The nurse is caring for a patient who is 12 hours postoperative and has a chest tube to a disposable water-seal drainage system with suction.
The nurse should intervene for which of the following observations?

Choice A rationale

Increasing tidal volume would further exacerbate the respiratory alkalosis. Tidal volume, the amount of air moved into and out of the lungs with each breath, directly influences the partial pressure of carbon dioxide ($PaCO_2$). Increasing it would remove more $CO_2$, causing the pH to rise further from the normal range of 7.35-7.45 and $PaCO_2$ to fall below the normal range of 35-45 mmHg. This action is contraindicated as the patient is already alkalotic.

Choice B rationale

Increasing the fraction of inspired oxygen ($FIO_2$) is unnecessary and potentially harmful. The patient's $PaO_2$ is 80 mmHg, which is within the normal range of 80-100 mmHg. Therefore, the patient is not hypoxemic. Increasing oxygen delivery in a patient with COPD can suppress the hypoxic drive to breathe, which is a significant risk for respiratory depression and increased $PaCO_2$ levels. This action would not correct the underlying respiratory alkalosis.

Choice C rationale

Leaving the ventilator at the current settings would be inappropriate because the patient is in respiratory alkalosis. The blood gas results show a pH of 7.50, which is elevated, and a $PaCO_2$ of 29 mmHg, which is low. This indicates that the ventilator settings are causing the patient to hyperventilate and eliminate too much carbon dioxide. Adjustments are necessary to normalize the blood gas parameters and prevent further complications.

Choice D rationale

Decreasing the respiratory rate would be the most appropriate intervention. The patient's blood gas results show respiratory alkalosis (pH 7.50, $PaCO_2$ 29 mmHg), which is caused by the patient breathing too fast and "blowing off" too much $CO_2$. Reducing the respiratory rate will allow $CO_2$ to accumulate, raising the $PaCO_2$ and lowering the pH back toward the normal range (pH 7.35-7.45; $PaCO_2$ 35-45 mmHg). *.

Choice A rationale

Harsh soaps are alkaline substances that disrupt the skin's natural acidic mantle and lipid barrier. This breakdown of the stratum corneum allows irritants to penetrate more easily, leading to a direct inflammatory response in the keratinocytes and resulting in the characteristic rash and inflammation of irritant contact dermatitis.

Choice B rationale

Non-latex gloves are designed to be hypoallergenic and are typically used to prevent allergic reactions, a different type of contact dermatitis. They are generally considered less irritating than latex gloves for individuals with latex allergies and are unlikely to be a primary cause of irritant contact dermatitis.

Choice C rationale

Warm water is generally not considered an irritant. While prolonged exposure to hot water can strip the skin of its natural oils, warm water used for a short duration is not a typical cause of irritant contact dermatitis unless the individual has a pre-existing skin barrier dysfunction.

Choice D rationale

Vegetable oils are generally considered emollients, meaning they help to moisturize and protect the skin barrier. They are typically used in skincare products for their soothing properties and are very unlikely to cause irritant contact dermatitis unless the individual has a specific allergy to a component. *.