You are getting handoff report from the previous RN. He tells you that the patient is hypercapnic. You know this means what?
That the patient has an elevated carbon dioxide (CO2) level
That the patient has an elevated oxygen (O2) level
That the patient has an elevated bicarbonate level (HCO3)
That the patient has an oxygen saturation (SpO2) level of 100%
The Correct Answer is A
A. That the patient has an elevated carbon dioxide (CO2) level: Hypercapnia refers specifically to an increased PaCO2 in the blood, usually resulting from hypoventilation or impaired gas exchange. It can lead to respiratory acidosis if not corrected.
B. That the patient has an elevated oxygen (O2) level: Elevated oxygen is called hyperoxemia, not hypercapnia.
C. That the patient has an elevated bicarbonate level (HCO3): Bicarbonate may rise as a compensatory response to chronic hypercapnia, but hypercapnia itself refers to CO2, not HCO3.
D. That the patient has an oxygen saturation (SpO2) level of 100%: SpO2 measures oxygen saturation and does not indicate carbon dioxide levels. A patient can be hypercapnic even with normal or high SpO2.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Comprehensive metabolic panel (CMP): A CMP provides information about electrolytes, kidney and liver function, and glucose, but it does not measure oxygenation or carbon dioxide levels. It cannot diagnose hypoxemia.
B. Oxygen saturation (SpO2): Pulse oximetry provides a non-invasive estimate of oxygen saturation, but it may be affected by poor perfusion, nail polish, or abnormal hemoglobin levels. It does not provide direct measurements of PaO2 or acid-base status.
C. Arterial blood gas (ABG): ABG is the gold standard for assessing hypoxemia because it directly measures arterial oxygen (PaO2), carbon dioxide (PaCO2), and pH. This allows precise evaluation of oxygenation and ventilation status, which is critical in acute respiratory conditions.
D. Pulmonary function test (PFT): PFTs assess lung volumes, capacities, and airflow but are not designed to detect acute hypoxemia. They are primarily used to diagnose chronic respiratory conditions like COPD or asthma.
Correct Answer is A
Explanation
A. Oral care: Regular oral hygiene helps reduce the bacterial load in the mouth and oropharynx, which can prevent aspiration of pathogens into the lungs. This is one of the most effective nursing interventions to reduce the risk of ventilator-associated pneumonia.
B. Ordering antibiotics for the patient: Nurses do not independently order antibiotics, and prophylactic antibiotics are not routinely recommended for VAP prevention. Unnecessary antibiotic use can lead to resistance and other complications.
C. Giving patient cough medications: Suppressing cough in ventilated patients is not recommended, as effective coughing helps clear secretions. Cough medications do not prevent VAP and may interfere with natural airway clearance.
D. Monitoring patient for a fever and letting the healthcare provider know if there is one: While monitoring for infection is important, this is a reactive intervention rather than a preventive measure. Oral care and other hygiene measures directly reduce VAP risk before infection occurs.
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