A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions is the priority for the nurse to take?

Begin oxygen therapy.

Start an IV infusion of lactated Ringer’s.

Initiate cardiac monitoring.

Administer IV morphine.

Answer and Explanation

The Correct Answer is A

a. Begin oxygen therapy: Oxygen therapy is the priority intervention for a client with a pulmonary embolism to improve oxygenation and prevent hypoxemia.

b. Start an IV infusion of lactated Ringer’s: While fluid resuscitation may be needed, oxygen therapy takes precedence to address the immediate respiratory compromise.

c. Initiate cardiac monitoring: Cardiac monitoring is important, but addressing oxygenation is the priority in a client with a pulmonary embolism.

d. Administer IV morphine: Pain management may be necessary, but the priority is to address the respiratory distress and potential hypoxemia associated with a pulmonary embolism.

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Free Nursing Study Resources

Correct Answer is B

Explanation

a. "Both illnesses begin in the rectum." This statement is not accurate. Ulcerative colitis typically begins in the rectum and progresses proximally, while Crohn's disease can involve any part of the digestive tract.

b. "Both illnesses are inflammatory in nature." This is the correct statement. Both ulcerative colitis and Crohn's disease are inflammatory bowel diseases characterized by chronic

inflammation of the gastrointestinal tract.

c. "Both illnesses manifest fistula formation." Fistula formation is more commonly associated with Crohn's disease, not ulcerative colitis.

d. "Both illnesses result in malabsorption of nutrients." While malabsorption can occur in both conditions, it is generally more associated with Crohn's disease than ulcerative colitis.

A. Pleural friction rub B. Fine rales C. Rhonchi D. Expiratory wheeze

Correct Answer is D

Explanation

a. Pleural friction rub: Pleural friction rub is a grating sound heard during inspiration and

expiration and is associated with inflammation of the pleura. It is not typically associated with asthma exacerbation.

b. Fine rales: Fine rales (crackles) are usually heard during inspiration and can be associated with conditions such as pneumonia or pulmonary fibrosis. They are not the typical lung sounds in

asthma exacerbation.

c. Rhonchi: Rhonchi are low-pitched wheezes heard during inspiration and expiration. While they can be associated with asthma, expiratory wheezes are more specific to asthma

exacerbation.

d. Expiratory wheeze: Expiratory wheezes are high-pitched, musical sounds heard during

expiration and are characteristic of asthma exacerbation. They result from narrowed airways and increased airway resistance.

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A nurse is caring for a client who develops a pulmonary embolism. Which of the following interventions is the priority for the nurse to take?

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