A nurse is caring for five patients.
For which patients should the nurse assess a high risk for developing a pulmonary embolism (PE)? Select all three that apply.
Patient with new spinal cord injury on a rotating bed.
Young obese patient with a fractured femur.
Patient who had a reaction to contrast dye yesterday.
Older patient who is one day post hip replacement surgery.
Correct Answer : B,D
Choice A rationale
A patient with a new spinal cord injury on a rotating bed is not at a high risk for developing a pulmonary embolism. The rotating bed is specifically designed to prevent complications associated with immobility, such as venous stasis and pressure ulcers. The constant movement of the bed helps to maintain blood flow and prevent the pooling of blood in the extremities, thereby reducing the risk of deep vein thrombosis and subsequent pulmonary embolism.
Choice B rationale
A young obese patient with a fractured femur is at a high risk for developing a pulmonary embolism. Obesity is a hypercoagulable state, increasing the baseline risk of thrombus formation. A fractured femur, especially if it requires immobilization, causes significant venous stasis and potential endothelial injury. This combination of factors, adhering to Virchow's triad, creates a highly prothrombotic environment, making the development of DVT and PE very likely.
Choice C rationale
A patient who had a reaction to contrast dye yesterday is not at a high risk for developing a pulmonary embolism. Allergic reactions to contrast dye are typically associated with hypersensitivity responses, affecting systems such as the respiratory, cardiovascular, and integumentary. There is no known physiological mechanism or evidence to suggest that a contrast dye reaction, even a severe one, directly increases the risk of developing a pulmonary embolism in the subsequent days.
Choice D rationale
An older patient who is one day post hip replacement surgery is at a very high risk for developing a pulmonary embolism. Surgical procedures, particularly orthopedic surgeries like hip replacements, cause significant endothelial injury and a hypercoagulable state. The post-operative period often involves extended immobility, leading to venous stasis. These three components of Virchow's triad converge to create an ideal environment for the formation of a deep vein thrombosis, which can easily embolize to the lungs.
Choice E rationale
A young man with an exacerbation of asthma is not at a high risk for developing a pulmonary embolism. Asthma is a chronic inflammatory disease of the airways characterized by bronchoconstriction. While a severe asthma exacerbation can lead to hypoxemia and respiratory distress, it does not directly cause the hypercoagulable state, venous stasis, or endothelial injury necessary to form a deep vein thrombosis. Therefore, it is not a direct risk factor for a pulmonary embolism
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Contact dermatitis is an inflammatory reaction of the skin caused by contact with an irritant or allergen. Avoiding hot showers and baths is a correct teaching point, as heat can exacerbate itching and further irritate the skin barrier, leading to increased inflammation and discomfort. This statement shows correct understanding.
Choice B rationale
Contact dermatitis is not contagious. The rash is a localized inflammatory response and cannot be spread from person to person. A statement about isolating oneself indicates a significant misunderstanding of the condition's etiology and transmission. This is the statement that requires further education from the nurse.
Choice C rationale
Applying unscented moisturizer is a correct and helpful intervention for contact dermatitis. Moisturizers help to restore the skin's barrier function, reduce dryness and scaling, and can soothe the irritated area. Using an unscented product is important to avoid further irritation from potential allergens in fragrances.
Choice D rationale
Maintaining adequate hydration is beneficial for overall skin health and can support the skin's healing process. While 100 oz may be a large amount for some, drinking adequate fluids is generally a sound recommendation for promoting skin barrier function and systemic health during an inflammatory process. .
Correct Answer is A
Explanation
Choice A rationale
Fragrances in cosmetics and personal care products are common causes of allergic contact dermatitis. These are often complex mixtures of chemical allergens that can trigger a T-cell mediated immune response, leading to a delayed-type hypersensitivity reaction. Avoiding products containing these known irritants is a key preventative strategy to reduce the frequency and severity of future episodes.
Choice B rationale
Washing the skin with very hot water is detrimental to the skin's barrier function. Hot water strips the skin of its natural oils (sebum), leading to excessive dryness and micro-fissures. This compromised skin barrier makes the skin more permeable to allergens and irritants, exacerbating existing dermatitis and increasing susceptibility to future episodes. The skin should be cleansed with lukewarm water.
Choice C rationale
Wearing gloves constantly, especially those made of latex or vinyl, can create a moist environment that traps sweat and irritants, leading to maceration and irritation of the skin. This can worsen existing dermatitis and potentially cause a new form of contact dermatitis. Gloves should only be worn for specific tasks and for limited periods to prevent this moisture-induced skin damage.
Choice D rationale
Fabric softeners often contain chemicals and fragrances that are known contact allergens and irritants. These substances can remain in the clothing fibers after washing and come into direct contact with the skin, triggering a hypersensitivity reaction. Therefore, the nurse should advise against using fabric softeners to reduce exposure to potential allergens and prevent future episodes of contact dermatitis.
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