A client with a pulmonary embolism develops signs of severe hemoptysis and hypotension.
What should be the nurse's immediate priority?

This scenario assesses management of post-thoracotomy chest tubes and stable respiratory findings. Knowledge of pleural space physiology, normal post-operative healing, and chest tube safety protocols is required to differentiate between expected recovery milestones and critical complications requiring urgent intervention.

Choice A rationale

Clamping chest tubes is contraindicated unless specifically checking for leaks or changing the drainage system. It risks tension pneumothorax by trapping air or fluid within the pleural space, which can lead to mediastinal shift and cardiovascular collapse.

Choice B rationale

Suction is typically maintained at -20 cm H2O to facilitate lung re-expansion. Increasing suction without a provider order can cause tissue trauma or exacerbate air leaks. The current respiratory rate and oxygen saturation indicate effective drainage and ventilation.

Choice C rationale

Bubbling in the water seal chamber indicates an air leak, but the current clinical data does not suggest one. A respiratory rate of 22 and 94 percent saturation are common 24 hours post-surgery while recovering from anesthesia.

Choice D rationale

Stable vital signs and manageable incisional pain are expected findings. Continuing to monitor ensures the lung remains expanded and the drainage system functions correctly. The SpO2 of 94 percent is acceptable during the early recovery phase after thoracotomy.

Following major orthopedic surgery, a client presenting with sudden shortness of breath and tachycardia is highly suspicious for a pulmonary embolism. Knowledge of venous thromboembolism complications, diagnostic imaging protocols, and immediate stabilization techniques is necessary to prevent cardiovascular collapse and ensure respiratory support.

Choice A rationale: Computed tomography pulmonary angiography is the gold standard for diagnosing a pulmonary embolism. It allows for direct visualization of the pulmonary vasculature to identify arterial obstructions, which is essential for confirming the suspected condition in a post-operative patient.

Choice B rationale: A flat supine position can worsen respiratory distress by increasing the work of breathing and reducing lung expansion. Clients experiencing shortness of breath should be placed in a high-Fowler position to optimize ventilation and improve oxygenation.

Choice C rationale: Laboratory testing, including a complete blood count and coagulation studies, provides a baseline for the client's hematological status. These values are critical for planning the safe administration of therapeutic anticoagulation and monitoring for potential bleeding risks.

Choice D rationale: Obtaining venous access is a priority intervention to allow for the rapid administration of emergency medications or intravenous fluids. In the event of hemodynamic instability or the need for IV anticoagulants, established access is life-saving.

Choice E rationale: Continuous cardiac monitoring is necessary to track the client's heart rate and rhythm. Pulmonary embolism can cause right heart strain and dysrhythmias; monitoring allows the nurse to detect early signs of cardiac decompensation or worsening tachycardia.

Choice F rationale: Continuous oxygen saturation monitoring provides real-time data on the client’s respiratory status. Since pulmonary embolism impairs gas exchange, tracking saturation levels is vital to ensure that oxygen therapy is maintaining adequate systemic tissue perfusion.

Choice G rationale: Nurses cannot independently increase medication dosages, as this constitutes prescribing. Any changes to anticoagulant therapy, such as apixaban, must be ordered by a provider based on weight-based protocols and the severity of the thrombotic event.

Choice H rationale: Supplemental oxygen should be applied immediately to address the client's shortness of breath and potential hypoxemia. Increasing the concentration of inspired oxygen helps compensate for the ventilation-perfusion mismatch caused by the obstruction in the pulmonary arteries.