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 C

Explanation

Choice A reason: 10% Dextrose is a hypertonic solution used for caloric supplementation or hypoglycemia treatment. It can cause hyperglycemia and fluid shifts, making it unsuitable for routine preoperative hydration. Surgical patients need balanced electrolyte solutions to replace fluid losses and maintain homeostasis, which 10% dextrose does not provide effectively.

Choice B reason: 3% NaCl, a hypertonic saline, is used for severe hyponatremia or cerebral edema. It risks causing hypernatremia and fluid overload if not carefully monitored. Preoperative patients typically require isotonic fluids to maintain electrolyte balance and hydration, making 3% NaCl inappropriate for standard surgical preparation.

Choice C reason: Lactated Ringer’s is an isotonic solution containing electrolytes like sodium, potassium, and calcium, closely mimicking plasma. It is ideal for preoperative hydration, as it replaces fluid losses, maintains electrolyte balance, and supports hemodynamic stability during surgery. Its balanced composition makes it the standard choice for surgical patients.

Choice D reason: 0.45% NaCl, a hypotonic solution, is used for maintenance hydration or hypernatremia correction. It provides less sodium than needed for surgical fluid replacement and may cause hyponatremia or fluid shifts. Isotonic fluids like Lactated Ringer’s are preferred preoperatively to ensure electrolyte stability and adequate hydration.

A. Sensible water loss B. Major magnesium losses C. Insensible water loss D. Low potassium levels

Correct Answer is C

Explanation

Choice A reason: Sensible water loss refers to measurable fluid loss, like urine or sweat. The client’s symptoms, including high serum sodium (153 mEq/L), suggest hypernatremia due to water loss, but sensible losses like urine are reduced (decreased urine output). Insensible losses better explain the unmeasurable fluid deficit in this scenario.

Choice B reason: Major magnesium losses cause hypomagnesemia, leading to tremors or arrhythmias, not typically confusion or hypernatremia. The client’s high sodium and dehydration symptoms point to water loss, not magnesium. Magnesium levels are not provided, and the symptoms align more with fluid imbalance than magnesium deficiency.

Choice C reason: Insensible water loss, from skin and respiration, is unmeasurable and can lead to hypernatremia (serum sodium 153 mEq/L) due to concentrated blood. Dry mucous membranes, decreased urine output, and confusion indicate dehydration from water loss, consistent with insensible losses in elderly patients with reduced thirst perception.

Choice D reason: Low potassium levels (hypokalemia) cause muscle weakness and arrhythmias, not hypernatremia or confusion. The client’s high sodium and dehydration symptoms point to water loss, not potassium imbalance. Potassium levels are not provided, but the clinical picture supports insensible water loss as the primary issue.

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

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