A client with partial-thickness burns to the trunk and both lower extremities is admitted 2 hours after injury.
Which intravenous fluid should the nurse initiate?

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.

Identifying life-threatening complications in immunocompromised patients is critical. Knowledge of the systemic inflammatory response syndrome and hemodynamic instability in neutropenic patients must be applied to differentiate between oncological emergencies like sepsis, tumor lysis syndrome, and superior vena cava obstruction.

Choice A rationale

Sepsis in neutropenic patients often leads to septic shock, characterized by hypotension (80/40 mm Hg) and tachycardia (142/min). The high fever and rapid breathing indicate a systemic response to infection and inadequate tissue perfusion.

Choice B rationale

Tumor lysis syndrome results from rapid cell destruction, causing hyperkalemia, hyperuricemia, and renal failure. While it is an oncological emergency, it does not typically present with the acute hemodynamic collapse and profound hypotension seen in this scenario.

Choice C rationale

While chemotherapy induces fatigue, it does not cause severe hypotension, high fever, or extreme tachycardia. These findings represent a critical physiological crisis rather than the expected side effects of exhaustion or malaise during oncological treatment.

Choice D rationale

Superior vena cava syndrome involves obstruction of blood flow from the upper body, causing facial edema, neck vein distention, and dyspnea. It does not primarily present with acute fever, sepsis symptoms, or profound hypotension.