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.

Answer and Explanation

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..

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Correct Answer is A

Explanation

This scenario requires evaluating medical orders against a client's specific allergy profile to morphine, iodine, and codeine. Knowledge of hypersensitivity reactions to intravenous contrast media and the safe selection of analgesics is necessary to ensure patient safety and prevent potentially fatal allergic responses.

Choice A rationale

Iodine is a primary component of many intravenous contrast agents used in imaging. The client's documented iodine allergy necessitates questioning this order to avoid life-threatening systemic reactions, such as angioedema or airway obstruction, typically associated with radiopaque medium exposure.

Choice B rationale

Therapeutic lifestyle changes, including dietary modifications, are foundational in stroke prevention. Reducing dietary fats and cholesterol helps mitigate cardiovascular risk factors, supporting the long-term management of transient ischemic attacks without conflicting with the client's specific known drug allergies.

Choice C rationale

Protocol-based vital sign monitoring ensures the early detection of neurological or hemodynamic instability. This order is a standard of care for any patient presenting with cerebrovascular symptoms and carries no risk related to the client's iodine or opioid sensitivities.

Choice D rationale

Acetaminophen belongs to the para-aminophenol derivative class of medications. It does not possess the structural components of phenanthrene alkaloids like morphine or codeine, making it a safe alternative for treating mild to moderate pain in opioid-allergic individuals..

A. It will increase heart rate to improve cardiac output. B. It will relieve the pain of the headache by stimulating endorphins. C. It will rapidly lower blood pressure to prevent stroke or bleeding. D. It will promote fluid loss to decrease blood pressure.

Correct Answer is C

Explanation

Management of hypertensive crisis involves using calcium channel blockers to achieve rapid vascular relaxation. Knowledge of pharmacodynamics is necessary to explain how nicardipine reduces systemic vascular resistance to mitigate the risk of cerebrovascular accidents and end organ damage in emergencies.

Choice A rationale

Nicardipine is a dihydropyridine calcium channel blocker that primarily causes vasodilation. It does not act as a positive chronotrope. Increasing heart rate in a hypertensive crisis could dangerously increase myocardial oxygen demand and exacerbate the clinical situation.

Choice B rationale

The medication does not possess analgesic properties or stimulate endorphin release. While the headache may improve as intracranial pressure decreases from lowered blood pressure, the primary pharmacological mechanism is vascular smooth muscle relaxation rather than pain modulation.

Choice C rationale

Nicardipine inhibits calcium ion influx into vascular smooth muscle, leading to rapid peripheral vasodilation. In a hypertensive emergency (BP > 180/120 mm Hg), quick reduction is critical to prevent intracranial hemorrhage, encephalopathy, or ischemic stroke.

Choice D rationale

Nicardipine does not function as a diuretic. While lowering blood pressure reduces renal strain, it does not promote fluid loss through the kidneys. Diuretics like furosemide are separate agents used for volume related hypertension or edema.

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A client with suspected pulmonary embolism has chronic kidney disease and recent contrast-induced nephropathy. Which diagnostic test is most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client being admitted with a transient ischemic attack reporting a headache is allergic to morphine, iodine, and codeine. Which healthcare provider order should the nurse querry

Correct Answer is A

Explanation

A client has a systolic blood pressure of over 200 mm Hg and a severe headache. The physician orders a nicardipine infusion. What should the nurse explain to the family about the use of this medication?

Correct Answer is C

Explanation

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A client with suspected pulmonary embolism has chronic kidney disease and recent contrast-induced nephropathy.
Which diagnostic test is most appropriate?