Chapter 95: Pulmonary Embolism Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism (PE)?

a. Arterial blood gases (ABGs) b. Computed tomography (CT) angiography c. D-dimer d. Electrocardiogram (ECG)

ANS: B a. Abnormal lung sounds b. Dyspnea c. Hypotension d. Tachycardia

CT angiography is used to diagnose PE. D-dimer assays have good negative predictive value but have poor positive predictive value, making it useful for excluding but not confirming the presence of PE. An ECG does not confirm PE but is used to demonstrate comorbid conditions. ABGs do not confirm PE and are used to identify the degree of respiratory compromise.

2. Which clinical sign is especially worrisome in a patient with a pulmonary embolism (PE)?

ANS: C

Hypotension in a patient with PE has a high correlation with acute right ventricular failure and subsequent death. The other signs are common with PE.

NURSINGTB.COM a. Low molecular heparin b. Tissue plasminogen activator c. Unfractionated heparin d. Warfarin

3. A patient develops a pulmonary embolism (PE) after surgery and shows signs of right-sided heart failure. Which drug will be administered to this patient?

ANS: B

Fibrinolytic therapy with recombinant tissue plasminogen activator is given to patients with hypotension and right-sided heart failure. Heparin is used for its anticoagulant properties in all patients with PE. Warfarin is not indicated.