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Quizzes > Health & Medicine > Diseases & Conditions

NCLEX Pulmonary Embolism Practice Quiz - 10 Questions

Challenge yourself with NCLEX practice questions on pulmonary embolism

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
paper art style lungs and quiz cover text free nclex pulmonary embolism quiz 10 exam style questions on sky blue background

Use this NCLEX pulmonary embolism quiz to practice key assessment points, ABG clues, and first-line interventions. Answer 10 exam-style questions and spot gaps before the test with short, realistic cases. For extra prep, try more pulmonary embolism practice when you finish today.

A client suddenly develops shortness of breath and pleuritic chest pain. Which finding is most suggestive of an acute pulmonary embolism?
Gradual weight gain
Sudden onset dyspnea
Bradycardia
Elevated blood glucose
Sudden onset dyspnea and pleuritic chest pain are classic presenting signs of acute pulmonary embolism due to ventilation - perfusion mismatch and lung tissue irritation. Other options are unrelated or non?specific. Early recognition of these symptoms prompts immediate diagnostic evaluation.
Which of the following is the most significant risk factor for developing a pulmonary embolism?
Daily aerobic exercise
Low?fat diet
Prolonged immobility after surgery
Use of NSAIDs for arthritis
Prolonged immobility, especially post?operative, increases risk of venous stasis and deep vein thrombosis, a primary source of pulmonary emboli. Regular exercise, diet changes, and NSAIDs do not significantly increase PE risk.
A D-dimer test is ordered for a client suspected of having a pulmonary embolism. What does a negative D-dimer result indicate?
Pulmonary embolism is unlikely
Massive clot burden present
Lab error, repeat test
Immediate thrombolysis required
A negative D?dimer has high negative predictive value for PE in low to moderate risk clients and essentially rules out significant clot burden. Positive values are non?specific and require imaging confirmation.
Ventilation-perfusion (V/Q) scan shows segmental perfusion defects with normal ventilation. This finding is labeled as:
Normal study
Inconclusive result
Low probability for pulmonary embolism
High probability for pulmonary embolism
Segmental perfusion defects with preserved ventilation (mismatch) indicate areas where blood flow is blocked by emboli, yielding a high?probability V/Q scan for PE. Matched defects or no defects lower suspicion.
Which anticoagulant is most commonly initiated intravenously to treat an acute pulmonary embolism in a hospitalized client?
Warfarin
Apixaban
Enoxaparin
Unfractionated heparin
Unfractionated heparin infusion is preferred in the acute hospital setting because of rapid onset, short half?life, and ease of titration via aPTT monitoring. LMWH is used outpatient or subcutaneously.
A client with acute PE is prescribed alteplase. Which of the following is a contraindication to this therapy?
History of hemorrhagic stroke
Active DVT
Uncontrolled hypertension
Age over 65
A history of hemorrhagic stroke is an absolute contraindication to thrombolytic therapy due to high risk of intracranial bleeding. Uncontrolled hypertension is a relative contraindication and may be managed; age and DVT are not contraindications.
While on continuous unfractionated heparin, the client's aPTT should be maintained at:
1.5 to 2.5 times control value
Equal to INR of 2 - 3
3 to 4 times control value
0.8 to 1.2 times control value
Therapeutic aPTT range for unfractionated heparin is 1.5 - 2.5 times the patient's baseline control to ensure adequate anticoagulation and reduce risk of clot propagation. Other ranges are sub? or supra?therapeutic.
Which nursing intervention is most appropriate for a client with pulmonary embolism experiencing hypoxemia?
Encourage fluid restriction
Administer prescribed supplemental oxygen
Place in Trendelenburg position
Perform incentive spirometry hourly
Supplemental oxygen improves arterial oxygenation by correcting hypoxemia from V/Q mismatch. Incentive spirometry helps prevent atelectasis but doesn't directly correct PE hypoxemia. Trendelenburg is contraindicated in respiratory distress.
An arterial blood gas on a client with acute pulmonary embolism often shows which pattern?
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Acute PE typically causes hyperventilation in response to hypoxemia, leading to decreased PaCO? and increased pH (respiratory alkalosis). Metabolic changes are secondary and less immediate.
A client receiving heparin develops a drop in platelet count by more than 50% from baseline. This is most suggestive of:
Vitamin K deficiency
Sepsis
Heparin-induced thrombocytopenia
Disseminated intravascular coagulation
A sudden 50% drop in platelets within 5 - 10 days of heparin initiation suggests heparin?induced thrombocytopenia (HIT). This immune?mediated reaction can paradoxically increase thrombotic risk.
An inferior vena cava (IVC) filter is indicated in clients with pulmonary embolism when:
Anticoagulation is contraindicated
D-dimer is persistently elevated
Warfarin maintenance therapy is effective
Client is stable on LMWH
An IVC filter is placed when clients have recurrent emboli or contraindications to anticoagulation (e.g., active bleeding). It prevents migration of thrombi from lower extremities to pulmonary circulation.
When initiating warfarin therapy after acute pulmonary embolism, how long should unfractionated heparin and warfarin overlap to ensure safe transition?
At least 5 days and until INR is therapeutic for 24 hours
Until platelet count exceeds 150,000/mm³
2 days regardless of INR
Overlap is not required if LMWH was used
Warfarin and heparin overlap for a minimum of 5 days and until the INR has been in therapeutic range (2.0 - 3.0) for at least 24 hours to allow depletion of vitamin K?dependent clotting factors. Early warfarin can transiently increase procoagulant proteins without overlap.
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Study Outcomes

  1. Identify Key Risk Factors -

    Recognize common and high-risk factors that contribute to pulmonary embolism development, enabling targeted patient assessment and preventive strategies.

  2. Analyze Clinical Presentations -

    Differentiate hallmark signs, symptoms, and diagnostic data of pulmonary embolism to strengthen clinical reasoning during rapid assessments.

  3. Apply Evidence-Based Assessment Techniques -

    Use appropriate assessment tools and interpret laboratory and imaging results to confirm or rule out pulmonary embolism effectively.

  4. Implement Nursing Interventions -

    Prioritize and execute evidence-based pharmacologic and non-pharmacologic interventions to stabilize patients with suspected or confirmed pulmonary embolism.

  5. Evaluate Complications and Patient Responses -

    Monitor patient outcomes, anticipate potential complications, and adjust the care plan to ensure safe, effective management of pulmonary embolism.

Cheat Sheet

  1. Virchow's Triad & Pathophysiology -

    PE formation hinges on Virchow's Triad: venous stasis, hypercoagulability, and endothelial injury (American Heart Association). Use the mnemonic "SHE" (Stasis, Hypercoagulability, Endothelial damage) to recall these key risk factors. Understanding this triad helps you identify high-risk scenarios in NCLEX pulmonary embolism questions.

  2. Clinical Presentation & Assessment -

    Classic signs include sudden dyspnea, pleuritic chest pain, tachycardia, and hemoptysis (Cleveland Clinic). Don't forget to check for signs of right ventricular strain like JVD and hypotension in NCLEX respiratory questions. A focused cardiopulmonary exam guides rapid identification and prioritization.

  3. Diagnostic Modalities & Interpretation -

    D-dimer >500 ng/mL suggests clot presence but lacks specificity, so follow up with CT pulmonary angiography (CTPA) or V/Q scan per NIH guidelines. Remember: "D for Danger" when D-dimer is elevated in low-risk patients. Accurate interpretation of imaging findings is tested frequently in pulmonary embolism NCLEX practice.

  4. Anticoagulation Therapy & Monitoring -

    Initial management often starts with unfractionated heparin or low-molecular-weight heparin, transitioning to warfarin with an INR goal of 2.0 - 3.0 as per ACCP recommendations. Use the mnemonic "HIT" (Heparin, INR, Transition) to remember key steps and monitor for heparin-induced thrombocytopenia. Mastering dosing and lab monitoring is crucial for NCLEX pulmonary embolism questions.

  5. Nursing Interventions & Patient Education -

    Prioritize continuous pulse oximetry, maintain IV access, and assess for bleeding complications when patients receive anticoagulants (Johns Hopkins Medicine). Educate patients on leg exercises, early ambulation, and signs of recurrent PE using the "STOP" strategy: Stop activity, Tell provider, Observe bleeding, Prevent falls. Clear teaching boosts confidence and safety in real-world care and on the NCLEX pulmonary embolism quiz.

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