NCLEX Question of the Day – Monday, March 09, 2026

Today’s question targets rapid recognition of pulmonary embolism (PE) and the first action to stabilize the patient. This matters because PE can progress to respiratory failure and shock within minutes. Nurses often see the first signs. Acting fast on airway and oxygenation saves lives and buys time for diagnosis and treatment.

Clinical Scenario

A 64-year-old man on post-op day 2 after a left total knee arthroplasty is on the orthopedic floor. History includes obesity, hypertension, and a 40-pack-year smoking history. He has been slow to ambulate due to pain. Prophylaxis includes low-dose heparin and intermittent pneumatic compression. He suddenly reports sharp right-sided chest pain and intense shortness of breath. You find him anxious, diaphoretic, and clutching his chest.

Vital signs: T 98.6 F, HR 124, RR 32, BP 98/60, SpO2 84% on 2 L/min nasal cannula. Lungs are clear to auscultation. The left calf appears more swollen than the right and is tender to palpation.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Apply 100% oxygen via nonrebreather mask.
2. B. Obtain a stat arterial blood gas sample.
3. C. Prepare the patient for CT pulmonary angiography.
4. D. Administer the prescribed PRN morphine for chest pain and anxiety.

Correct Answer

A. Apply 100% oxygen via nonrebreather mask.

Detailed Rationale

This patient’s sudden dyspnea, pleuritic chest pain, tachycardia, hypotension, hypoxemia, and unilateral calf swelling strongly suggest an acute PE. In a suspected PE, the immediate threat is impaired gas exchange and potential hemodynamic collapse. The safest first move follows the ABCs: secure oxygenation.

Why oxygen first: PE blocks blood flow to parts of the lung, creating dead space and severe ventilation-perfusion mismatch. This drops oxygen saturation even when the lungs sound clear. Applying 100% oxygen by nonrebreather maximizes the fraction of inspired oxygen (FiO2), increases oxygen delivery to vital organs, and buys time for further interventions.

What to do next (after oxygen):

• Elevate the head of the bed. This reduces work of breathing and improves ventilation.
• Stay with the patient and call a rapid response. He is unstable (SpO2 84%, HR 124, BP 98/60, RR 32).
• Ensure patent IV access (preferably two large-bore). Anticipate orders for heparin, IV fluids if hypotensive, and vasopressors if needed.
• Notify the provider immediately with focused SBAR. Include onset, vitals, O2 delivery, and suspected PE risk factors.
• Prepare for diagnostics once the airway and circulation are stabilized (ABG, ECG, labs including troponin, D-dimer per protocol, and imaging such as CT pulmonary angiography or V/Q scan if contrast is contraindicated).
• Continuous monitoring: pulse oximetry, cardiac rhythm, blood pressure. Watch for mental status changes and signs of worsening shock.
• Avoid unnecessary ambulation or leg massage. This could dislodge more thrombi.

Why this order matters: ABGs and imaging confirm the diagnosis, but neither treats hypoxemia. Analgesia can help, but it does not fix oxygenation. Treating oxygenation first follows evidence-based priorities and reduces the risk of cardiac arrest while the team mobilizes definitive care.

Why the Other Options Are Wrong

• B. Obtain a stat arterial blood gas sample. Helpful to quantify hypoxemia and acid-base status, but this is a diagnostic step, not a life-saving action. Do it after applying high-flow oxygen and activating support.
• C. Prepare the patient for CT pulmonary angiography. Definitive imaging is important, but transporting an unstable, severely hypoxemic patient without first stabilizing oxygenation is unsafe. Stabilize first, then image.
• D. Administer the prescribed PRN morphine for chest pain and anxiety. Pain control matters, but opioids can depress respiration and lower blood pressure. In an already hypoxemic, hypotensive patient, this can worsen instability. Provide oxygen first, reassess, and give analgesia when safer.

Key Takeaways

• Suspect PE with sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, and DVT signs after immobility or surgery.
• ABCs guide priorities: correct hypoxemia immediately with high-flow oxygen.
• Stabilize before diagnostics. Imaging can wait until the patient is safer.
• Call rapid response early for unstable vitals. Anticipate anticoagulation and supportive care.
• Avoid leg massage and unnecessary ambulation when PE/DVT is suspected.

On-shift mini-checklist (suspected PE):

• Apply 100% O2 via nonrebreather; raise head of bed.
• Call rapid response; stay with the patient.
• Place on continuous pulse ox and cardiac monitoring.
• Secure two IV lines; draw labs as ordered.
• Notify provider with concise SBAR; prep for anticoagulation and imaging once stable.

Quick Practice Extension

1. A patient with COPD develops sudden pleuritic chest pain and SpO2 drops from 92% on 2 L nasal cannula to 84%. What two assessments would most increase your suspicion for PE over a COPD exacerbation?
2. After initiating high-flow oxygen for a suspected PE, the patient’s BP falls to 86/54. What immediate interventions should you anticipate and in what order?

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