# A 55-year-old patient on post-op day 5 from an extensive abdominal surgery suddenly develops dyspnea, pleuritic chest pain, and tachycardia. Which findings and actions are appropriate as the team works up suspected pulmonary embolism (PE)? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373402&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

A 55-year-old patient on post-op day 5 from an extensive abdominal surgery suddenly develops dyspnea, pleuritic chest pain, and tachycardia. Which findings and actions are appropriate as the team works up suspected pulmonary embolism (PE)? Select all that apply.

1

Send the patient for a ventilation-perfusion (V/Q) scan as the initial test, as it is less invasive and preferred over CT angiography in postoperative patients.

2

Apply supplemental oxygen, obtain continuous SpO2 and cardiac monitoring, and place the patient on bed rest with head of bed elevated.

3

Apply Wells criteria to determine pretest probability; with high probability and stable patient, anticipate CT pulmonary angiography as the diagnostic test of choice.

4

Anticipate prompt anticoagulation when clinical probability is high and bleeding risk is acceptable, particularly if diagnostic imaging will be delayed.

5

Establish IV access and draw labs (troponin, BNP, BMP); D-dimer is most useful when pretest probability is LOW or moderate (high negative predictive value).

## Explanation

Options 2, 3, 4, and 5 are appropriate. Support oxygenation and monitoring, assess pretest probability, and obtain CT pulmonary angiography when suitable. If clinical probability is high and bleeding risk is acceptable, the team may begin anticoagulation promptly, especially when imaging will be delayed; recent surgery and other contraindications must be weighed. D-dimer is most useful to exclude PE in appropriately selected patients with low or intermediate pretest probability, while troponin and BNP may help risk stratification after PE is suspected or confirmed. Option 1 is incorrect because a V/Q scan is generally reserved for situations in which CT pulmonary angiography is unsuitable or unavailable rather than being automatically preferred after surgery.

## In-depth explanation

The ABSOLUTE rule for suspected DVT/PE: never massage, never apply hot or cold, never elevate aggressively, never measure leg circumference if extremely tender. The job is to suspect, anticoagulate, and image. The "massage to break up the clot" trap is one of the most-tested patient-safety errors on NCLEX.

## Clinical scenario

**55-year-old, post-op day 5 from extensive abdominal surgery**. Sudden **dyspnea, pleuritic chest pain, tachycardia**. SpO2 90% on RA. Right calf is swollen and tender. Suspected **pulmonary embolism**.

## Key concepts

- **Pulmonary embolism (PE)** — Acute occlusion of a pulmonary artery by thrombus; presents with dyspnea, pleuritic pain, tachycardia, and hypoxemia.
- **Wells criteria for PE** — Clinical scoring tool to stratify pretest probability; informs whether to use D-dimer or proceed to CTPA.
- **Empiric anticoagulation** — Heparin or LMWH given before imaging in high-probability or unstable PE patients to prevent extension/recurrence.

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