A patient is recounting her experience with a pulmonary embolism. Which of the following is the nurse most likely to hear from the patient?
“I immediately stopped breathing and passed out.”
“I was surprised to be diagnosed with a pulmonary embolism, because I had no signs or symptoms.”
“I knew I had an increased chance for pulmonary embolism, because I take anticoagulants.”
“I know pulmonary embolisms are not serious, so I knew I did not have to worry.”
The Correct Answer and Explanation is:
The correct answer is:
“I was surprised to be diagnosed with a pulmonary embolism, because I had no signs or symptoms.”
Explanation (300+ words):
A pulmonary embolism (PE) is a potentially life-threatening condition that occurs when a blood clot (usually from the deep veins in the legs, known as deep vein thrombosis or DVT) travels to the lungs and blocks a pulmonary artery. While some individuals exhibit classic symptoms such as sudden shortness of breath, chest pain (especially when breathing deeply), rapid heartbeat, coughing (possibly with blood), and lightheadedness, others may have few or no symptoms, especially if the embolism is small or in the early stages.
The statement, “I was surprised to be diagnosed with a pulmonary embolism, because I had no signs or symptoms,” accurately reflects a possible real-life scenario. Silent or asymptomatic pulmonary embolisms can and do occur. In some cases, they are found incidentally during imaging done for another purpose. This highlights the need for a high index of suspicion in at-risk individuals, such as those with recent surgery, immobility, cancer, obesity, or a history of clotting disorders.
Let’s review the incorrect options:
- “I immediately stopped breathing and passed out.”
This would be more likely in a massive PE that causes sudden cardiovascular collapse, but most PEs do not present this dramatically. Moreover, complete cessation of breathing and loss of consciousness are not the most common initial symptoms. - “I knew I had an increased chance for pulmonary embolism, because I take anticoagulants.”
This is incorrect because anticoagulants reduce the risk of clots and pulmonary embolism. A person on anticoagulants is less likely—not more likely—to develop a PE. - “I know pulmonary embolisms are not serious, so I knew I did not have to worry.”
This is a false statement. Pulmonary embolisms are very serious and can be fatal if not treated promptly.
In summary, a PE can present with minimal or no symptoms, and a patient may express surprise upon diagnosis. This makes early recognition and risk assessment crucial in clinical practice.