A patient with dyspnea and chest pain has the following ...

[K@]

A patient with dyspnea and chest pain has the following diagnostic study results. The nurse suspects the patient has which condition?
 
  1. coronary artery disease and metabolic acidosis
  2. chronic obstructive pulmonary disease with respiratory acidosis
  3. pulmonary embolism and respiratory alkalosis
  4. acute asthma attack with metabolic alkalosis

Question 2

The nurse is reviewing the information from a patient who is 22 weeks pregnant. For which physician order should the nurse request clarification before implementing it?
 
  1. Administer oxygen at 3 liters per minute, keep oxygen saturation level above 95.
  2. Assess arterial blood gases.
  3. Administer heparin: initial dose 10,000 units, then set at 1,200 units per hour via intravenous line.
  4. Administer urokinase.

[Bsand8]

Answer to Question 1

Correct Answer: 3
: An elevated plasma D-dimer result indicates pulmonary embolism. Arterial blood gases usually show hypoxemia (PO2 < 80 mmHg) and often respiratory alkalosis (pH > 7.45, PaCO2 < 38 mmHg) due to tachypnea and hyperventilation. The patient does not have metabolic acidosis; the elevated pH indicates alkalosis. The patient does not have respiratory acidosis. An acute asthma attack would produce respiratory alkalosis.

Answer to Question 2

Correct Answer: 4
Most patients receive a thrombolytic to help treat a pulmonary embolus, but thrombolytics are contraindicated for the pregnant patient. The nurse would anticipate administering oxygen. The patient's arterial blood gases should be assessed. The patient should be started on heparin. Heparin therapy is initiated with an intravenous bolus of 5,000 to 10,000 units, followed by continuous infusion at the rate of 1,000 to 1,500 units per hour.

[K@]

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