PULMONARY EMBOLISM

1. Which statement below is incorrect about a deep vein thrombosis (DVT)?

A. "Veins that are most susceptible to a deep vein thrombosis are the peroneal, posterior tibial, popliteal and
superficial femoral."
B. "DVTs tend to mostly occur in the lower extremities but can occur in the upper extremities too."
-C. "A deep vein thrombosis in the lower extremity has a low probability of becoming a pulmonary embolism."
D. "A DVT is a type of venous thromboembolism (VTE), which is a blood clot that starts in the vein."
2. Select all the factors regarding a deep vein thrombosis that are included in Virchow's Triad:
A. Hypocoagulability
B. Atherosclerosis
-C. Endothelial damage
-D. Stasis of venous blood
-E. Excessive coagulability
F. Increased venous blood flow
3. Based on Virchow's Triad, select which patients below are at RISK for the development of a deep vein
thrombosis? Select all that apply:
A. A 55-year-old male with hyperlipidemia and diabetes.
B. A 70-year-old female with severe sepsis.
C. A 25-year-old male who uses intravenous drugs.
D. A 65-year-old female who is post-op day 1 after joint replacement surgery.
4. You're developing a plan of care for a patient who is at risk for the development of a deep vein thrombosis
after surgery. What nursing intervention below would the nurse NOT include in the patient's plan of care to
prevent DVT formation?
A. The patient will eat all meals out of the bed daily by sitting in the bedside chair.
-B. The nurse will apply sequential compression devices (SCDs) per physician’s order to the patient's lower
extremities every night at bedtime.
C. The nurse will administer per physician's order Enoxaparin in the subcutaneous tissue of the abdomen.
D. The patient will ambulate daily.
5. The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and
symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein
thrombosis is present?
A. Cool extremity
B. Decreases pulses
-C. Redness
-D. Pain
-E. Warm extremity
-F. Swelling
G. Cyanosis
6. True or False: Assessment of Homan's Sign is the most reliable indicator of a deep vein thrombosis.
True
-False
7. A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order
for this medication to have a therapeutic effect on the patient, the aPTT should be?
A. 0.5-2.5 times the normal value range
B. 2-3 times the normal value range
-C. 1.5-2.5 times the normal value range
D. 1-3.5 times the normal value range
8. A patient, who is receiving continuous IV Heparin for the treatment of a DVT, has an aPTT of 110 seconds.
What is your next nursing action per protocol?
A. Continue with the infusion because no change is needed based on this aPTT.
B. Increase the drip rate per protocol because the aPTT is too low.
C. Re-draw the aPTT STAT.
-D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.
9. You’re educating a patient about Warfarin (Coumadin) and how it is used to treat blood clots. Which
statements by the patient require you to re-educate them about how this medication works? Select all that
apply:
-A. “This medication will help dissolve the blood clot.”
B. “This medication will prevent another blood clot from forming.”
C. “This medication will help prevent the blood clot from becoming bigger in size.”
-D. “This medication starts working immediately after the first dose.”
10. A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR
range for this medication?
-A. 2-3
B. 1-3
C. 4-8
D. 0.5-2.5
11. Which option below is considered a positive Homan's Sign for the assessment of a deep vein thrombosis
(DVT)?
-A. The patient reports pain when the foot is manually dorsiflexed.
B. The patient reports pain when the foot is manually plantarflexed.
C. The patient experiences pain when the leg is extended.
D. the patient experiences pain when the leg is flexed.
12. Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV
Heparin. Select all the nursing interventions that are appropriate for this patient:
A. Apply cool compresses to affected extremity
-B. Measure leg circumference
C. Massage affected extremity
-D. Elevate affected extremity above heart level
E. Encourage frequent ambulation
F. Monitor the patient's INR level
-G. Monitor the patient's aPTT level
H. Apply sequential compression device (SCD) to the affected extremity
13. A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses _______ and this
result means?
A. fibrin degradation fragment; positive for a blood clot
B. platelet degradation protein; negative for a blood clot
C. clotting factors; positive for a blood clot
-D. fibrin degradation fragment; negative for a blood clot

PULMONARY HYPERTENSION
PNEUMOTHORAX
1. A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia,
and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On
assessment, you note there is unequal rise and fall of the chest with absent breath sounds on
the left side. You also note a "sucking" sound when the patient inhales and exhales. The
patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?
A. Closed pneumothorax
-B. Open pneumothorax
C. Tension pneumothorax
D. Spontaneous pneumothorax
2. In regards to the patient in the question above, which of the following options below is a
nursing intervention you would provide to this patient?
A. Place the patient in supine position
B. Place a non-occlusive dressing over the chest wound
-C. Place a sterile occlusive dressing over the chest wound and tape it on three sides
D. Prepare the patient for a thoracentesis
3. A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following
is NOT a correct statement about this type of pneumothorax?
A. It can be caused by the rupture of a pulmonary bleb.
B. It can occur in patients who are young, tall and thin without a history of lung disease.
-C. Smoking increases the chances of a patient developing a spontaneous pneumothorax.
D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.
4. Which of the following is a LATE sign of the development of a tension pneumothorax?
A. Hypotension
B. Tachycardia
-C. Tracheal deviation
D. Dyspnea
5. While caring for a patient with a suspected pneumothorax, you note there are several
areas on the patient’s skin that appear to be “bulging” out. These “bulging” areas are located
on the patient’s neck, face, and abdomen. On palpation on these areas, you note they feel
"crunchy". When charting your findings you would refer to this finding as?
A. Subcutaneous paresthesia
B. Pigment molle
-C. Subcutaneous emphysema
D. Veisalgia
6. You're providing care to a patient with a pneumothorax who has a chest tube. On
assessment of the chest tube system, you note there is no fluctuation of water in the water
seal chamber as the patient inhales and exhales. You check the system for kinks and find
none. What is your next nursing action?
A. Keep monitoring the patient because this is a normal finding.
B. Increase wall suction to the system until the water fluctuates in the water seal chamber.
-C. Assess patient's lung sounds to assess if the affected lung has re-expanded.
D. Notify the physician.
7. A patient is receiving mechanical ventilation with PEEP. The patient had developed a
tension pneumothorax. Select ALL the signs and symptoms that can present with this
condition:
-A. Hypotension
-B. Jugular Venous Distention
C. Bradycardia
-D. Tracheal deviation
E. Hyperemia
-F. Tachypnea
8. A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding
during your assessment requires immediate nursing intervention?
A. The water seal chamber has intermittent bubbling.
-B. The patient has slight tracheal deviation to the right side.
C. The water seal chamber fluctuates while the patient inhales and exhales.
D. The patient complains of tenderness at the chest tube insertion site.
9. Which statement is CORRECT about a tension pneumothorax?
A. This condition happens when an opening to the intrapleural space creates a two-way valve
which causes pressure to build up in the space leading to shifting of the mediastinum.
-B. A tension pneumothorax is a medical emergency and is treated with needle decompression.
C. Tracheal deviation is an early sign of a tension pneumothorax
D. An open pneumothorax is the only cause of a tension pneumothorax.
10. A patient receiving treatment for a pneumothorax calls on the call light to tell you
something is wrong with their chest tube. When you arrive to the room you note that the
drainage system has fallen on its side, and there is a large crack in the system. What is your
next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of
sterile water and obtain a new system

11.A patient was admitted after a motor vehicle accident with multiple fractured ribs.
Respiratory assessment includes signs/symptoms of secondary pneumothorax, which
includes which of the following?
A: Sharp pleuritic pain that worsens on inspiration
B: Crackles over lung bases of affected lung
C: Tracheal deviation toward the affected lung
D: Increased diaphragmatic excursion on side of rib fractures
12.A patient was admitted following a motor vehicle accident with multiple fractured ribs.
Respiratory assessment includes signs/symptoms of secondary pneumothorax. Which
are the most common assessment findings associated with a pneumothorax? (Select all
that apply).
-A. Sharp pleuritic pain that worsens on inspiration
B. Crackles over lung bases of affected lung
C. Tracheal deviation toward the affected lung
-D. Worsening dyspnea
-E. Absent lung sounds to auscultation on affected side
13.The emergency department nurse is assessing a client who has sustained a blunt
injury to the chest wall. Which finding indicates the presence of a pneumothorax in this
client?
a. A low respiratory rate
-b. Diminished breath sounds
c. The presence of a barrel chest
d. A sucking sound at the site of injury
14.A patient is exhibiting signs of a pneumothorax following tracheostomy. The surgeon
inserts a chest tube into the anterior chest wall. What should the nurse tell the family is
the primary purpose of this chest tube?
-A) To remove air from the pleural space
B) To drain copious sputum secretions
C) To monitor bleeding around the lungs
D) To assist with mechanical ventilation
15. The nurse is caring for a patient after thoracentesis. Which actions can be delegated
from the nurse to the unlicensed assistive personnel (UAP)? Select all that apply.
1.) Assess puncture site and dressing for leakage.
-2.)Check vital signs every 15 minutes for 1 hour.
3.) Auscultate for absent or reduced lung sounds.
-4.)Remind the patient to take deep breaths.
-5.)Take the specimens to the laboratory.
6.) Teach the patient symptoms of pneumothorax.
16.A patient enters the ED presenting with symptoms of shortness of breath, severe
chest pain, and diminished heart sounds. His blood pressure is 90/70 and his heart rate
is 110. You notice that the trachea appears to be deviated to the right. What is your
nursing priority?
-A) Prepare for an emergency insertion of a needle into the second intercostal space,
midclavicular line
B) Hang IV fluids and prepare for chest tube insertion
C) Encourage patient to breathe into a paper bag and obtain ABG's.
D) Assess for allergies and administer epinephrine as ordered.
17.The patient has been diagnosed with having an open pneumothorax r/t penetrating
injury. Which of the following symptoms would the nurse most expect to see in this
patient?
A) Chest pain and tracheal shifting
B) Hyperresanance and hyperexpansion of the affected side
-C) High pitched respiratory sounds and SpO2 89%
D) Muffled heart sounds and bradycardia
The nurse is taking care of the patient with a pneumothorax. Which of the following, if found in
the patients history, would be most contributory to the development of this pneumothorax?

A) MVA involvement approximately 2 weeks ago.

B) Hx of diabetes, HTN, and asthma
-C) Insertion of subclavian line yesterday
D) Daily use of albuterol and corticosteroid inhaler

A nurse enters the room of a patient with a left-sided pneumothorax to perform an afternoon
assessment. The nurse finds the patient's trachea deviated slightly to the right side compared to
her morning findings, and the patient reports feeling increasingly short of breath. What is the
first action the nurse should take?

-1) Administer high-flow supplemental oxygen.

2) Position the patient's HOB at 30-45 degrees.
3) Call the physician.
4) Document the extent of tracheal shift in the patient's chart and reassess in 15 minutes.

The nurse should include all of the following in the plan of care for the client with a chest tube r/t
hemothorax? SATA:

-A) Report drainage of 100 ml/hr

-B) Teach the patient to cough and deep breath frequently
-C) Report intermittent bubbling in the water seal chamber
D) Keep the patient on bedrest with bedside commode
E) Loop tubing to keep it off of the floor

Your patient with chronic obstructive pulmonary disease suddenly complains of sharp pain that
began with a coughing fit. You know the doctor will require the following:

a) Surgical consent for lobectomy

b) Nothing- this is normal
c) Chest tube set-up
d) Ventilator set-up

A patient has come into the ED with a hemothorax and has had a chest tube inserted 2 hours
ago. Which of the following would be most concerning if observed by the nurse?

A) Tidaling in the water seal of the chest tube with a popping sensation in the skin around the
chest tube
B) The patient is complaining of pain 8/10 and is taking shallow breaths with a RR of 27
C) There is intermittent bubbling in the water seal of the chest tube with 200 ml of bright red
drainage
-D) The patient begins to pick at his IV lines and tries to get out of bed and is sweating profusely

A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and
fluids is administered intravenously (IV), but the client's vital signs do not improve. A central
venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of
these findings is which of the following?

A. Spontaneous pneumothorax
B. Ruptured diaphragm
C. Hemothorax
-D. Pericardial tamponade
A nurse walks in to a client who is in respiratory distress. The client has tracheal deviation to the
right side. The nurse knows to prepare for which of the following emergent procedures?

-a. Chest tube insertion on the left side.

b. Chest tube insertion on the right side.
c. Intubation
d. Tracheostomy

LUNG CANCER