A client suffered a fractured femur and is scheduled for surgery one day after sustaining the injury. The client develops acute respiratory distress syndrome (ARDS) and the healthcare provider suspects fat embolism (FES) based on which of the following clinical manifestations? (Select all that apply.)

Decreased PaO2 <60mmHg.

PaO2 greater than 80mmHg.

Decreased platelet count and hematocrit levels.

Changes in ST segment and T-wave.

PaCO2 40mmHg.

Answer and Explanation

Correct Answer : A,C,D

A. Decreased PaO2 <60mmHg: A hallmark of fat embolism syndrome (FES) is hypoxemia, which results in a PaO2 less than 60 mmHg. This is a key indicator of the severity of respiratory compromise in FES and ARDS.

B. PaO2 greater than 80mmHg: This would not be consistent with FES. Fat embolism often causes significant hypoxemia, and PaO2 greater than 80 mmHg would indicate adequate oxygenation.

C. Decreased platelet count and hematocrit levels: In fat embolism syndrome, there is often a decrease in platelet count and hematocrit due to disseminated intravascular coagulation (DIC), which can occur as a complication of fat embolism.

D. Changes in ST segment and T-wave: Electrocardiographic changes, including changes in ST segment and T-wave, are commonly seen in fat embolism syndrome due to myocardial injury, hypoxemia, or shock.

E. PaCO2 40mmHg: A PaCO2 of 40 mmHg is within normal limits and does not indicate any significant respiratory distress or abnormality that would be expected in fat embolism syndrome.

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Correct Answer is ["0.5"]

Explanation

Convert units: Since the available medication is in mg, convert the prescribed dose from mcg to mg. There are 1000 mcg in 1 mg, so:

125 mcg / 1000 mcg/mg = 0.125 mg

· Set up the calculation: Divide the desired dose by the available dose per tablet:

0.125 mg / 0.25 mg/tablet = X tablets

· Solve for X:

X = 0.5 tablets

A. Anxiety attack B. Pneumonia C. Pulmonary embolism D. Asthma exacerbation

Correct Answer is C

Explanation

A. While anxiety can cause rapid breathing and confusion, the patient's clinical presentation (dyspnea, confusion, tachycardia, hypotension, and oxygen desaturation) is more consistent with a serious physical condition, such as a pulmonary embolism, rather than an anxiety attack.

B. Pneumonia could cause dyspnea and confusion, but the rapid onset of symptoms, along with the patient's history of prolonged bed rest and risk factors, suggests a pulmonary embolism rather than pneumonia.

C. Pulmonary embolism (PE) is a life-threatening condition that can occur in patients on prolonged bedrest, especially after a pelvic fracture. The patient’s symptoms of dyspnea, confusion, tachycardia, hypotension, and oxygen desaturation are classic signs of PE. This requires immediate intervention, including anticoagulation and possibly thrombolytic therapy.

D. Asthma exacerbation typically presents with wheezing and difficulty breathing, but it would not typically cause the severe hypotension, confusion, and rapid oxygen desaturation seen in this patient.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["0.5"]

Explanation

A patient on prolonged bedrest following a pelvic fracture becomes dyspneic and confused. Pulse = 135 beats/minute, blood pressure = 90/50 mmHg, respirations = 36/minute, Oxygen saturation starts dropping rapidly. Which of the following conditions should the nurse prepare to treat for this patient?

Correct Answer is C

Explanation

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