A patient is on mechanical ventilation with + 20 of PEEP. Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment?
HCO3 28 mmHg
PaO2 79 mmHg
Blood pressure 70/45
PaCO2 32 mmHg
The Correct Answer is C
Rationale:
A. An HCO3 of 28 mEq/L is slightly elevated and may indicate metabolic compensation for a chronic respiratory acidosis, but it is not an acute complication of PEEP therapy and does not require immediate intervention.
B. A PaO2 of 79 mmHg is slightly below normal but may be acceptable depending on the patient’s baseline and underlying condition. Mild hypoxemia alone is not an emergency in a ventilated patient.
C. Hypotension is a serious complication of high levels of positive end-expiratory pressure (PEEP). PEEP increases intrathoracic pressure, which can reduce venous return to the heart, decrease cardiac output, and lead to hypotension. A blood pressure of 70/45 mmHg indicates shock or severe hemodynamic compromise and requires immediate intervention, such as fluid resuscitation, vasopressors, or adjustment of PEEP settings.
D. A PaCO2 of 32 mmHg indicates mild respiratory alkalosis due to hyperventilation, which is not uncommon in mechanically ventilated patients. It does not represent an acute complication requiring immediate treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Neuromuscular blocking agents (NMBAs) do not relieve anxiety. They only paralyze skeletal muscles and do not affect the central nervous system’s perception of fear or distress.
B. NMBAs do not provide pain relief. A patient under the effects of an NMBA may still experience pain but cannot move or communicate discomfort. Analgesics must be administered separately.
C. NMBAs do not induce sedation. The patient remains fully conscious and aware unless sedatives or anesthetics are given concurrently.
D. Neuromuscular blocking agents only cause skeletal muscle paralysis. They do not affect pain perception, consciousness, or anxiety. Because patients cannot move or communicate while paralyzed, it is essential to provide concurrent sedation and analgesia to prevent severe distress.
Correct Answer is B
Explanation
Rationale:
A. Cardiac output of 6 L/min is incorrect because a cardiac output in this range is generally adequate for tissue perfusion. Normal adult cardiac output is roughly 4–8 L/min, so this value alone would not impair the ability to wean from a ventilator.
B. Hemoglobin of 8 g/dL is correct. Low hemoglobin (normal 13.5–17.5 g/dL in males, 12–15.5 g/dL in females) reduces the oxygen-carrying capacity of the blood, meaning tissues—including respiratory muscles—receive less oxygen. This can lead to fatigue of the respiratory muscles and difficulty weaning from mechanical ventilation. Patients with anemia may require transfusion or optimization of oxygen delivery before successful weaning.
C. Sputum culture and sensitivity are negative is incorrect because the absence of infection does not contribute to weaning difficulty. In fact, a negative culture suggests no ongoing pulmonary infection, which would favor weaning.
D. White blood cell count of 8000 is incorrect because this is within the normal range (approximately 4,000–11,000/mm³). A normal WBC count does not indicate infection or inflammation that would interfere with ventilator weaning.
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