The nurse understands that the patient diagnosed with pulmonary embolism will be treated by

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Explanation

IV heparin sodium is the standard-of-care initial anticoagulant for treating acute pulmonary embolism (PE).
Its primary function is to prevent the extension of the existing clot and inhibit the formation of new thrombi.
Heparin has a rapid onset of action, making it the ideal choice for immediate intervention in acute thromboembolic events.
It works by potentiating antithrombin III, which in turn inhibits thrombin and factor Xa, key components of the coagulation cascade.

Option A: Streptokinase is a thrombolytic ('clot-busting') agent, not a first-line anticoagulant. Its use is associated with a high risk of hemorrhage.
Option B: Similar to streptokinase, tissue plasminogen activator (tPA) is a powerful thrombolytic agent reserved for severe cases due to a significant risk of bleeding.
Option D: Sodium warfarin is an oral anticoagulant with a slow onset of action (taking several days to become therapeutic). It is unsuitable for initial, acute treatment of PE.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological Management of Pulmonary Embolism to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role in managing a patient on IV heparin for PE is vigilant monitoring for signs of bleeding (e.g., hematuria, melena, epistaxis, bruising) and ensuring therapeutic aPTT levels.
Prompt recognition of PE symptoms (sudden dyspnea, chest pain, tachypnea) and immediate initiation of prescribed anticoagulants are critical to preventing mortality and morbidity.
Patient education is crucial, focusing on the importance of adherence to long-term anticoagulation (like warfarin), dietary considerations (Vitamin K intake), and recognizing bleeding risks.

How to Approach the Question

First, identify the core clinical condition: pulmonary embolism (PE).
The question asks for the standard treatment. This implies the usual, first-line therapy for a typical patient.
Differentiate the roles of the medications listed. Categorize them into anticoagulants (prevent clot growth) and thrombolytics (dissolve existing clots).
Recognize that anticoagulants are the standard initial therapy for most PEs, while thrombolytics are reserved for more severe, life-threatening situations.
Compare the anticoagulants: Heparin has a rapid onset for acute situations, whereas warfarin has a slow onset and is used for long-term management.
Based on this, conclude that IV heparin is the appropriate initial treatment for an undifferentiated PE.

Concept Tested & Keywords

QKHe1EuswT4rRR4Ie751ZL

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 12-14

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 485-487

E6 Pharmacology Katzung 16e p. 976-978

Practise the full RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.