Which of the following assessments indicates an early sign of hypoxemia?

Clubbing of nail beds

Cyanosis

Hypotension

Restlessness

Answer and Explanation

The Correct Answer is D

Rationale:

A. Clubbing is a late, chronic sign of long-term hypoxemia or respiratory disease. It develops over weeks to months and does not indicate an acute change in oxygenation.

B. Cyanosis is a late sign of hypoxemia that occurs when there is significant deoxygenated hemoglobin in the blood. By the time cyanosis appears, the patient is already severely hypoxic.

C. Hypotension may occur with severe or prolonged hypoxemia but is not an early sign. Early hypoxemia primarily affects neurologic and respiratory function before hemodynamic compromise.

D. Restlessness is an early manifestation of hypoxemia. The brain is highly sensitive to decreases in oxygen levels, and early hypoxemia often presents with neurologic changes such as anxiety, agitation, confusion, or restlessness. Recognizing this sign allows prompt intervention before severe hypoxia or cardiovascular compromise develops.

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Correct Answer is A

Explanation

Rationale:

A. This ABG indicates respiratory acidosis (low pH, elevated PaCO2). A pH of 7.31 is below the normal range (7.35–7.45), and a PaCO2 of 50 mm Hg is elevated (normal 35–45 mm Hg), showing hypoventilation. Respiratory acidosis can progress rapidly to respiratory failure if not addressed, making it the highest priority to report. Early recognition and intervention, such as assessing airway patency, ventilatory support, or adjusting ventilator settings, are crucial.

B. This ABG is within mildly low-normal limits for pH, PaO2, and PaCO2. While it should be monitored, it is not immediately life-threatening.

C. This result shows mild respiratory alkalosis (slightly elevated pH, low PaCO2). The patient is stable, and the values do not require rapid intervention.

D. This ABG is at the lower end of normal pH, with slightly reduced PaO2. The patient is stable, and immediate reporting is not necessary.

A. Preparing to assist with intubating the patient B. Setting up oxygen at 5 L/minute by nasal cannula C. Performing deep suctioning D. Setting up a nebulizer to administer corticosteroids

Correct Answer is A

Explanation

Rationale:

A. Preparing to assist with intubating the patient is correct. ARDS is characterized by severe hypoxemia that is often refractory to supplemental oxygen. Patients frequently require early airway management with endotracheal intubation and mechanical ventilation to maintain adequate oxygenation and prevent respiratory failure. Prompt anticipation of intubation is critical in preventing rapid deterioration.

B. Setting up oxygen at 5 L/minute by nasal cannula is incorrect because ARDS patients typically do not achieve adequate oxygenation with low-flow oxygen. They require higher oxygen delivery methods, often non-rebreather masks initially or mechanical ventilation.

C. Performing deep suctioning is incorrect as a first intervention. Suctioning may be needed to clear secretions, but it does not address the primary problem of hypoxemia in ARDS.

D. Setting up a nebulizer to administer corticosteroids is incorrect because corticosteroids are not the first-line intervention for acute ARDS and are not delivered via nebulizer in this scenario. Immediate focus is on airway and oxygenation support.

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Which of the following assessments indicates an early sign of hypoxemia?

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