PH7.28
PaCO2 46 mm Hg Bicarbonate 22 mEq/L
Pa 02 58 mm Hg
02 saturation 88%
What interdisciplinary staff member does the nurse notify to assist in the care of this patient while preparing to carry out provider orders?
Phlebotomy to obtain another set of blood gasses
Respiratory therapist to adjust ventilator
Social worker to notify family
Nursing assistant to help reposition the patient
The Correct Answer is B
A. While repeat blood gases may eventually be required, the priority is correcting the patient’s hypoxemia and acid-base imbalance. Waiting for another blood draw without immediate intervention could worsen hypoxia and tissue perfusion.
B. The ABG values indicate acidemia (pH 7.28), mild hypercapnia (PaCO₂ 46), and significant hypoxemia (PaO₂ 58, O₂ sat 88%). This patient is hypoxic and acidotic, likely requiring immediate ventilator adjustment or oxygen therapy. The respiratory therapist has the expertise to optimize ventilator settings or oxygen delivery, which is crucial for stabilizing the patient before further interventions.
C. While family notification is important, it is not the immediate priority in the context of acute hypoxemia and acid-base imbalance. Patient stabilization takes precedence over social interventions.
D. Repositioning may improve ventilation-perfusion matching, but it is insufficient to correct severe hypoxemia. Respiratory therapy intervention is required to ensure adequate oxygenation and ventilation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Metabolic acidosis results from increased acid production, decreased acid excretion, or bicarbonate loss (e.g., diabetic ketoacidosis, renal failure, diarrhea). The scenario describes hypoventilation due to opioid-induced respiratory depression, which is a respiratory problem, not a metabolic one.
B. Respiratory alkalosis occurs when there is hyperventilation, leading to excessive carbon dioxide elimination (PaCO₂ < 35 mm Hg). In this patient, morphine depresses spontaneous respirations, causing hypoventilation, not hyperventilation.
C. Metabolic alkalosis results from bicarbonate excess or hydrogen ion loss (e.g., vomiting, diuretics), which is unrelated to this patient’s ventilatory changes.
D. Respiratory acidosis occurs when alveolar ventilation decreases, causing carbon dioxide retention (PaCO₂ > 45 mm Hg) and lowering pH. Morphine sulfate depresses the patient’s spontaneous respirations from 12 to 4 breaths per minute, significantly reducing CO₂ elimination. Since the SIMV rate is low (4 breaths/min), total ventilation is inadequate, leading to CO₂ accumulation and respiratory acidosis.
Correct Answer is B
Explanation
A. 15: This rate would result in the unit being infused over 4 hours, which is slower than the prescribed 2-hour duration. Under-infusion can delay treatment and reduce the effectiveness of oxygen delivery from PRBCs.
B. 25: To calculate drops per minute: use the formula (Volume in mL × Drop factor in gtts/mL) ÷ Time in minutes. Here, (300 × 10) ÷ 120 = 3000 ÷ 120 = 25 gtts/min. This rate will ensure the unit is transfused over 2 hours as prescribed.
C. 20: Infusing at 20 gtts/min would extend the transfusion slightly beyond 2 hours, resulting in under-delivery of the blood unit within the intended time frame.
D. 10: This rate is far too slow; the transfusion would take 5 hours, significantly exceeding the prescribed time and delaying treatment.
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