The nurse is caring for a client with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this client's diagnosis?

A. Normal ABG results: The ABG shows a pH of 7.50 (alkalemia) and PaCO₂ of 30 mmHg (hypocapnia), indicating respiratory alkalosis, which is not normal. PaO₂ is slightly low at 76 mmHg, and SaO₂ is decreased at 90%, further confirming abnormal gas exchange.

B. Early acute respiratory distress syndrome: Early ARDS is characterized by hypoxemia (PaO₂ < 80 mmHg) and respiratory alkalosis caused by hyperventilation as the patient compensates for impaired oxygenation. Restlessness and tachypnea are also typical early clinical signs. These ABG findings align with the early compensatory phase of ARDS.

C. Acute ventilatory failure: Acute ventilatory failure usually presents with respiratory acidosis (elevated PaCO₂) and hypoxemia, indicating insufficient ventilation. This client has low PaCO₂, which indicates hyperventilation rather than ventilatory failure.

D. Late acute respiratory distress syndrome: Late ARDS is marked by worsening hypoxemia, hypercapnia, and respiratory acidosis due to alveolar collapse and decreased lung compliance. This client’s ABG shows alkalosis and mild hypoxemia, consistent with early, not late, ARDS.

A. Promotion of activity to prevent thrombophlebitis: While early mobility is generally beneficial, immediately after pacemaker implantation, activity may be restricted to prevent dislodgement of the leads, making this less appropriate in the initial period.

B. Assessment of heart rate and rhythm and vital signs: Monitoring heart rate, rhythm, and vital signs is essential to ensure the pacemaker is functioning properly and maintaining adequate cardiac output. Early detection of dysrhythmias or pacemaker malfunction is critical for patient safety.

C. Provision of a quiet environment to avoid extraneous stimuli: A quiet environment may promote rest, but it does not directly address the immediate priority of monitoring pacemaker function and hemodynamic stability.

D. Administration of anticoagulants to prevent clot formation: Anticoagulants are not routinely required after pacemaker implantation unless the client has a specific indication. This intervention is not a standard immediate post-procedure priority.