraging the patient to place pillows under the knees.
    5. EEncouraging the patient to ambulate every hour or so.
    6. FTeaching the patient to not cross the legs when sitting.
  9. 9You have a new admit to the ICU. During hand-off, the med-surg RN that took care of the patient reported that she's having trouble breathing, had 10/10 chest pain, felt anxious, and couldn't stop coughing. When the RN took her vital signs, her heart rate was 110 BPM, RR 30 breaths/min, BP 104/66, temp 100.1 Fahrenheit, and SpO2 92%. She had inspiratory and expiratory crackles in her middle right lung. A chest CT on the patient showed a rather large pulmonary embolism, so the doctor has ordered a 5,000 U IV bolus of heparin, followed by a continual heparin infusion at 1,000 U/hr. The doctor has also ordered streptokinase.

    Select interventions you can enact for this patient.
    1. AReassess patient heart sounds, skin color and temp, neck veins, extremities, pulmonary arterial pressure, and respiratory status every 4 hours.
    2. BPlace patient on constant pulse oximetry monitoring.
    3. CKeep the head of the bed between 45 and 90 degrees and the foot of the bed dependent.
    4. DKeep pressure on injection sites for 30 minutes.
    5. EMake sure the patient ambulates every 2 hours.
    6. FAssess the patient for bleeding gums, incisional bleeding, bruising of injection sites, bruising with minor trauma, joint pain, and abdominal pain at the beginning of the shift.
    7. GProcure an order for an arterial line.
    8. HKeep vitamin K readily available.
  10. 10The "antidote" to counteract heparin is protamine sulfate
    1. AVerdadero
    2. BFalso

Información

Descripción
NCLEX (Medical-Surgical) Nursing Test sobre Exemplar 16.1: Pulmonary Embolism, creado por Olivia McRitchie el 08/12/2018.
Idioma
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