A patient experienced a penetrating wound of the chest that led to acute respiratory failure.
Which goal of treatment will the care team prioritize when planning this patient's care?
Restoration of adequate gas exchange.
Attainment of effective coping.
Facilitation of long-term intubation.
Self-management of oxygen therapy.
The Correct Answer is A
Choice A rationale
A penetrating chest wound can lead to pneumothorax, hemothorax, or flail chest, all of which compromise the patient's ability to breathe and exchange gases effectively. The immediate and most life-threatening consequence is acute respiratory failure. Therefore, the highest priority goal is to restore adequate gas exchange to ensure proper oxygenation of the blood and removal of carbon dioxide. This goal supersedes all others.
Choice B rationale
While effective coping is important for a patient with a long-term illness or injury, it is a psychosocial goal that is not prioritized over the immediate physiological need for life support. Coping mechanisms cannot be addressed until the patient's immediate and life-threatening medical conditions, such as respiratory failure, are stabilized.
Choice C rationale
Facilitation of long-term intubation is not a primary goal of treatment; rather, it is a potential intervention to achieve the primary goal of restoring gas exchange. The ultimate goal is to wean the patient off mechanical ventilation and extubate them as soon as medically possible, not to keep them on the ventilator long-term. The intervention is a means to an end, not the end itself.
Choice D rationale
Self-management of oxygen therapy is a long-term goal that is only applicable to patients who survive the acute phase of their illness and require supplemental oxygen at home. This goal is not appropriate for a patient in acute respiratory failure in a hospital setting. The immediate priority is the stabilization of the patient and restoration of normal respiratory function, not patient education for home care
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Psoriasis is a chronic, autoimmune skin disorder characterized by the rapid overproduction of skin cells, leading to the formation of thick, red plaques covered with silvery-white scales. These lesions are a result of keratinocyte proliferation and inflammation. The most common sites for these plaques are the extensor surfaces of the body, such as the scalp, knees, and elbows, due to repetitive trauma or friction (Koebner phenomenon).
Choice B rationale
Red-purplish scaly lesions are more characteristic of other inflammatory skin conditions, such as lichen planus, not psoriasis. Psoriasis typically presents with a well-demarcated, erythematous base covered by silvery-white scales. The color and scale characteristics are key differentiators in the clinical diagnosis of skin disorders.
Choice C rationale
Psoriasis is typically associated with dry, not oily, skin. The rapid cell turnover and scale formation lead to significant epidermal dryness. Furthermore, pruritus (itching) is a common symptom of psoriasis, often a major source of discomfort for patients. The absence of pruritus is not a characteristic of this condition.
Choice D rationale
Nail changes are a very common manifestation of psoriasis, affecting up to 50% of patients. These changes include pitting, discoloration, onycholysis (separation of the nail from the nail bed), and thickening. Clear, thin nail beds are a sign of healthy nails, not a characteristic finding in a patient with psoriasis.
Correct Answer is D
Explanation
Choice A rationale
Increasing tidal volume would further exacerbate the respiratory alkalosis. Tidal volume, the amount of air moved into and out of the lungs with each breath, directly influences the partial pressure of carbon dioxide ($PaCO_2$). Increasing it would remove more $CO_2$, causing the pH to rise further from the normal range of 7.35-7.45 and $PaCO_2$ to fall below the normal range of 35-45 mmHg. This action is contraindicated as the patient is already alkalotic.
Choice B rationale
Increasing the fraction of inspired oxygen ($FIO_2$) is unnecessary and potentially harmful. The patient's $PaO_2$ is 80 mmHg, which is within the normal range of 80-100 mmHg. Therefore, the patient is not hypoxemic. Increasing oxygen delivery in a patient with COPD can suppress the hypoxic drive to breathe, which is a significant risk for respiratory depression and increased $PaCO_2$ levels. This action would not correct the underlying respiratory alkalosis.
Choice C rationale
Leaving the ventilator at the current settings would be inappropriate because the patient is in respiratory alkalosis. The blood gas results show a pH of 7.50, which is elevated, and a $PaCO_2$ of 29 mmHg, which is low. This indicates that the ventilator settings are causing the patient to hyperventilate and eliminate too much carbon dioxide. Adjustments are necessary to normalize the blood gas parameters and prevent further complications.
Choice D rationale
Decreasing the respiratory rate would be the most appropriate intervention. The patient's blood gas results show respiratory alkalosis (pH 7.50, $PaCO_2$ 29 mmHg), which is caused by the patient breathing too fast and "blowing off" too much $CO_2$. Reducing the respiratory rate will allow $CO_2$ to accumulate, raising the $PaCO_2$ and lowering the pH back toward the normal range (pH 7.35-7.45; $PaCO_2$ 35-45 mmHg)
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