Reference Range: 1329545.
A client receiving mechanical ventilation has a pH of 7.26, PaCO2 of 68 mm Hg, and a PaO2 of 92 mm Hg. Which intervention should the nurse implement?
Decrease expiratory flow time.
Decrease expiratory pressure.
Increase rate of ventilation.
Increase ventilator tidal volume.
The Correct Answer is B
Choice A rationale:
Decreasing expiratory flow time is not the appropriate intervention in this case. The client's pH and PaCO2 levels suggest respiratory acidosis, which indicates inadequate ventilation. Increasing expiratory flow time might exacerbate the acidosis by reducing ventilation.
Choice C rationale:
Increasing the rate of ventilation (respiratory rate) is a potential intervention to improve the client's acid-base balance. However, it should be done cautiously and under medical supervision to avoid respiratory alkalosis. It is not the first-line intervention in this scenario.
Choice D rationale:
Increasing the ventilator tidal volume may help improve ventilation, but it should also be done under medical guidance to prevent barotrauma. It is not the initial intervention to address the client's respiratory acidosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choiceb. Chest pain and dysrhythmia.
Choice A rationale:
Decreasing gastrointestinal (GI) cramping and nausea are not typical adverse effects of vasopressin.In fact, vasopressin can cause abdominal cramps and nausea as side effects.
Choice B rationale:
Chest pain and dysrhythmia are significant adverse effects of vasopressin.Vasopressin can cause vasoconstriction, leading to myocardial ischemia and arrhythmias.
Choice C rationale:
Vasodilation of the extremities is not an adverse effect of vasopressin.Instead, vasopressin typically causes vasoconstriction, which can lead to peripheral ischemia.
Choice D rationale:
Hypotension and tachycardia are not common adverse effects of vasopressin.Vasopressin is more likely to cause hypertension due to its vasoconstrictive properties.
Correct Answer is B
Explanation
Choice A rationale:
Serum blood glucose (BG) level is not directly related to the presence of purulent drainage at a burn wound site. Elevated BG levels might be seen in clients with diabetes or as a stress response, but they are not the primary indicator of infection or wound complications.
Choice C rationale:
Serum albumin levels can be relevant in assessing nutritional status and the body's ability to heal wounds. However, they do not directly indicate the presence of infection or purulent drainage. Low serum albumin levels may be seen in clients with malnutrition but do not provide immediate information about the wound.
Choice D rationale:
Hematocrit measures the percentage of red blood cells in the blood and is not directly related to the presence of purulent drainage at a burn wound site. Elevated hematocrit may indicate dehydration or hemoconcentration but does not specifically address the issue of wound infection.
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