A nurse is preparing to administer propofol to an intubated client who weighs 88 lbs. The propofol is ordered to start at 20 mcg/kg/hr and to titrate as ordered. How many micrograms will the client receive for the first hour? (Round to the nearest whole number.)

A. Lowering the sedation dose on the intravenous pump is inappropriate because reducing sedation may cause the client to become more awake and agitated, leading to increased coughing, movement, and fighting against the ventilator, which can worsen high pressure alarms rather than resolve them.
B. Turning off the alarm's volume to promote a therapeutic environment is dangerous and should never be done. Alarm systems are critical safety features that alert nurses to life-threatening problems such as airway obstruction, ventilator disconnection, or high pressures, and silencing them risks patient harm.
C. Tightening connections from endotracheal tube to the ventilator is typically a response for low-pressure alarms indicating disconnection or leak, not high pressure alarms. High pressure alarms signal increased airway resistance or decreased lung compliance rather than loose connections.
D. Suctioning the client's endotracheal airway is appropriate because high pressure alarms often result from secretions blocking the airway. Suctioning removes these obstructions, improves airflow, and decreases resistance within the endotracheal tube, effectively addressing one of the most common causes of high pressure alarms.

A. Respiratory acidosis is characterized by a low pH (below 7.35) and an elevated PaCO₂ (above 45 mm Hg), both of which are present in the client's ABG results. A respiratory rate of 7/min indicates hypoventilation, causing CO₂ retention and leading directly to respiratory acidosis. The normal bicarbonate level further confirms that the primary problem is respiratory, not metabolic.
B. Metabolic alkalosis is marked by a high pH and elevated bicarbonate levels, neither of which is present here. The client's pH is low, and the bicarbonate is within the normal range, ruling out a metabolic origin for the acid-base imbalance.
C. Respiratory alkalosis would present with a high pH and a low PaCO₂, usually caused by hyperventilation. In this case, the client is hypoventilating, with high CO₂ and low pH values, which is the opposite pattern seen in respiratory alkalosis.
D. Metabolic acidosis involves a low pH accompanied by a decreased bicarbonate level, typically less than 22 mEq/L. Since the client's bicarbonate is normal at 26 mEq/L and the PaCO₂ is elevated, the acid-base disturbance is respiratory rather than metabolic.