The signs of pulmonary embolism are all EXCEPT?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Medical Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

A rise in blood pressure (hypertension) is not a characteristic sign of pulmonary embolism.
A significant PE obstructs blood flow from the right ventricle into the pulmonary artery.
This obstruction increases pulmonary vascular resistance and right ventricular afterload, leading to right-sided heart failure.
The consequence is a decrease in cardiac output and a subsequent drop in systemic blood pressure (hypotension), which can lead to obstructive shock.
Therefore, a rise in blood pressure is the exception among the listed signs.

Option A: Dyspnoea (shortness of breath) is the most common symptom of pulmonary embolism, resulting from the ventilation-perfusion mismatch caused by the blocked artery.
Option C: Cyanosis (bluish skin discoloration) is a sign of severe hypoxemia that can occur in cases of massive pulmonary embolism where gas exchange is severely compromised.
Option D: Tachycardia (heart rate greater than 100 bpm) is a frequent compensatory response to both hypoxemia and the decreased cardiac output seen in PE.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs and symptoms of Pulmonary Embolism (PE) as background academic context rather than a clinical decision trigger.
Early recognition of PE signs is critical as death can occur within one hour of symptom onset. Nurses must be vigilant for sudden dyspnea, chest pain, and tachycardia.
A sudden drop in blood pressure in a patient with respiratory distress is a red flag for a massive PE and requires immediate emergency intervention.
Nursing priorities for a suspected PE include stabilizing the patient by administering oxygen, positioning for optimal breathing, and preparing for anticoagulant or thrombolytic therapy.

How to Approach the Question

First, identify the core concept of the question, which is the clinical signs of pulmonary embolism (PE).
Note the keyword 'EXCEPT'. This means you are looking for the option that is NOT a sign of PE.
Evaluate each option based on your knowledge of PE pathophysiology.
Recall that dyspnoea, tachycardia, and cyanosis are all classic or possible signs of PE due to hypoxia and cardiac strain.
Analyze the effect of a large pulmonary artery obstruction on hemodynamics. It impedes blood flow, reduces cardiac output, and causes hypotension (a drop in BP), not hypertension.
Select 'Rise in blood pressure' as the correct answer because it is the opposite of the expected hemodynamic change.

Concept Tested & Keywords

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