A 65-year-old male is admitted to the progressive care unit with a diagnosis of pneumonia. He has a past history of pulmonary disease and diabetes. A set of arterial blood gases is obtained on admission: room air includes the following: pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These levels reflect:

hypoxemia and compensated metabolic acidosis.

hypoxemia and compensated respiratory acidosis.

normal oxygenation and partly compensated metabolic alkalosis.

normal oxygenation and uncompensated respiratory acidosis

Answer and Explanation

The Correct Answer is B

Rationale:
A. Hypoxemia and compensated metabolic acidosis is incorrect because metabolic acidosis is characterized by a low pH (<7.35) and low bicarbonate (<22 mEq/L). In this case, the bicarbonate is elevated at 30 mEq/L, indicating compensation for a primary respiratory issue, not metabolic acidosis.

B. Hypoxemia and compensated respiratory acidosis is correct. The patient’s PaCO2 is elevated at 55 mm Hg (normal 35–45 mm Hg), indicating respiratory acidosis. The pH is 7.35, which is at the lower end of normal, suggesting that the body has partially compensated via renal retention of bicarbonate (HCO3 30 mEq/L, above normal 22–28 mEq/L). The PaO2 is 65 mm Hg (normal 80–100 mm Hg), indicating hypoxemia likely due to pneumonia and underlying pulmonary disease. This ABG pattern is typical of chronic or compensated respiratory acidosis.

C. Normal oxygenation and partly compensated metabolic alkalosis is incorrect because PaO2 is low (hypoxemia) and metabolic alkalosis would present with high pH (>7.45) and elevated bicarbonate, which is not the case here.

D. Normal oxygenation and uncompensated respiratory acidosis is incorrect because although there is respiratory acidosis (elevated PaCO2), the pH is near normal, indicating that compensation has already occurred. Additionally, oxygenation is not normal (PaO2 65 mm Hg).

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Correct Answer is D

Explanation

Rationale:

A. Mild hoarseness is a common and expected finding after extubation. It occurs because the endotracheal tube can irritate or inflame the vocal cords and larynx during insertion or while in place. Hoarseness usually resolves within a few days without intervention and does not indicate an emergency.

B. Sore throat is another typical post-extubation symptom. The mucosa of the pharynx and larynx may be irritated, causing mild pain or discomfort. This symptom is generally self-limiting and can be managed with hydration, analgesics, and supportive care.

C. After extubation, patients may have increased oral secretions as swallowing and airway reflexes gradually return. This finding is not immediately dangerous. Regular suctioning and oral care are typically sufficient to maintain airway patency and comfort.

D. Stridor is a high-pitched, wheezing sound heard during inspiration, caused by partial obstruction of the upper airway, often due to laryngeal or subglottic edema following extubation. Stridor is a serious complication because it indicates that the airway is compromised. If left untreated, it can progress to complete airway obstruction, respiratory distress, and hypoxemia. Immediate actions include alerting the provider, administering humidified oxygen, providing nebulized epinephrine if prescribed, and being prepared for possible reintubation or emergency airway management.

A. Stable vital signs and ABGS B. Pulse oximetry above 80% and stable vital signs C. Stable nutritional status and ABGS D. Normal orientation and level of consciousness

Correct Answer is A

Explanation

Rationale:
A. Stable vital signs and ABGs is correct. Successful weaning from mechanical ventilation depends on the patient’s ability to maintain adequate gas exchange and hemodynamic stability. Stable vital signs (heart rate, blood pressure, respiratory rate) indicate cardiovascular stability, and normal arterial blood gases (ABGs) demonstrate that the patient can maintain sufficient oxygenation (PaO₂) and ventilation (PaCO₂) without assistance. These are the most reliable physiological predictors of successful weaning.

B. Pulse oximetry above 80% and stable vital signs is incorrect because a PaO₂ corresponding to an SpO₂ of 80% indicates significant hypoxemia. Successful weaning generally requires adequate oxygenation (SpO₂ typically ≥90% on minimal oxygen support) to ensure tissue oxygen delivery. Stable vital signs alone are not sufficient if oxygenation is inadequate.

C. Stable nutritional status and ABGs is incorrect because while good nutrition supports overall recovery and respiratory muscle strength, it is not an immediate predictor for weaning readiness. ABGs are important, but nutritional status alone does not determine ventilator independence.

D. Normal orientation and level of consciousness is incorrect because cognitive status is supportive but not the primary determinant of weaning success. Patients can be sedated or temporarily altered in consciousness and still be physiologically ready if vital signs and ABGs are stable. Cognitive ability mainly affects cooperation during weaning trials rather than physiological readiness.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client immediately after the provider removed the client's endotracheal tube. Which of the following findings should the nurse report to the provider?

Correct Answer is D

Explanation

The critical care nurse and the other members of the care team are assessing the patient to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify?

Correct Answer is A

Explanation

A patient's status worsens and he needs mechanical ventilation. The pulmonologist wants him to receive 10 breaths/min minute from the ventilator but wants to encourage him to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is called:

A client will need serial blood pressure monitoring and frequent blood sampling for ABG's and diagnostic studies. Which of the following vascular devices should the nurse recommend?

The physician orders Lorabid 350 mg po for pneumonia. After reconstitution, the medication is available as 200 mg/5 mL. How many milliliters will the nurse administer? Round to tenths.

A client's arterial blood gas (ABG) results are as follows: pH 7.54 PaCO2 29 PaO2 103 HCO3 24 SaO2 94% Based on his ABG results, what would be some appropriate interventions?

Which set of arterial blood gases will the nurse expect to find in a client who developed a pulmonary embolism 15 minutes ago?

The physician orders erythromycin 1 g in 100 mL of D5W to infuse in 30 minutes. Calculate the flow rate in milliliters per hour using an "IV" pump. Whole number

Select all of the factors that may predispose the patient to respiratory acidosis. Select all that apply.

A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see?