A client with suspected pulmonary embolism has chronic kidney disease and recent contrast-induced nephropathy.
Which diagnostic test is most appropriate?
Pulmonary angiography.
D-dimer assay.
Ventilation-perfusion scan.
Chest X-ray.
The Correct Answer is C
Evaluating pulmonary embolism in patients with renal impairment requires knowledge of contrast-induced nephropathy risks. One must apply understanding of different imaging modalities to select a test that provides diagnostic clarity without using nephrotoxic agents that would worsen kidney failure.
Choice A rationale
Pulmonary angiography is an invasive procedure requiring a large bolus of iodinated contrast. In a client with chronic kidney disease and recent nephropathy, this would likely cause further irreversible damage to the remaining renal function.
Choice B rationale
D-dimer is a screening tool with high sensitivity but low specificity. While it does not require contrast, it cannot definitively diagnose a PE. It is used to rule out PE in low-risk patients rather than confirm.
Choice C rationale
A ventilation-perfusion scan uses radioactive isotopes rather than iodinated contrast. It is the preferred diagnostic test for patients with renal failure because it avoids the risk of contrast-induced nephropathy while effectively assessing for V/Q mismatch.
Choice D rationale
A chest X-ray is useful for ruling out other causes of respiratory distress like pneumonia or pneumothorax, but it is not sensitive or specific enough to diagnose a pulmonary embolism. Most PE patients have normal X-rays..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","F","G","H"]
Explanation
Evaluating post surgical and post pulmonary embolism recovery requires assessing functional mobility, respiratory stability, and wound healing. Knowledge of normal rehabilitation milestones and the resolution of thromboembolic symptoms is necessary to determine if the client is meeting expected outcomes.
Choice A rationale
Independent performance of activities of daily living indicates restored functional capacity and successful rehabilitation after surgery. It demonstrates that the client has regained sufficient strength and coordination to manage self care tasks without exhausting their cardiovascular reserves.
Choice B rationale
Unintentional weight loss of 27 lbs within six weeks is an abnormal finding that suggests underlying pathology, malnutrition, or chronic illness. It does not indicate improvement and instead necessitates further medical investigation to rule out complications.
Choice C rationale
Transitioning to independent walking with a cane shows progress in gait stability and weight bearing tolerance on the prosthetic joint. This movement away from more restrictive assistive devices like walkers is a positive indicator of recovery.
Choice D rationale
Significant bruising and discoloration are concerning signs, potentially indicating a bleeding disorder or complications from ongoing anticoagulation therapy. This finding represents a setback or a new problem rather than a sign of successful clinical improvement.
Choice E rationale
Increased pain with movement in the surgical area suggests potential complications such as infection, prosthesis loosening, or hip dislocation. Expected progress involves a steady decrease in pain levels as the surgical site heals over the weeks.
Choice F rationale
The absence of shortness of breath and chest pain indicates that the pulmonary embolism has resolved and gas exchange is stable. This respiratory comfort suggests that pulmonary perfusion has been restored and the lungs are healing.
Choice G rationale
An oxygen saturation of 95 is within the normal range of 95 to 100 percent. This indicates adequate arterial oxygenation and demonstrates that the client no longer requires supplemental oxygen to maintain systemic tissue perfusion after recovery.
Choice H rationale
A visible hairline scar without redness, swelling, or drainage confirms successful primary intention healing of the surgical incision. This indicates that the skin integrity is restored and the risk of localized or systemic infection is decreasing.
Correct Answer is D
Explanation
This question requires knowledge of acid-base balance and pathophysiology of chronic kidney disease. Understanding how impaired renal function leads to metabolic acidosis through decreased hydrogen ion excretion and reduced bicarbonate regeneration is essential to identify the correct values.
Choice A rationale
A pH of 7.55 and HCO3 of 30 indicate metabolic alkalosis. Normal pH is 7.35 to 7.45 and HCO3 is 22 to 28 mEq/L. Renal failure typically results in acid accumulation, not excess base.
Choice B rationale
A pH of 7.30 and PaCO2 of 50 indicate respiratory acidosis. In renal failure, the lungs typically compensate for metabolic acid by hyperventilating to lower PaCO2, which is the opposite of the hypoventilation shown here.
Choice C rationale
A pH of 7.50 and PaCO2 of 32 indicate respiratory alkalosis. This state occurs when the patient hyperventilates excessively, leading to an alkaline pH, which does not align with the metabolic acidosis expected in renal disease.
Choice D rationale
Chronic kidney disease causes metabolic acidosis. A pH of 7.25 and HCO3 of 19 mEq/L demonstrate low pH and low bicarbonate. The PaCO2 of 30 mm Hg reflects respiratory compensation for the primary metabolic acid-base imbalance.
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