A patient on mechanical ventilation has the following settings: FIO2 40%, PEEP 5 cm H2O, RR 12/min, VT 400 mL. The patient's PaO2 is 58 mmHg. Which setting should be adjusted first to improve oxygenation?
Increase PEEP
Increase respiratory rate
Increase FIO2
Increase tidal volume
The Correct Answer is A
A. Increase PEEP: Positive end-expiratory pressure helps keep alveoli open at the end of expiration, improving oxygenation by increasing functional residual capacity and preventing alveolar collapse. Since the patient’s PaO2 is low (58 mmHg), increasing PEEP is the most effective first step to enhance oxygenation.
B. Increase respiratory rate: Increasing the respiratory rate primarily improves CO2 elimination rather than oxygenation. In this patient, hypoxemia is the priority concern, so adjusting rate will not adequately address low PaO2.
C. Increase FIO2: Increasing the fraction of inspired oxygen can raise PaO2, but prolonged high FIO2 levels increase the risk of oxygen toxicity. PEEP adjustments are generally prioritized before raising FIO2 to high levels.
D. Increase tidal volume: Raising tidal volume mainly improves CO2 removal and ventilation but has limited effect on oxygenation in a patient with alveolar collapse or shunting. Additionally, increasing VT carries a risk of volutrauma.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Turning/repositioning patient: While repositioning is important for overall patient care and to prevent pressure injuries, it is not specific to tracheostomy management and does not directly maintain airway patency.
B. Bathing patient: Bathing is part of routine hygiene care but does not relate directly to the function or safety of the tracheostomy tube.
C. Assessing patency of tracheostomy tube: Ensuring the tracheostomy tube is patent is critical to maintaining a clear airway, preventing obstruction, and ensuring adequate ventilation. Regular assessment includes checking for secretions, tube displacement, and airway obstruction.
D. Providing bag mask ventilation to patient each shift: Bag-mask ventilation is only indicated in emergencies when the patient is not ventilating adequately. Routine ventilation is not part of standard tracheostomy care.
Correct Answer is A
Explanation
A. That the patient has an elevated carbon dioxide (CO2) level: Hypercapnia refers specifically to an increased PaCO2 in the blood, usually resulting from hypoventilation or impaired gas exchange. It can lead to respiratory acidosis if not corrected.
B. That the patient has an elevated oxygen (O2) level: Elevated oxygen is called hyperoxemia, not hypercapnia.
C. That the patient has an elevated bicarbonate level (HCO3): Bicarbonate may rise as a compensatory response to chronic hypercapnia, but hypercapnia itself refers to CO2, not HCO3.
D. That the patient has an oxygen saturation (SpO2) level of 100%: SpO2 measures oxygen saturation and does not indicate carbon dioxide levels. A patient can be hypercapnic even with normal or high SpO2.
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