NCLEX-PN

Category - Physiological Adaptation

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A nurse is monitoring a client who gave birth 24 hours earlier. Which of the following signs should prompt the nurse to report to the physican or RN that the client is probably experiencing pulmonary embolus?

Abnormal increase in blood pressure
Client is having chills
Client abruptly complains of difficulty breathing
Increasing temperature

Explanation

Answer: C - Development of abrupt dyspnea, increased sweating, and confusion should prompt the nurse to report a possible occurrence of pulmonary embolus. Chills and fever indicate a possible infection. An abnormal decrease in blood pressure is seen in pulmonary embolus.

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