A client admitted for treatment of a deep venous thrombosis of the calf complains of dyspnea and chest pain. What is the best response by the nurse?

  • administer oxygen at 2L/min as ordered prn
  • place client in a semi-Fowler’s position
  • prepare client for diagnostic tests
  • obtain vital signs
Number 2 is correct.
The client is experiencing symptoms of a pulmonary embolism. The best action by the nurse is to place the client in a semi-Fowler’s position to enable a clear airway. Obtaining vital signs would be action number 2, to compare to established baseline data. Administering oxygen as ordered would be the third response to provide adequate oxygenation of the client. Last, prepare the client for diagnostic tests such as blood gases, ventilation-perfusion lung scan, and pulmonary angiography.