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The following 6 questions are part of the NextGen Case Study

Question 750

Read the following case study, then refer to the case study to answer the questions.

The nurse is caring for a 22-year-old male client admitted with multiple injuries resulting from a motor vehicle accident.

\begin{tabular}{|l|l|l|}
\hline \begin{tabular}{l}
Primary Care Provider \\
Admitting Notes
\end{tabular} & Nurse's Notes & Prescriptions \\
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\end{tabular}
1955: Alert and oriented 22-year-old client admitted post motor vehicle accident (rear-ended) after being seen in ED. Diagnosis: Fracture of right femur, right clavicle, and right ribs 5 \& 6. Seat belt contusion noted across chest. Chest wall symmetrical. No lifts, heaves, or thrills. No murmurs, gallops, or rubs are auscultated. [tex]$S_1$[/tex] and [tex]$S_2$[/tex] are of normal intensity. No S3, S4. EKG shows sinus tachycardia at [tex]$114 /$[/tex] min. Pulse oximetry reading [tex]$98 \%$[/tex] on oxygen 2 L/nc. Lungs clear bilaterally. Radial pulses equal [tex]$+3 /+4$[/tex] and regular. Pedal pulses: Right [tex]$+2 /+4$[/tex], Left [tex]$+3 /+4$[/tex]. Pain of 9 on a 1-10 pain scale to right shoulder, right chest, and right leg relieved with morphine 4 mg IV. Vital signs: T [tex]$98.2^{\circ} F \left(36.7^{\circ} C \right)$[/tex], RR 24 shallow, BP 148/88. Skin warm and dry. Right arm immobilized in sling. Scheduled for open reduction and internal fixation (ORIF) right femur.

2230: Client stable following ORIF right femur. Alert, oriented. Vital signs within normal limits/afebrile. Lactated Ringers 1 liter infused. Postop Hct: 36. Fiber cast dry/intact. Post op plan: IV hydration, Cefoxitin 1 gram every 8 hours, physical therapy.

Complete the following sentence(s) by choosing from the list of options:

The client has likely developed a [tex]$\square$[/tex] pulmonary embolus as evidenced by [tex]$\square$[/tex].

Select an Option:
- CBC results
- absent lung sounds right upper lobe
- diminished lung sounds right lower lobe
- high BNP
- positive D-dimer



Answer :

GinnyAnswer
Certainly! Let's solve this step-by-step:

### Step 1: Understanding the Clinical Scenario
The clinical case involves a 22-year-old male admitted to the hospital following a motor vehicle accident, with multiple injuries including fractures in his right femur, clavicle, and ribs. Initially, his vital signs and examination showed no significant abnormalities other than the fractures and pain.

### Step 2: Identifying Key Information
- After surgery (ORIF of the right femur), the patient's progress is stable.
- We need to ascertain if the patient has developed a pulmonary embolus (a blood clot in the lungs).

### Step 3: Diagnostic Marker for Pulmonary Embolus
A pulmonary embolus is typically confirmed with specific diagnostic tests. One such test is the D-dimer. A positive D-dimer result suggests the presence of blood clot formation and breakdown in the body, which aligns with symptoms of a pulmonary embolus.

### Step 4: Review the Options
Given the context, let's review the provided options:
1. CBC results
2. absent lung sounds right upper lobe
3. diminished lung sounds right lower lobe
4. high BNP
5. positive D-dimer

### Step 5: Conclusion
To complete the sentence, the most relevant clinical indicator for a pulmonary embolus in this case would be:
positive D-dimer.

### The Completed Sentence
The client has likely developed a pulmonary embolus as evidenced by positive D-dimer.

Hence, the correct option is the fifth one:
5.