After receiving midazolam and fentanyl prior to a bronchoscopy, an older adult's respiratory rate drops to 8 breaths/minute with periods of apnea. The client's arterial blood gas levels are obtained and evaluated. Which laboratory value indicates respiratory depression that can lead to respiratory arrest if left untreated?

Reference Range:

pH [7.35 to 7.45]

PaCO2 [35 to 45 mm Hg]

HCO3 [21 to 28 mEq/L]

PaO2 [80 to 100 mm Hg]

PaO2 60 mm Hg.

pH 7.30.

HCO3 26 mEq/L (26 mmol/L).

PaCO2 80 mm Hg.

Answer and Explanation

The Correct Answer is D

A. PaO₂ 60 mm Hg: A PaO₂ of 60 mm Hg indicates moderate hypoxemia, which is concerning but not the most direct marker of respiratory depression. It reflects impaired oxygenation, but CO₂ retention is more closely associated with respiratory arrest risk.

B. pH 7.30: A pH of 7.30 shows mild acidemia, which may result from respiratory or metabolic causes. While this indicates some imbalance, it does not specifically point to the severity of respiratory depression as much as rising CO₂ levels do.

C. HCO₃ 26 mEq/L (26 mmol/L): This bicarbonate value is within the normal range and does not suggest acute metabolic compensation or decompensation. It offers limited insight into the acute respiratory depression caused by sedatives like midazolam and fentanyl.

D. PaCO₂ 80 mm Hg: This significantly elevated PaCO₂ indicates severe hypoventilation and respiratory depression. Such a high carbon dioxide level can suppress central respiratory drive, impair consciousness, and quickly progress to respiratory arrest if not promptly reversed.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is A

Explanation

A. Continue to monitor the client's condition: The ABG values are all within normal limits: pH 7.38, PaCO₂ 40 mm Hg, HCO₃⁻ 24 mEq/L, and PaO₂ 90 mm Hg. This indicates adequate acid-base balance and oxygenation. No immediate intervention is needed, so continued monitoring is the most appropriate nursing action.

B. Encourage the client to cough and deep breathe: Coughing and deep breathing are useful for clearing secretions or improving oxygenation in clients with hypoxia or atelectasis. However, the client’s PaO₂ is within the normal range, so this intervention is unnecessary.

C. Administer oxygen per face mask per PRN protocol: Supplemental oxygen is used when PaO₂ levels are below normal or when signs of respiratory distress are present. Since the client’s PaO₂ is 90 mm Hg, which is normal, there is no need to initiate oxygen therapy.

D. Instruct the client to breathe into a paper bag: Breathing into a paper bag is used to treat hyperventilation leading to respiratory alkalosis. The client’s ABG results do not show alkalosis; therefore, this intervention would be inappropriate and potentially harmful.

A. Begin chest compressions at a depth of at least 2 in (5.1 cm). B. Perform forceful sternal rub to check for unresponsiveness. C. Assess the client for any obvious injuries due to the sudden fall. D. Remove the client's clothes and apply automated external defibrillator (AED) pads to chest.

Correct Answer is A

Explanation

A. Begin chest compressions at a depth of at least 2 in (5.1 cm): Initiating high-quality chest compressions immediately is the priority in a pulseless and non-breathing client. This promotes circulation of oxygenated blood to vital organs, and improves chances of survival until defibrillation or advanced care is available.

B. Perform forceful sternal rub to check for unresponsiveness: A sternal rub is used to assess responsiveness, but it is unnecessary once the client is confirmed to be unresponsive, pulseless, and not breathing. Delaying compressions could reduce survival chances.

C. Assess the client for any obvious injuries due to the sudden fall: While it is important to note injuries, it is not the immediate priority in a client without a pulse or respirations. Life-saving measures such as CPR should take precedence over secondary assessments.

D. Remove the client's clothes and apply automated external defibrillator (AED) pads to chest: Applying the AED is a critical step but should follow the immediate initiation of chest compressions. If another responder is present, tasks can be divided, but CPR should not be delayed for AED pad placement.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A client collapses while ambulating in the hallway. The nurse calls for help after verifying that the client is not breathing and has no palpable pulse. Which intervention should the nurse implement?

Correct Answer is A

Explanation

A client is admitted to the hospital for shortness of breath and chest pain after an episode of syncope. Which laboratory finding is most important for the nurse to report to the healthcare provider (HCP)?

When entering the room to administer scheduled daily medications, the nurse observes the client leaning forward and using pursed-lip breathing. Which action is most important for the nurse to take?

A client's radial heart rate suddenly increases from 82 to 112 beats/minute with a 1+ pulse volume. Which assessment should the nurse complete next?

A client with a history of anxiety and asthma had an open cholecystectomy 3 days ago. Shortly after ambulating to the bathroom, the client is restless and troubled by shortness of breath. Which action should the nurse implement first?

An adult male is admitted with dyspnea on exertion, persistent cough, and palpitations. His telemetry reveals atrial fibrillation. Which additional assessment finding warrants the most immediate intervention by the nurse?