The nurse suspects a client with jaundice, dark urine, and pruritus has a biliary obstruction.
Which set of lab results would support the nurse's suspicion?

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.

Acute trauma causes physiological and psychological distress, often manifesting as agitation or panic. Resolving this requires applying crisis intervention principles, prioritizing safety, and using therapeutic communication to de-escalate the client while monitoring for signs of worsening physical or mental instability.

Choice A rationale

Leaving an agitated, tachycardic client alone is unsafe. The client may fall, pull out invasive lines, or suffer a physiological crisis. Constant observation is necessary to maintain physical safety and monitor a heart rate exceeding 100/min.

Choice B rationale

While understanding coping mechanisms is part of psychosocial assessment, it is not the priority during an acute, agitated crisis. The immediate need is to stabilize the client and ensure safety before exploring long-term behavioral patterns.

Choice C rationale

Staying with the client provides immediate support and safety. Positioning near the door ensures nurse safety, while calm communication reduces sympathetic nervous system overactivity, helping to lower a heart rate of 128/min and rapid respirations.

Choice D rationale

Commanding a distressed client to calm down is often counterproductive and non-therapeutic. It minimizes the client's feelings and can increase agitation. Therapeutic intervention requires a calm presence rather than authoritative demands during a traumatic event.