Twelve hours following orthopedic surgery on the right leg, the client begins to have acute chest pain and difficulty breathing. Which action should the nurse take first?

Notify healthcare provider (HCP) of the symptoms and administer a PRN pain medication.

Increase the client's IV flow rate and start low flow oxygen.

Position the client on the left side while immobilizing the affected leg.

Take the client's vital signs and auscultate all lung sounds.

Answer and Explanation

The Correct Answer is B

A. Notify healthcare provider (HCP) of the symptoms and administer a PRN pain medication. While notifying the HCP is necessary, administering pain medication does not address the underlying cause of the client’s acute chest pain and difficulty breathing. These symptoms suggest a possible pulmonary embolism (PE), a life-threatening complication after orthopedic surgery. Immediate supportive interventions should be initiated before notifying the provider.
B. Increase the client's IV flow rate and start low-flow oxygen. The client is experiencing acute respiratory distress, which could indicate a pulmonary embolism (PE), a fat embolism, or another postoperative complication. Providing oxygen helps improve oxygenation and reduce hypoxia, while increasing the IV flow rate helps maintain perfusion and prevent shock. These immediate interventions support vital functions while preparing for further medical management.
C. Position the client on the left side while immobilizing the affected leg. This position is used in air embolism management, not pulmonary embolism. In suspected PE, the priority is to optimize oxygenation and circulation rather than repositioning. The affected leg should be immobilized to prevent further embolization, but this is not the first priority.
D. Take the client's vital signs and auscultate all lung sounds. While assessing the client’s vital signs and lung sounds is important, intervention should not be delayed. The priority is to support oxygenation and circulation immediately, as PE can rapidly lead to hypoxia, hemodynamic instability, or cardiac arrest. Assessment should be done concurrently with emergency interventions.

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Correct Answer is A

Explanation

A. Normal sinus rhythm (NSR) at 84 beats/minute. The goal of cardioversion for atrial fibrillation (AFib) is to restore a normal sinus rhythm (NSR). NSR indicates that the atria and ventricles are depolarizing in a coordinated manner, reducing the risk of thromboembolism, stroke, and hemodynamic instability. A heart rate of 84 beats/minute is within the normal range, confirming the success of the procedure.
B. Regular rhythm with consistent pacemaker capture. Cardioversion is used to restore normal rhythm in AFib, not to manage pacemaker function. A pacemaker is not part of standard AFib cardioversion unless the client has underlying conduction issues requiring pacing.
C. Return of elevated ST segment to the baseline. ST elevation suggests acute myocardial infarction (MI), which is unrelated to atrial fibrillation or cardioversion. Cardioversion does not treat ST elevation or myocardial ischemia, making this an incorrect indicator of success.
D. Increased frequency of QRS complexes. An increase in QRS frequency suggests tachycardia, which would indicate treatment failure rather than success. The goal of cardioversion is to restore a normal, controlled heart rate and rhythm, not to increase the number of ventricular contractions.

A. Decreased cardiac output. B. Ineffective airway clearance. C. Ineffective peripheral tissue perfusion. D. Deficient fluid volume.

Correct Answer is A

Explanation

A. Decreased cardiac output. Central venous pressure (CVP), also called right atrial pressure (RAP), reflects right ventricular preload and overall fluid status. An increasing CVP indicates fluid overload or impaired right ventricular function, both of which can lead to decreased cardiac output. Conditions such as right heart failure, pulmonary hypertension, or excessive fluid resuscitation can cause elevated CVP, reducing the heart’s ability to pump effectively and leading to poor systemic circulation.
B. Ineffective airway clearance. Airway clearance is not directly related to CVP measurements. While severe pulmonary conditions like ARDS or COPD can contribute to cardiac strain and right heart failure, the primary mechanism for rising CVP is cardiac dysfunction or fluid overload, not airway obstruction.
C. Ineffective peripheral tissue perfusion. Although decreased cardiac output can impair tissue perfusion, this choice is too broad. Increased CVP specifically reflects right-sided heart function and preload, making decreased cardiac output the more precise diagnosis related to the pathophysiologic mechanism.
D. Deficient fluid volume. A low CVP is associated with hypovolemia and fluid deficits, while an increasing CVP suggests fluid overload, heart failure, or venous congestion. Deficient fluid volume would cause a downward trend in CVP, not an increase.

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Twelve hours following orthopedic surgery on the right leg, the client begins to have acute chest pain and difficulty breathing. Which action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has been treated for uncontrolled atrial fibrillation with cardioversion. Following the cardioversion, which assessment finding indicates to the nurse that the desired outcome was achieved?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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