A patient, admitted with respiratory failure, is intubated and placed on the ventilator with the following settings: Continuous mandatory volume (CMV) rate of 12 breaths per minute. TV 500 mL. Fi02 50% and PEEP 5 cm H20. The following arterial blood gases are obtained: pH 7.30. PaCO2 50 mmHg HCO3 23 mEq/L. PaO2 82 mmHg. Which of the following ventilator changes would the nurse recommend in the SBAR to the physician?
An increase in the CMV rate
Change to SIMV MODE
A decrease in The PaO2
A decrease in the CMV rate
The Correct Answer is B
A. An increase in the CMV rate:
Increasing the continuous mandatory volume (CMV) rate would provide more mandatory breaths, which may not address the patient's respiratory acidosis. It could potentially worsen the situation by causing respiratory alkalosis.
B. Change to SIMV (Synchronized Intermittent Mandatory Ventilation) MODE
The patient's arterial blood gas results indicate respiratory acidosis with an elevated PaCO2 (50 mmHg) and a low pH (7.30). The nurse would recommend changing to SIMV mode to allow for spontaneous breaths in addition to the set mandatory breaths. This change helps the patient to have more control over their respiratory efforts and may assist in lowering the PaCO2.
C. A decrease in the PaO2:
Decreasing the partial pressure of oxygen (PaO2) is not an appropriate response, especially when the patient is already on mechanical ventilation and has a moderate PaO2 level. The primary concern is the elevated PaCO2 and respiratory acidosis.
D. A decrease in the CMV rate:
Decreasing the CMV rate would reduce the number of mandatory breaths, potentially allowing the patient to hypoventilate further and retain more carbon dioxide. This is not the appropriate intervention for a patient with respiratory acidosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Suppress respiratory effort
Pancuronium is a neuromuscular blocking agent that is often used to induce paralysis in patients requiring mechanical ventilation. It works by blocking the transmission of nerve impulses at the neuromuscular junction, leading to skeletal muscle paralysis. In the context of a client with acute respiratory distress syndrome (ARDS) on mechanical ventilation, the use of pancuronium helps to suppress respiratory effort, allowing for better control of the patient's ventilation and oxygenation.
B. Decrease chest wall compliance:
Pancuronium does not directly affect chest wall compliance. It primarily acts on skeletal muscles, leading to paralysis.
C. Decrease respiratory secretions:
Pancuronium is not used to decrease respiratory secretions. It is a neuromuscular blocking agent with the main goal of inducing paralysis.
D. Induce sedation:
Pancuronium does not induce sedation. It works on the neuromuscular junction and does not have sedative properties. Sedation may be achieved with other medications, such as sedative agents.
Correct Answer is ["1170"]
Explanation
To calculate the total fluid intake for a client during a 4-hour period, the nurse should convert all the measurements to milliliters (mL) and add them together. One cup is equal to 240 mL, one ounce is equal to 30 mL, and one teaspoon is equal to 5 mL. Therefore, the client consumes:
- 1 cup of coffee = 240 mL
- 4 oz of orange juice = 120 mL
- 3 oz of water = 90 mL
- 1 cup of flavored gelatin = 240 mL
- 1 cup of tea = 240 mL
- 5 oz of broth = 150 mL
- 3 oz of water = 90 mL
The total fluid intake is:
240 + 120 + 90 + 240 + 240 + 150 + 90 = 1170 mL
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