Update – Galen
1. The nurse is caring for a pt who is receiving a heparin infusion for
treatment of a pulmonary embolism. Which of the following
indicates a therapeutic effect of treatment?
a) activated partial thromboplastin time appt is 72 seconds
b) platelet count is 160,000
c) PT is 10.2 seconds
d) d-dimer level is increased at 600
2. The nurse is caring for a pt who is 4 days postoperative and suddenly
develops difficulty breathing and sharp chest pain. The nurse has
called a rapid
responsible team, raised the head of the bed, and applied oxygen to
the not. Which action a from the box be low should the nurse take
next?
1. Auscultate the pt lungs sounds
2. Initiate continuous cardiac monitoring
3. Prepare the admin IV alteplase
4. Connect the pt to continuous pulse oximeter
5. Apply bilateral anti embolism stocking to the
legs
6. Assess the pt skin color
a) 1,2,4,6
b) 1,4,5
c) 3,4,6
d) 2,3,5,6
3. The nurse has provided discharge instructions to a pt who
developed a pulmonary embolism following a surgical procedure.
The pt will be taking newly prescribed warfarin at home. Which of
the following pt statements indicates a correct understanding of the
teaching?
a) “I will take this med for about 1-2 months”
b) “hard candy can be used of develop a dry mouth while taking warfarin”
c) “the warfarin will continue to break up clots over the next several months”
d) “I should avoid anything rectally such as enemas or suppositories”
, 4. The nurse is caring for a pt who appear a to have developed a
pulmonary embolism. Which of the following ABG results would the
nurse expect the pt to initially have?
a) ph 7.45, PaO2 70, PaCO2 38, HCO3 28, SaO2 86%
b) ph 7.35, PaO2 63, PaCO2 42, HCO3 26, SaO2 84%
c) ph 7.31, PaO2 73, PaCO2 50, HCO3 22, SaO2 85%
d) ph 7.50, PaO2 79, PaCO2 32, HCO3 23, SaO2 88%
5. The nurse is working in the ER is caring for a pt who was in a
boating crash 3 hours ago and has the following date:
Report a of a
headache Restless
and irritable
ABG ph 7.28, PaO2 60, PaCO2 52, HCO3 24, SaO2
84%
Pulse 110
RR 10 and dysgenic
a) PE
b) pleural effusion
c) a tension pneumothorax
d) acute respiratory failure
6. The nurse is caring for a pt who has a chest tube. Which
assessment findings from the box be low requires the nurse to
immediately notify the primary health care provider?
Continuous bubbling in the suction control chamber Tracheal
deviation
Tidaling in the water seal chamber with breathing 100 me of
drainage with in and hr
Visibility of the eyelets of the chest tube
Low water level in the water seal chamber
a) 1,3,6
b) 1,2,4,3
c) 2,3,6
d) 2,4,5