A nurse is caring for a client with a suspected pulmonary embolism. Which diagnostic test is most likely to confirm this diagnosis?

Chest X-ray

Electrocardiogram (ECG)

CT pulmonary angiography

Arterial blood gas (ABG)

Answer and Explanation

The Correct Answer is C

Choice A reason: A chest X-ray may show secondary signs like atelectasis in pulmonary embolism but is not specific for diagnosis. It primarily rules out other conditions like pneumonia. Pulmonary embolism requires visualization of a clot, which X-rays cannot provide, making them insufficient for confirming the diagnosis.

Choice B reason: An ECG may show tachycardia or right heart strain in pulmonary embolism but is not diagnostic. It detects cardiac changes secondary to the embolism, not the clot itself. Specific imaging, like CT angiography, is needed to visualize the pulmonary artery obstruction for confirmation.

Choice C reason: CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, as it directly visualizes thrombi in pulmonary arteries using contrast-enhanced imaging. It confirms the presence, location, and extent of the clot, enabling rapid diagnosis and treatment to prevent life-threatening complications like right heart failure.

Choice D reason: Arterial blood gas may show hypoxemia or respiratory alkalosis in pulmonary embolism due to impaired gas exchange but is not diagnostic. It reflects physiological changes, not the clot itself. Imaging, like CT angiography, is required to confirm the presence of a pulmonary artery obstruction.

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Correct Answer is B

Explanation

Choice A reason: Fluid volume deficit, or hypovolemia, involves decreased fluid volume, causing symptoms like dehydration and hypotension. Heart failure leads to fluid retention due to poor cardiac output, resulting in edema and lung crackles, which are signs of fluid overload, not deficit, making this an incorrect diagnosis.

Choice B reason: Fluid volume excess, or hypervolemia, occurs in heart failure when the heart’s reduced pumping capacity causes fluid backup, leading to edema and pulmonary congestion (crackles). This matches the client’s symptoms, as ineffective cardiac output increases venous pressure, causing fluid to accumulate in tissues and lungs.

Choice C reason: Myocardial infarction is a heart attack caused by coronary artery occlusion, leading to myocardial ischemia. While it can cause heart failure, the client’s symptoms of edema and crackles specifically indicate fluid volume excess due to heart failure, not the acute event of infarction itself.

Choice D reason: Atelectasis is lung collapse due to airway obstruction or compression, causing reduced breath sounds, not crackles. Heart failure’s pulmonary edema causes coarse crackles due to fluid in alveoli. Atelectasis does not explain the client’s edema or fluid-related symptoms, making it an incorrect choice.

A. Supine with head elevated B. Prone with legs extended C. Lateral recumbent with knees flexed D. Sitting upright with back straight

Correct Answer is C

Explanation

Choice A reason: Supine with head elevated is used for comfort or respiratory support but not for lumbar puncture. This position does not allow access to the lumbar spine or flex the back to open intervertebral spaces, which is necessary for safe needle insertion during the procedure.

Choice B reason: Prone with legs extended is used for procedures like wound care but not lumbar puncture. This position does not flex the spine to widen intervertebral spaces, making needle insertion difficult and risky. The lateral recumbent position is standard for accessing the subarachnoid space.

Choice C reason: Lateral recumbent with knees flexed maximizes lumbar spine flexion, opening intervertebral spaces for safe needle insertion into the subarachnoid space during a lumbar puncture. This position reduces the risk of nerve damage and ensures accurate cerebrospinal fluid collection, making it the standard choice.

Choice D reason: Sitting upright with back straight may be used in some procedures but is less common for lumbar puncture. It does not provide optimal spinal flexion compared to the lateral recumbent position, which better exposes the lumbar vertebrae, reducing complications during needle insertion.

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