Chapter 30: Pulmonary Embolism Flashcards
What is the most common source of a pulmonary embolism (PE)?
A) Deep vein thrombosis (DVT) from the deep veins of the legs
B) Fat embolism from fractured long bones
C) Air embolism from improperly administered IV therapy
D) Amniotic fluid embolism
A) Deep vein thrombosis (DVT) from the deep veins of the legs
Rationale: The majority of pulmonary embolisms originate from deep vein thrombosis (DVT) in the deep veins of the legs. Other sources are less common.
Which of the following is a risk factor for pulmonary embolism (PE)? (Select all that apply)
A) History of deep vein thrombosis (DVT)
B) Pregnancy
C) Recent hip surgery
D) Use of oral contraceptives
E) Smoking
all of the choices are correct
What is a “saddle embolus”?
A) A large thrombus lodged at the arterial bifurcation
B) A small thrombus located in the pulmonary veins
C) A fat embolism from a fractured long bone
D) An air embolism from improper IV therapy
A) A large thrombus lodged at the arterial bifurcation
Rationale: A saddle embolus refers to a large thrombus that becomes lodged at the bifurcation of a pulmonary artery, potentially obstructing blood flow to both lungs.
Which of the following is the most likely consequence of a pulmonary embolism (PE)?
A) Increased blood flow to the alveoli
B) Obstruction of perfusion to the alveoli
C) Decreased cardiac output
D) Elevated blood pressure in the lungs
B) Obstruction of perfusion to the alveoli
Rationale: A pulmonary embolism causes a blockage of pulmonary arteries, obstructing the blood flow to the alveoli and impairing oxygen exchange.
A patient with a history of pelvic surgery presents with sudden chest pain and shortness of breath. Which of the following is the priority assessment?
A) Auscultate lung sounds
B) Check for signs of deep vein thrombosis (DVT)
C) Administer pain medication
D) Assess for signs of a stroke
A) Auscultate lung sounds
Rationale: A patient presenting with sudden chest pain and shortness of breath may have a pulmonary embolism. Auscultation of lung sounds is a priority to assess for abnormal lung sounds like crackles or decreased breath sounds.
Which of the following describes the pathophysiology of pulmonary embolism (PE)?
A) A thrombus forms in the pulmonary veins and blocks gas exchange
B) An embolus travels through the left side of the heart and obstructs systemic circulation
C) An embolus travels through the pulmonary arteries and obstructs alveolar perfusion
D) Fat cells from fractured long bones enter the lungs and obstruct airflow
C) An embolus travels through the pulmonary arteries and obstructs alveolar perfusion
Rationale: The embolus travels through the venous system to the pulmonary circulation, where it lodges in a pulmonary artery, blocking perfusion to the alveoli.
Which of the following is considered a less common cause of a pulmonary embolism (PE)?
A) Deep vein thrombosis (DVT)
B) Fat embolism
C) Pregnancy
D) Oral contraceptive use
B) Fat embolism
Rationale: While DVT, pregnancy, and oral contraceptive use are common risk factors, fat embolism from fractured long bones is considered a less common cause of PE.
A patient with a central venous catheter is at increased risk for which of the following?
A) Upper extremity deep vein thrombosis (DVT)
B) Pulmonary embolism (PE)
C) Pneumothorax
D) Systemic infection
A) Upper extremity deep vein thrombosis (DVT)
Rationale: Central venous catheters are associated with an increased risk of upper extremity DVT, which can lead to PE if the thrombus embolizes.
Which of the following is the most appropriate intervention for a patient suspected of having a pulmonary embolism (PE)?
A) Encourage deep breathing exercises
B) Provide high-flow oxygen therapy
C) Start IV fluids at a rapid rate
D) Administer anticoagulant therapy as prescribed
D) Administer anticoagulant therapy as prescribed
Rationale: Anticoagulant therapy is a primary intervention to prevent further clot formation and reduce the risk of complications from a PE.
Which part of the lungs is most commonly affected by a pulmonary embolism (PE)?
A) Upper lobes
B) Middle lobes
C) Lower lobes
D) All lobes equally
C) Lower lobes
Rationale: The lower lobes of the lungs are most commonly affected by pulmonary embolism due to gravity and blood flow dynamics.
A patient with a suspected pulmonary embolism (PE) presents with sudden onset of dyspnea, tachypnea, and chest pain. What is the priority assessment for this patient?
A) Measure oxygen saturation
B) Administer pain medication
C) Auscultate lung sounds
D) Check for deep vein thrombosis (DVT)
A) Measure oxygen saturation
Rationale: Dyspnea, tachypnea, and chest pain are classic symptoms of PE. Measuring oxygen saturation is the priority assessment to evaluate hypoxemia and guide oxygen therapy.
Which of the following is the most common presenting symptom of a pulmonary embolism (PE)?
A) Hemoptysis
B) Tachycardia
C) Dyspnea
D) Syncope
C) Dyspnea
Rationale: Dyspnea (shortness of breath) is the most common presenting symptom in patients with pulmonary embolism.
A patient with a massive pulmonary embolism (PE) is exhibiting hypotension, confusion, and a feeling of impending doom. What is the priority nursing action?
A) Reassure the patient and allow them to rest
B) Administer analgesics to relieve pain
C) Prepare the patient for a chest x-ray
D) Administer oxygen and monitor vital signs
D) Administer oxygen and monitor vital signs
Rationale: In the case of a massive PE, the priority is to stabilize the patient by administering oxygen to correct hypoxemia and monitoring vital signs for any further deterioration.
Which of the following symptoms is most likely to occur in a patient with a large pulmonary embolism (PE)?
A) Mild cough and wheezing
B) Chest pain, tachypnea, and hemoptysis
C) Low-grade fever and crackles
D) Syncope, hypotension, and change in mental status
D) Syncope, hypotension, and change in mental status
Rationale: Massive PE can cause a sudden change in mental status, hypotension, and syncope due to decreased blood flow and oxygenation.
A patient with pulmonary embolism (PE) is found to have hemoptysis. What does this symptom indicate?
A) Pulmonary congestion due to heart failure
B) Rupture of alveolar capillaries from the embolus
C) Infection or pneumonia in the lungs
D) Severe pain from the pleural lining irritation
B) Rupture of alveolar capillaries from the embolus
Rationale: Hemoptysis (coughing up blood) in the context of PE is often due to the rupture of alveolar capillaries as a result of increased pressure from the embolus blocking blood flow to the lungs.
A patient is admitted with suspected pulmonary embolism (PE) and presents with tachycardia and crackles on auscultation. What is the nurse’s most appropriate action?
A) Initiate IV fluids to prevent dehydration
B) Prepare for possible intubation and mechanical ventilation
C) Administer oxygen therapy and monitor vital signs
D) Encourage the patient to deep breathe and cough
C) Administer oxygen therapy and monitor vital signs
Rationale: Tachycardia and crackles are signs of possible PE and associated hypoxemia. The priority is to administer oxygen to improve oxygenation and closely monitor vital signs.
A patient with a pulmonary embolism (PE) is experiencing mild to moderate hypoxemia. Which of the following is the most appropriate intervention?
A) Administer IV fluids rapidly to increase blood volume
B) Place the patient in the Trendelenburg position
C) Start continuous oxygen therapy to improve oxygen saturation
D) Encourage the patient to drink fluids to increase circulation
C) Start continuous oxygen therapy to improve oxygen saturation
Rationale: For patients with hypoxemia, oxygen therapy is the primary intervention to maintain adequate oxygen saturation and prevent further complications.
Which of the following is the most common complication of pulmonary embolism (PE)?
A) Pulmonary infarction
B) Pulmonary hypertension
C) Acute respiratory distress syndrome (ARDS)
D) Chronic thromboembolic pulmonary hypertension
A) Pulmonary infarction
Rationale: Pulmonary infarction, or the death of lung tissue, is a common complication of PE, especially when there is occlusion of a large pulmonary vessel or insufficient collateral circulation.
A patient with a massive pulmonary embolism (PE) has sudden hypotension and shock. What is the most likely cause of these symptoms?
A) Pulmonary infarction
B) Pulmonary hypertension
C) Decreased blood flow to the left ventricle
D) Right ventricular failure due to increased pulmonary resistance
D) Right ventricular failure due to increased pulmonary resistance
Rationale: Massive PE increases resistance in the pulmonary arteries, leading to right ventricular failure, which causes hypotension and shock.
Which of the following is most likely to occur if a patient with a pulmonary embolism (PE) develops pulmonary infarction?
A) Decreased alveolar necrosis
B) Development of an abscess in necrotic tissue
C) Increased oxygenation in the affected lung area
D) Increased production of pleural fluid
B) Development of an abscess in necrotic tissue
Rationale: Pulmonary infarction causes alveolar necrosis and hemorrhage, which can become infected, leading to the formation of a pulmonary abscess.
*What is the primary factor in the development of pulmonary hypertension following a pulmonary embolism (PE)?
A) Acute respiratory distress syndrome (ARDS)
B) Chronic thromboembolic obstruction of pulmonary arteries
C) Decreased blood flow to the left ventricle
D) Overuse of anticoagulant therapy
B) Chronic thromboembolic obstruction of pulmonary arteries
Rationale: Pulmonary hypertension after PE typically results from chronic thromboembolic obstruction and recurrent PEs, which gradually reduce capillary bed blood flow over time.
Which of the following increases a patient’s risk for developing chronic thromboembolic pulmonary hypertension (CTEPH) after a pulmonary embolism (PE)?
A) Early anticoagulant therapy
B) Complete resolution of the PE
C) Recurrent pulmonary embolism
D) Acute right ventricular failure
C) Recurrent pulmonary embolism
Rationale: Recurrent PEs that do not completely resolve can gradually cause persistent obstruction and lead to chronic thromboembolic pulmonary hypertension.
A patient diagnosed with pulmonary embolism (PE) develops pleural effusion. What is the most likely cause of this complication?
A) Lung tissue infection
B) Pulmonary infarction and hemorrhage
C) Right-sided heart failure
D) Acute respiratory distress syndrome (ARDS)
B) Pulmonary infarction and hemorrhage
Rationale: Pleural effusions are common in patients with PE and are typically caused by pulmonary infarction and subsequent hemorrhage.
Which of the following would most likely result in an increased risk of death within the first hour of a massive pulmonary embolism (PE)?
A) Immediate initiation of anticoagulant therapy
B) Pre-existing lung disease
C) Mild to moderate hypoxemia
D) Occlusion of a large or medium-sized pulmonary vessel
D) Occlusion of a large or medium-sized pulmonary vessel
Rationale: Massive PE, particularly when it involves occlusion of a large pulmonary vessel, can cause immediate and severe cardiovascular collapse, leading to death within the first hour.
