Pulmonary Embolism Patients NCLEX Verified A+
A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain, and having a
blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes priority?
a. Assess the clients lung sounds.
b. Not...
A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain, and having a
blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes priority?
a. Assess the clients lung sounds.
b. Notify the Rapid Response Team.
c. Provide reassurance to the client.
d. Take a full set of vital signs. ✔️✔️B ~ This client has manifestations of a pulmonary embolism, and
the most critical action is to notify the Rapid Response Team for speedy diagnosis and treatment. The
other actions are appropriate also but are not the priority.
What is a pulmonary embolism?
✔️✔️ A pulmonary embolism (PE) is a blockage in one of the pulmonary arteries in the lungs, typically
caused by blood clots that travel from the legs or other parts of the body.
Why does a pulmonary embolism occur?
✔️✔️ It occurs when a blood clot, usually from deep veins in the legs (deep vein thrombosis), travels
to the lungs, blocking a pulmonary artery.
What are common symptoms of pulmonary embolism?
✔️✔️ Symptoms often include sudden shortness of breath, chest pain (especially when breathing
deeply), rapid heartbeat, and lightheadedness.
A client is on intravenous heparin to treat a pulmonary embolism. The clients most recent partial
thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate?
a. Decrease the heparin rate.
b. Increase the heparin rate.
c. No change to the heparin rate.
d. Stop heparin; start warfarin (Coumadin). ✔️✔️B ~ For clients on heparin, a PTT of 1.5 to 2.5 times
the normal value is needed to demonstrate the heparin is working. A normal PTT is 25 to 35 seconds, so
, this clients PTT value is too low. The heparin rate needs to be increased. Warfarin is not indicated in this
situation.
How does a pulmonary embolism affect blood flow?
✔️✔️ A PE blocks blood flow through the affected pulmonary artery, reducing oxygen levels and
causing strain on the heart.
Why can a pulmonary embolism be life-threatening?
✔️✔️ A severe blockage can prevent blood from reaching the lungs, leading to reduced oxygen in the
blood and potential heart failure.
What are common risk factors for developing a pulmonary embolism?
✔️✔️ Risk factors include prolonged immobility, surgery, cancer, smoking, obesity, pregnancy, and
certain genetic clotting disorders.
How is a pulmonary embolism diagnosed?
✔️✔️ It is often diagnosed with imaging tests like a CT pulmonary angiography, D-dimer blood tests,
or ultrasound to assess for deep vein thrombosis.
What is the purpose of anticoagulant therapy in pulmonary embolism treatment?
✔️✔️ Anticoagulants help prevent new clots from forming and existing clots from growing, allowing
the body time to naturally break down the clot.
What lifestyle changes might reduce the risk of a pulmonary embolism?
✔️✔️ Regular physical activity, staying hydrated, avoiding long periods of immobility, maintaining a
healthy weight, and avoiding smoking can help reduce the risk.
Can pulmonary embolisms recur, and how can this be prevented?
✔️✔️ Yes, they can recur. Prevention includes taking prescribed anticoagulants, regular follow-ups,
and managing lifestyle risk factors.
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