A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm.Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally.Intravenous heparin and Cardizem are given.
The nurse caring for the patient understands that the main goal of treatment is what?

Choice A rationale

This laboratory result represents metabolic acidosis, which is common in shock due to lactic acid accumulation from anaerobic metabolism. A pH of 7.22 is well below the normal range of 7.35 to 7.45. The bicarbonate level of 15 mEq/L is also low compared to the normal 22 to 26 mEq/L. These values indicate that the patient is still experiencing tissue hypoxia and inadequate perfusion, meaning the circulating volume and oxygen delivery have not been sufficiently restored.

Choice B rationale

These arterial blood gas values are within the normal physiological ranges. A pH of 7.35 is at the lower limit of normal, a PaCO2 of 40 mm Hg is exactly mid-range (normal 35 to 45 mm Hg), and a bicarbonate level of 22 mEq/L is at the lower limit of normal (normal 22 to 26 mEq/L). Achieving these values suggests that tissue perfusion is adequate to prevent the buildup of metabolic acids and that the respiratory system is effectively managing gas exchange.

Choice C rationale

The SaO2 measures the percentage of hemoglobin saturated with oxygen. A normal SaO2 value should be between 95 percent and 100 percent. A value of 76 percent is critically low and indicates severe hypoxemia. This could be due to continued blood loss, pulmonary complications from the trauma, or inadequate volume to transport oxygen. This measurement clearly demonstrates that the patient has not been stabilized and that the replacement of circulating volume and oxygenation is currently insufficient.

Choice D rationale

Normalization of vital signs and oxygen tension is a primary indicator of successful volume resuscitation. A blood pressure of 120/80 mm Hg and a pulse of 80 beats/minute are within standard normal limits, suggesting that the vascular space is adequately filled to maintain cardiac output. A PaO2 of 95 mm Hg is also within the normal range of 80 to 100 mm Hg, confirming that there is sufficient pressure to drive oxygen into the tissues following the transfusion.

Choice A rationale

Forcing a terminally ill patient to eat is medically and ethically inappropriate. As the body nears death, the metabolic rate slows down, and the digestive system begins to shut down. Forcing intake can lead to complications such as aspiration, nausea, vomiting, and increased physical distress. The goal of care at this stage shifts from nutrition and life extension to comfort and symptom management, respecting the patient's natural physiological decline and their personal autonomy.

Choice B rationale

This response addresses the wife's concern while prioritizing the patient's comfort and autonomy. In terminal illness, anorexia is a natural part of the dying process as the body no longer requires or can process significant caloric intake. Providing food only when requested prevents the discomfort associated with forced feeding. This approach supports the family emotionally by providing a clear strategy that honors the patient's wishes while ensuring that the opportunity for nourishment remains available.

Choice C rationale

Stating that a patient is getting all needed nutrients from an IV is often scientifically inaccurate in terminal care. IV fluids provided for hydration do not typically contain sufficient calories or proteins to maintain nutritional status. Furthermore, over-hydration in a dying patient can lead to pulmonary edema, increased secretions, and discomfort. This response dismisses the wife's concern with potentially false information and fails to address the underlying physiological reality of the patient's condition and nutritional needs.

Choice D rationale

Placing a feeding tube in a terminally ill patient is generally discouraged unless it aligns with specific goals of care or temporary recovery. In the end-of-life phase, enteral nutrition does not improve survival or quality of life and can cause significant complications like infection, agitation, and the need for restraints. Suggesting a feeding tube focuses on a technical intervention that may increase suffering rather than addressing the natural transition toward death and the need for comfort.