Which patient is most likely experiencing a pulmonary embolism (PE)?
A 40-year-old woman who came into the ER with a swollen, painful calf and now complains of chest pains and having trouble breathing, with tachycardia and tachypnea.
A 60-year-old man who is tired and has been in the med-surg unit for 3 days with AKI after taking IV antibiotics.
A 30-year-old man with a history of smoking and a sedentary lifestyle who had an appendectomy 1 day ago and is refusing to ambulate or wear compression stockings.
A 55-year-old woman who came into the ER with chest pains, shortness of breath, nausea, tachypnea, and radiating jaw pain.
The Correct Answer is A
Choice A reason : The symptoms described for the 40-year-old woman align closely with the clinical presentation of a pulmonary embolism. Swelling and pain in the calf may indicate deep vein thrombosis (DVT), which can lead to PE. The presence of chest pain, difficulty breathing, rapid heart rate (tachycardia), and rapid breathing (tachypnea) are hallmark signs of PE³⁴.
Choice B reason : While the 60-year-old man is experiencing fatigue, which can be a symptom of many conditions, there is no direct indication of PE. Acute kidney injury (AKI) after IV antibiotics suggests a different pathophysiology unrelated to PE.
Choice C reason : The 30-year-old man's refusal to ambulate or wear compression stockings after surgery increases his risk for DVT and subsequently PE; however, he does not currently exhibit symptoms that are as indicative of PE as the 40-year-old woman.
Choice D reason : The 55-year-old woman's symptoms could suggest a cardiac event, such as a heart attack, especially with the radiating jaw pain. While PE can present with similar symptoms, the radiating pain is more characteristic of cardiac issues³.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The statement that the antidote for warfarin is protamine is incorrect. The primary antidote for warfarin is Vitamin K, and in cases of significant bleeding, prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP) may be used¹². Protamine is used as an antidote for heparin, not warfarin¹.
Choice B reason: Observing the client for manifestations of hemorrhage is a critical nursing action when administering warfarin. Warfarin is an anticoagulant, and one of the major risks associated with its use is bleeding. The nurse should monitor for signs such as unusual bruising, petechiae, hematuria, tarry stools, or any other indications of internal or external bleeding⁷⁸.
Choice C reason: Monitoring the client's aPTT (activated partial thromboplastin time) is not typically associated with warfarin therapy. Warfarin's effect is monitored through the prothrombin time (PT) and the International Normalized Ratio (INR), not aPTT, which is more commonly used to monitor heparin therapy⁴⁵.
Choice D reason: Warfarin should not be administered along with NSAIDs without careful consideration and monitoring due to the increased risk of bleeding. NSAIDs can affect platelet function and gastrointestinal mucosa, leading to an elevated risk of gastrointestinal bleeding when taken with warfarin¹¹¹².
Correct Answer is B
Explanation
Choice A reason : Avoiding exercise during flare-ups of fibromyalgia may seem intuitive to prevent exacerbating pain and fatigue. However, maintaining a gentle exercise routine, even during flare-ups, can help manage symptoms and prevent deconditioning¹.
Choice B reason : Establishing a regular sleep pattern is crucial for managing fibromyalgia. Poor sleep can exacerbate pain, fatigue, and cognitive difficulties commonly experienced with this condition. Good sleep hygiene practices can improve sleep quality and overall symptom management¹.
Choice C reason : While adequate calcium intake is essential for general health, there is no specific indication that increasing calcium intake alone would manage fibromyalgia symptoms. Nutritional needs should be addressed as part of a comprehensive approach to self-care¹.
Choice D reason : Yoga or running between flare-ups can be beneficial for clients with fibromyalgia. Regular exercise, including yoga, can improve pain, function, and quality of life. Running or other aerobic exercises can also be helpful if tolerated and done in moderation¹.
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