# Stage 4 — Generate solutions. CT pulmonary angiography confirms acute PE in the right main and segmental pulmonary arteries, and the completed bedside echocardiogram shows mild right-ventricular dilation. After oxygen and initial support, BP is 102/64 without vasopressors or signs of shock. Which interventions are appropriate now? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372447&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question Stage 4 — Generate solutions. CT pulmonary angiography confirms acute PE in the right main and segmental pulmonary arteries, and the completed bedside echocardiogram shows mild right-ventricular dilation. After oxygen and initial support, BP is 102/64 without vasopressors or signs of shock. Which interventions are appropriate now? Select all that apply. 1 Continue supplemental oxygen, titrating to hypoxemia, work of breathing, and the prescribed oxygenation goal 2 Use aspirin 325 mg as the sole antithrombotic treatment because CT pulmonary angiography has confirmed the embolism 3 Administer the prescribed therapeutic anticoagulant after reviewing CBC, platelets, renal function, and bleeding risk 4 Place an inferior vena cava filter routinely now, even though the client has no identified contraindication to anticoagulation 5 Give systemic thrombolysis immediately solely because right-ventricular dilation is present, despite current hemodynamic stability 6 Use a closely monitored inpatient setting and promptly involve the PE-response or critical-care team because RV dysfunction increases deterioration risk ## Explanation Why choices 1, 3, and 6 are appropriate Confirmed acute PE with hypoxemia requires ongoing oxygen support and reassessment. Therapeutic anticoagulation is the treatment foundation; the specific agent and monitoring depend on renal function, bleeding risk, and whether rapid adjustment or advanced therapy may be needed. Right-ventricular dysfunction plus the initial low BP warrants hospitalization, close monitoring, and prompt multidisciplinary escalation. Why choices 2, 4, and 5 are not appropriate Aspirin alone does not treat acute VTE. An IVC filter is not routine when anticoagulation can be given. Right-ventricular dilation without persistent hypotension, shock, or clinical deterioration does not by itself mandate immediate systemic thrombolysis. ## In-depth explanation Step 1 — Use completed data once CT pulmonary angiography has confirmed PE, and the echocardiogram has already shown right-ventricular dilation. Reordering the same echocardiogram is not a new solution. Step 2 — Treat and monitor the current risk Continue oxygen according to the client's hypoxemia and work of breathing. Administer the selected therapeutic anticoagulant after baseline safety review. Because RV dysfunction and the initial low BP raise concern for deterioration, keep the client hospitalized in a monitored setting and involve the appropriate PE-response or critical-care team. Step 3 — Avoid over-treatment and false exclusion Do not use aspirin as sole therapy, insert an IVC filter routinely, or give systemic thrombolysis solely for RV dilation while the client is currently stable. A single negative troponin and nonischemic ECG reduce but do not independently eliminate ACS; the confirmed PE and full clinical picture guide the immediate plan. Key concept Generate solutions that match the client's present severity and completed workup. ## Clinical scenario Scenario (Stage 4 — Generate solutions) CT pulmonary angiography confirms acute PE, and the already completed echocardiogram shows mild RV dilation. BP has improved after initial support, with no persistent hypotension or shock. Background NCJMM Stage 4 — Select all appropriate treatment, surveillance, and escalation strategies without repeating completed tests. ## Key concepts - **Acute PE with right-ventricular dysfunction** — Right-ventricular dilation increases concern for adverse outcomes and supports close inpatient monitoring. Reperfusion decisions also depend on hemodynamics, bleeding risk, and clinical deterioration. - **Therapeutic anticoagulation** — The agent is selected from patient factors and the care plan. Use institution-specific, agent-specific dosing and monitoring rather than assuming one universal aPTT target. - **IVC filter** — An inferior vena cava filter is generally reserved for selected situations such as an absolute contraindication to anticoagulation; it is not routine first-line treatment when therapeutic anticoagulation can be given. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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