Study Guide and Answer Key - Lewis Medical-
Surgical Nursing
Which are major risk factors for venous thromboembolism leading to pulmonary embolism?
Select all that apply.
a. Malnutrition
b. Central venous catheters
c. COPD
d. Obesity
e. Prolonged immobility
f. Conditions that decrease blood clotting - ANSWERSb. Central venous catheters
d. Obesity
e. Prolonged immobility
What is the most common site of origin for a clot to occur, causing a pulmonary embolism?
a. Right side of the heart
b. Deep veins of the legs and pelvis
c. Antecubital vein in the upper extremities
d. Subclavian veins - ANSWERSb. Deep veins of the legs and pelvis
What is the most common cause of an embolism?
a. Amniotic fluid
b. Bolus of air
c. Blood clot
,d. Arterial plaque - ANSWERSc. Blood clot
Which conditions define respiratory failure? Select all that apply.
a. Ventilatory failure
b. Circulatory failure
c. Oxygenation failure
d. Severe anemia
e. Combination of ventilatory and oxygenation failure
f. Chronic emphysema - ANSWERSa. Ventilatory failure
c. Oxygenation failure
e. Combination of ventilatory and oxygenation failure
A patient in the hospital is receiving a continuous infusion of heparin for a pulmonary
embolism. When the nurse enters the room, the patient has blood on the front of his chest and
is holding a tissue saturated with blood to his nose. What is the first priority action the nurse
must take?
a. Have the patient sit up and lean forward, pinching the nostrils.
b. Have a UAP set up oral suctioning to suction excess blood from the patient's mouth.
c. Stop the heparin IV solution
d. Obtain laboratory results for prothrombin time and complete blood count. - ANSWERSc. Stop
the heparin IV solution
The nurse's young neighbor who smokes is going on an overseas flight. The neighbor knows he
is at risk for DVT and PE, and asks the nurse for advice. What does the nurse suggest?
a. Exercise regularly and walk around before boarding the flight
,b. Get a prescription for heparin therapy and take it before the flight
c. Drink water and get up every hour for at least 5 mins during the flight.
d. Elevate the legs as much as possible during and after the flight. - ANSWERSc. Drink water and
get up every hour for at least 5 mins during the flight
The nurse is caring for several post-operative patients at risk for developing pulmonary
embolism. Which interventions does the nurse use to help prevent the development of PE in
these patients? Select all that apply.
a. Start passive and active ROM exercises for the extremities.
b. Ambulate postoperative patients soon after surgery.
c. Use antiembolism devices postoperatively
d. Elevate legs in an extended position
e. Change patient position every 4-6 hours.
f. Administer stool softeners to prevent constipation. - ANSWERSa. Start passive and active ROM
exercises for the extremities.
b. Ambulate postoperative patients soon after surgery
c. Use antiembolism devices postoperatively
f. Administer stool softeners to prevent constipation.
The nurse suspects a patient has a pulmonary embolism and notifies the provider, who orders
an ABG. The HCP is one the way to the facility. The nurse anticipates and prepares the patient
for which additional diagnostic test?
a. Ultrasound
b. Pulmonary angiography
c. 12-lead ECG
d. Venous dopplers - ANSWERSb. Pulmonary angiography
, The healthcare provider orders heparin therapy for a patient with a relatively small pulmonary
embolism. THe patient states, "I didn't tell the doctor my complete medical history." Which
condition may affect the healthcare provider's decision to immediately start heparin therapy?
a. Type 2 diabetes mellitus
b. Recent cerebral hemorrhage
c. Newly diagnosed osteoarthritis
d. Asthma since childhood - ANSWERSb. Recent cerebral hemorrhage
A patient with pulmonary embolism asks for an explanation of heparin therapy. What is the
nurse's best response?
a. "It keeps the clot from getting larger by preventing platelets from sticking together to improve
blood flow."
b. "It will improve your breathing and decrease chest pain by dissolving the clot in your lung."
c. "It promotes the absorption of the clot in your leg that originally caused the PE."
d. "It increases the time it takes for blood to clot, therefore preventing further clotting and
improving blood flow." - ANSWERSd. "It increases the time it takes for blood to clot, therefore
preventing further clotting and improving blood flow."
A patient is being treated with heparin therapy for a pulmonary embolism. What does the nurse
monitor in relation to the heparin therapy and potential for bleeding?
a. Lab values for any elvation of PT or PTT value
b. PTT values for greater than 2.5 times the control and/or the patient for bleeding
c. Occurrence of a pulmonary infarction by blood in sputum
d. PT INR for a therapeutic range of 2 to 3 and/or the patient for bleeding. - ANSWERSb. PTT
values for greater than 2.5 times the control and/or the patient for bleeding
Surgical Nursing
Which are major risk factors for venous thromboembolism leading to pulmonary embolism?
Select all that apply.
a. Malnutrition
b. Central venous catheters
c. COPD
d. Obesity
e. Prolonged immobility
f. Conditions that decrease blood clotting - ANSWERSb. Central venous catheters
d. Obesity
e. Prolonged immobility
What is the most common site of origin for a clot to occur, causing a pulmonary embolism?
a. Right side of the heart
b. Deep veins of the legs and pelvis
c. Antecubital vein in the upper extremities
d. Subclavian veins - ANSWERSb. Deep veins of the legs and pelvis
What is the most common cause of an embolism?
a. Amniotic fluid
b. Bolus of air
c. Blood clot
,d. Arterial plaque - ANSWERSc. Blood clot
Which conditions define respiratory failure? Select all that apply.
a. Ventilatory failure
b. Circulatory failure
c. Oxygenation failure
d. Severe anemia
e. Combination of ventilatory and oxygenation failure
f. Chronic emphysema - ANSWERSa. Ventilatory failure
c. Oxygenation failure
e. Combination of ventilatory and oxygenation failure
A patient in the hospital is receiving a continuous infusion of heparin for a pulmonary
embolism. When the nurse enters the room, the patient has blood on the front of his chest and
is holding a tissue saturated with blood to his nose. What is the first priority action the nurse
must take?
a. Have the patient sit up and lean forward, pinching the nostrils.
b. Have a UAP set up oral suctioning to suction excess blood from the patient's mouth.
c. Stop the heparin IV solution
d. Obtain laboratory results for prothrombin time and complete blood count. - ANSWERSc. Stop
the heparin IV solution
The nurse's young neighbor who smokes is going on an overseas flight. The neighbor knows he
is at risk for DVT and PE, and asks the nurse for advice. What does the nurse suggest?
a. Exercise regularly and walk around before boarding the flight
,b. Get a prescription for heparin therapy and take it before the flight
c. Drink water and get up every hour for at least 5 mins during the flight.
d. Elevate the legs as much as possible during and after the flight. - ANSWERSc. Drink water and
get up every hour for at least 5 mins during the flight
The nurse is caring for several post-operative patients at risk for developing pulmonary
embolism. Which interventions does the nurse use to help prevent the development of PE in
these patients? Select all that apply.
a. Start passive and active ROM exercises for the extremities.
b. Ambulate postoperative patients soon after surgery.
c. Use antiembolism devices postoperatively
d. Elevate legs in an extended position
e. Change patient position every 4-6 hours.
f. Administer stool softeners to prevent constipation. - ANSWERSa. Start passive and active ROM
exercises for the extremities.
b. Ambulate postoperative patients soon after surgery
c. Use antiembolism devices postoperatively
f. Administer stool softeners to prevent constipation.
The nurse suspects a patient has a pulmonary embolism and notifies the provider, who orders
an ABG. The HCP is one the way to the facility. The nurse anticipates and prepares the patient
for which additional diagnostic test?
a. Ultrasound
b. Pulmonary angiography
c. 12-lead ECG
d. Venous dopplers - ANSWERSb. Pulmonary angiography
, The healthcare provider orders heparin therapy for a patient with a relatively small pulmonary
embolism. THe patient states, "I didn't tell the doctor my complete medical history." Which
condition may affect the healthcare provider's decision to immediately start heparin therapy?
a. Type 2 diabetes mellitus
b. Recent cerebral hemorrhage
c. Newly diagnosed osteoarthritis
d. Asthma since childhood - ANSWERSb. Recent cerebral hemorrhage
A patient with pulmonary embolism asks for an explanation of heparin therapy. What is the
nurse's best response?
a. "It keeps the clot from getting larger by preventing platelets from sticking together to improve
blood flow."
b. "It will improve your breathing and decrease chest pain by dissolving the clot in your lung."
c. "It promotes the absorption of the clot in your leg that originally caused the PE."
d. "It increases the time it takes for blood to clot, therefore preventing further clotting and
improving blood flow." - ANSWERSd. "It increases the time it takes for blood to clot, therefore
preventing further clotting and improving blood flow."
A patient is being treated with heparin therapy for a pulmonary embolism. What does the nurse
monitor in relation to the heparin therapy and potential for bleeding?
a. Lab values for any elvation of PT or PTT value
b. PTT values for greater than 2.5 times the control and/or the patient for bleeding
c. Occurrence of a pulmonary infarction by blood in sputum
d. PT INR for a therapeutic range of 2 to 3 and/or the patient for bleeding. - ANSWERSb. PTT
values for greater than 2.5 times the control and/or the patient for bleeding
