NSG 223 Exam 2: NSG223 - Exam 2 Study Guide:
Questions & Answers
Pulmonary embolism - ANSWER:Refers to obstruction of the pulmonary artery or one of its branches by
a thrombi that originates somewhere in the right side of the heart.
Causes of Pulmonary Embolism - ANSWER:Includes trauma, surgery (orthopedic, abdominal, pelvic),
pregnancy, heart failure, hypercoagulable states, and prolonged immobility.
Common causes of PE - ANSWER:Most commonly due to blood clot, but can also be due to air, fat,
amniotic fluid, sepsis (bacterial vegetation).
Effects of Pulmonary Embolism - ANSWER:Can cause complete or partial occlusion, little or no blood-
flow to distal area, ventilation/perfusion impairment, and impaired or no gas exchange.
Hemodynamic changes due to PE - ANSWER:Includes edema, regional vasoconstriction, increased
pressures, which can lead to right sided heart failure.
Clinical manifestations of PE - ANSWER:Depends on the size of the thrombus and includes dyspnea,
tachycardia, bloody sputum, cough, chest pain (pleuritic), anxiety, fever, diaphoresis, and syncope.
Emergency treatment for PE - ANSWER:Includes nasal O2 immediately to relieve hypoxemia, respiratory
distress, and central cyanosis.
IV lines for PE treatment - ANSWER:Used for fluids and medications such as anticoagulants and
vasopressors.
Vasopressors for hypotension - ANSWER:If hypotension is not improved by IV fluids, give vasopressors
like Dopamine, Dobutamine, or Norepinephrine.
Evaluations for PE - ANSWER:Includes hemodynamic evaluation, hypoxemia evaluation (ABG), and
MDCTA.
Labs for PE treatment - ANSWER:Includes electrolytes, CBC, and coagulation tests.
Pain relief in PE - ANSWER:May involve small doses of morphine sulfate and sedatives if intubated.
General management for PE - ANSWER:Includes oxygen therapy to relieve hypoxemia, anti-embolism
stockings or SCDs to reduce venous stasis, and elevating legs for venous return.
Anticoagulation therapy for suspected PE - ANSWER:Treatment may last up to 10 days.
Long-term anticoagulation after embolic event - ANSWER:May last from 10 days to 3 months.
Anticoagulants for stable PE - ANSWER:Includes LMW Heparin (Lovanox), unfractionated Heparin (SQ),
or new oral agents such as Dabigatran (Pradaxa) and Rivaroxaban (Xarelto).
Coumadin treatment - ANSWER:For patients who do not qualify for new oral agents, requires regular
blood draws for INR and has bleeding precautions with the antidote being Vitamin K.
, Thrombolytic therapy - ANSWER:Used in patients with acute PE who are hemodynamically unstable and
do not have any risk factors for bleeding.
Clot busters - ANSWER:Includes Activase and Streptase.
Criteria for thrombolytic therapy - ANSWER:Patients must meet specific criteria, and labs must be done
prior to starting treatment, including PTT, INR, Hematocrit, and Platelets.
Anticoagulant for patients not meeting criteria - ANSWER:Heparin IV is used if the patient does not meet
criteria for clot busters.
Prevention of Pulmonary Embolism - ANSWER:Involves identifying patients at risk and preventing
thrombus formation.
Ambulation for PE prevention - ANSWER:Encourages active and passive leg exercises and pumping
exercises in bed or standing next to the bed.
Prolonged sitting or lying - ANSWER:Should be avoided to prevent thrombus formation.
Monitoring for complications - ANSWER:Includes assessing for signs/symptoms of clots, oxygenation,
and monitoring thrombolytic therapy for vital signs, PTT, INR, and bleeding precautions.
ARDS clinical manifestations - ANSWER:Includes rapid onset of severe dyspnea and hypoxemia that does
not respond to supplemental oxygen therapy.
Onset of ARDS - ANSWER:Usually occurs within <72 hours post precipitous event.
X-ray findings in ARDS - ANSWER:Similar to severe pulmonary edema.
ARDS - ANSWER:Acute Respiratory Distress Syndrome affecting lung function.
Intubation - ANSWER:Insertion of a tube to maintain airway.
PEEP - ANSWER:Positive End-Expiratory Pressure; prevents alveolar collapse.
PaO2 Goal - ANSWER:Maintain arterial oxygen pressure > 60 mmHg.
Hypovolemia - ANSWER:Low blood volume requiring treatment and monitoring.
Inotropic Agents - ANSWER:Medications to improve heart contractility.
Vasopressor Agents - ANSWER:Medications that constrict blood vessels to raise BP.
Sedation - ANSWER:Use of drugs to calm or induce sleep.
Neuromuscular Blocking Agents - ANSWER:Medications like Pancuronium to relax muscles.
Train of 4 - ANSWER:Method to assess neuromuscular blockade effectiveness.
Pulmonary Edema - ANSWER:Fluid accumulation in lungs affecting gas exchange.
Diuretics - ANSWER:Medications like Furosemide to reduce fluid overload.
Respiratory Failure - ANSWER:Inability to maintain adequate gas exchange.
Questions & Answers
Pulmonary embolism - ANSWER:Refers to obstruction of the pulmonary artery or one of its branches by
a thrombi that originates somewhere in the right side of the heart.
Causes of Pulmonary Embolism - ANSWER:Includes trauma, surgery (orthopedic, abdominal, pelvic),
pregnancy, heart failure, hypercoagulable states, and prolonged immobility.
Common causes of PE - ANSWER:Most commonly due to blood clot, but can also be due to air, fat,
amniotic fluid, sepsis (bacterial vegetation).
Effects of Pulmonary Embolism - ANSWER:Can cause complete or partial occlusion, little or no blood-
flow to distal area, ventilation/perfusion impairment, and impaired or no gas exchange.
Hemodynamic changes due to PE - ANSWER:Includes edema, regional vasoconstriction, increased
pressures, which can lead to right sided heart failure.
Clinical manifestations of PE - ANSWER:Depends on the size of the thrombus and includes dyspnea,
tachycardia, bloody sputum, cough, chest pain (pleuritic), anxiety, fever, diaphoresis, and syncope.
Emergency treatment for PE - ANSWER:Includes nasal O2 immediately to relieve hypoxemia, respiratory
distress, and central cyanosis.
IV lines for PE treatment - ANSWER:Used for fluids and medications such as anticoagulants and
vasopressors.
Vasopressors for hypotension - ANSWER:If hypotension is not improved by IV fluids, give vasopressors
like Dopamine, Dobutamine, or Norepinephrine.
Evaluations for PE - ANSWER:Includes hemodynamic evaluation, hypoxemia evaluation (ABG), and
MDCTA.
Labs for PE treatment - ANSWER:Includes electrolytes, CBC, and coagulation tests.
Pain relief in PE - ANSWER:May involve small doses of morphine sulfate and sedatives if intubated.
General management for PE - ANSWER:Includes oxygen therapy to relieve hypoxemia, anti-embolism
stockings or SCDs to reduce venous stasis, and elevating legs for venous return.
Anticoagulation therapy for suspected PE - ANSWER:Treatment may last up to 10 days.
Long-term anticoagulation after embolic event - ANSWER:May last from 10 days to 3 months.
Anticoagulants for stable PE - ANSWER:Includes LMW Heparin (Lovanox), unfractionated Heparin (SQ),
or new oral agents such as Dabigatran (Pradaxa) and Rivaroxaban (Xarelto).
Coumadin treatment - ANSWER:For patients who do not qualify for new oral agents, requires regular
blood draws for INR and has bleeding precautions with the antidote being Vitamin K.
, Thrombolytic therapy - ANSWER:Used in patients with acute PE who are hemodynamically unstable and
do not have any risk factors for bleeding.
Clot busters - ANSWER:Includes Activase and Streptase.
Criteria for thrombolytic therapy - ANSWER:Patients must meet specific criteria, and labs must be done
prior to starting treatment, including PTT, INR, Hematocrit, and Platelets.
Anticoagulant for patients not meeting criteria - ANSWER:Heparin IV is used if the patient does not meet
criteria for clot busters.
Prevention of Pulmonary Embolism - ANSWER:Involves identifying patients at risk and preventing
thrombus formation.
Ambulation for PE prevention - ANSWER:Encourages active and passive leg exercises and pumping
exercises in bed or standing next to the bed.
Prolonged sitting or lying - ANSWER:Should be avoided to prevent thrombus formation.
Monitoring for complications - ANSWER:Includes assessing for signs/symptoms of clots, oxygenation,
and monitoring thrombolytic therapy for vital signs, PTT, INR, and bleeding precautions.
ARDS clinical manifestations - ANSWER:Includes rapid onset of severe dyspnea and hypoxemia that does
not respond to supplemental oxygen therapy.
Onset of ARDS - ANSWER:Usually occurs within <72 hours post precipitous event.
X-ray findings in ARDS - ANSWER:Similar to severe pulmonary edema.
ARDS - ANSWER:Acute Respiratory Distress Syndrome affecting lung function.
Intubation - ANSWER:Insertion of a tube to maintain airway.
PEEP - ANSWER:Positive End-Expiratory Pressure; prevents alveolar collapse.
PaO2 Goal - ANSWER:Maintain arterial oxygen pressure > 60 mmHg.
Hypovolemia - ANSWER:Low blood volume requiring treatment and monitoring.
Inotropic Agents - ANSWER:Medications to improve heart contractility.
Vasopressor Agents - ANSWER:Medications that constrict blood vessels to raise BP.
Sedation - ANSWER:Use of drugs to calm or induce sleep.
Neuromuscular Blocking Agents - ANSWER:Medications like Pancuronium to relax muscles.
Train of 4 - ANSWER:Method to assess neuromuscular blockade effectiveness.
Pulmonary Edema - ANSWER:Fluid accumulation in lungs affecting gas exchange.
Diuretics - ANSWER:Medications like Furosemide to reduce fluid overload.
Respiratory Failure - ANSWER:Inability to maintain adequate gas exchange.
