NCLEX Question of the Day – Wednesday, February 25, 2026

Today’s question targets rapid recognition of pulmonary embolism and choosing the first nursing action. This matters because hypoxia kills quickly. In real practice, your first 60 seconds set the tone for survival. Prioritizing airway and breathing creates a safe window for the team to diagnose and treat.

Clinical Scenario

A 68-year-old patient on the orthopedic floor is 2 days post–right total knee arthroplasty. History includes atrial fibrillation (warfarin held for surgery), obesity (BMI 34), and smoking. He suddenly reports sharp right-sided chest pain that worsens with inspiration and says, “I can’t catch my breath.” Vitals: HR 122 and irregular, RR 30, BP 92/58, SpO2 86% on room air, temp 37.0 C. He appears anxious and diaphoretic. The right calf is warm, swollen, and tender compared with the left.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Apply a nonrebreather mask at 15 L/min and raise the head of the bed.
2. B. Call the provider to request a STAT CT pulmonary angiography.
3. C. Administer the prescribed PRN oxycodone for chest pain.
4. D. Encourage the patient to deep breathe and use the incentive spirometer.

Correct Answer

A. Apply a nonrebreather mask at 15 L/min and raise the head of the bed.

Detailed Rationale

This patient has classic signs of acute pulmonary embolism (PE): sudden pleuritic chest pain, dyspnea, tachycardia, hypoxemia, hypotension, anxiety, and a likely source of thrombus (unilateral calf swelling after recent surgery with held anticoagulation). A PE causes a ventilation-perfusion mismatch and dead space, leading to rapid drops in oxygen saturation and potential cardiovascular collapse.

ABCs guide priority. Airway is patent, but breathing is compromised (SpO2 86% and RR 30). The first, fastest nursing action that improves oxygenation is to apply high-flow oxygen via nonrebreather mask and position the patient upright. This increases the fraction of inspired oxygen, improves ventilation, and reduces work of breathing. It buys time while you escalate care.

After oxygen is applied and the patient is positioned, remain at the bedside, reassess vitals, and then activate the rapid response team and notify the provider. Ensure IV access is patent, place the patient on continuous cardiac and pulse oximetry monitoring, and anticipate orders: ABG, ECG, labs (CBC, BMP, coagulation), imaging (CT pulmonary angiography or V/Q scan if contrast is contraindicated), and anticoagulation (e.g., heparin) if not contraindicated. For hemodynamic instability, be ready to assist with fluids, vasopressors per protocol, and possible thrombolysis per provider orders.

Why the Other Options Are Wrong

• B. Call the provider to request a STAT CT pulmonary angiography. This delays immediate life-saving oxygenation. Nurses can and should apply oxygen without waiting for an order in acute hypoxia. Diagnostics come after stabilization of breathing and circulation.
• C. Administer the prescribed PRN oxycodone for chest pain. Opioids can depress respirations and mask clinical changes. Treating pain before correcting hypoxia risks further respiratory compromise. Address oxygenation first, then reassess pain once the airway-breathing status is safer.
• D. Encourage the patient to deep breathe and use the incentive spirometer. While helpful for atelectasis, incentive spirometry will not fix the severe hypoxemia of a PE and may increase distress. Coaching breathing is supportive, but not the first action when SpO2 is 86% and the patient is unstable.

Key Takeaways

• Suspect PE with sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, hypotension, and unilateral leg swelling—especially after surgery or immobility.
• ABCs rule: correct hypoxia first. Apply high-flow oxygen and elevate the head of the bed immediately.
• Do not delay stabilization for diagnostics or pain medication. Oxygen, monitor, then escalate.
• After initial stabilization, activate rapid response, notify the provider, maintain IV access, and anticipate anticoagulation and imaging orders.
• Monitor closely for deterioration: dropping BP, rising HR/RR, worsening mental status, or new arrhythmias.

On-shift mini-checklist for suspected PE:

• Apply nonrebreather at 10–15 L/min and raise HOB.
• Stay with the patient; reassess SpO2, RR, HR, BP every few minutes.
• Place on cardiac and pulse oximetry monitors; ensure IV access.
• Activate rapid response and notify provider after oxygenation starts improving.
• Prepare for labs, imaging, and anticoagulation; assess bleeding risk and recent procedures.
• Document assessments, interventions, and patient response in real time.

Quick Practice Extension

• In a patient with suspected PE and recent intracranial surgery, what immediate interventions remain appropriate, and which therapies are likely contraindicated?
• If the provider orders CT pulmonary angiography, heparin infusion, ABG, and a 12-lead ECG, in what order would you prioritize these, and why?

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com