A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active, and has no known risk factors for PE. What action by the nurse is most appropriate?

Correct Answer: C

Rationale: The correct answer is C because teaching the client about factor V Leiden testing is important in this scenario. Factor V Leiden is a genetic mutation that increases the risk of blood clot formation, including pulmonary embolism. Since the client has no known risk factors for PE, testing for this specific genetic mutation can help identify an underlying cause. Encouraging walking (choice A) is generally beneficial but may not address the root cause. Referring for smoking cessation (choice B) is not relevant in this case. Explaining that sometimes no cause is found (choice D) is not proactive and may lead to missed opportunities for prevention.

Correct Answer: B

Rationale: The correct answer is B: Increase the heparin rate. A PTT of 25 seconds indicates that the client's blood is not adequately anticoagulated, as the therapeutic range for PTT is typically around 60-80 seconds for heparin therapy. Therefore, the nurse should anticipate increasing the heparin rate to achieve the desired anticoagulant effect and prevent further clot formation. Incorrect choices: A: Decreasing the heparin rate would further decrease the anticoagulant effect, potentially putting the client at risk for thrombus progression. C: No change to the heparin rate would not address the subtherapeutic PTT level and could lead to inadequate anticoagulation. D: Stopping heparin and starting warfarin is not appropriate at this time as warfarin takes time to reach therapeutic levels, whereas heparin provides immediate anticoagulation for acute situations like a pulmonary embolism.

Correct Answer: B

Rationale: The correct answer is B: Prepare preoperative teaching for an inferior vena cava (IVC) filter. In the context of a client with an alteration in the gene CYP2C19 and recurrent pulmonary embolism, the use of an IVC filter helps prevent blood clots from traveling to the lungs. This intervention is crucial in managing the risk of further pulmonary embolism. Teaching the client about the purpose, care, and potential complications of the IVC filter is essential for their understanding and cooperation in the treatment plan. Incorrect Choices: A: Instruct the client to eliminate all vitamin K from the diet. This choice is not relevant to the management of recurrent pulmonary embolism associated with a genetic alteration. C: Refer the client to a chronic illness support group. While support is important, it is not the immediate priority in this case of managing a recurrent PE. D: Teach the client to use a soft-bristled toothbrush. This recommendation is not directly

Correct Answer: B

Rationale: The correct answer is B because coordinating discharge planning for home safety is not directly related to interdisciplinary work. The other choices (A, C, D) involve active collaboration and communication with different disciplines to ensure comprehensive client care. Consulting with other disciplines, participating in client rounding, and sharing care plans all demonstrate a high priority on interdisciplinary work by fostering teamwork and integration of various perspectives to enhance patient outcomes. In contrast, coordinating discharge planning for home safety is more focused on individual patient needs and safety rather than interdisciplinary collaboration.

Correct Answer: D

Rationale: The correct answer is D: Experimenting on patients. The IOM report emphasizes the importance of evidence-based practice, collaboration, and patient-centered care to ensure nurses are practicing at their highest levels of competency. Experimenting on patients is unethical and not a part of competent nursing practice. Nurses should rely on established evidence and best practices rather than experimenting on patients. Assessing nurses' competency in collaborating with teams, implementing evidence-based care, and providing family-focused care aligns with the IOM's recommendations for quality nursing practice.