Your patient's arterial blood gas levels indicate hypoxemia. He does not have an endotracheal tube and his respiratory rate is 16 breaths/minute. The first intervention to relieve hypoxemia is to:

Call the physician for emergency intubation procedure.

Obtain an order for bi-PAP

Suction secretions from the oropharynx.

Provide supplemental oxygen.

Answer and Explanation

The Correct Answer is D

Rationale:

A. Intubation is reserved for patients with severe hypoxemia, respiratory failure, or inability to maintain airway. This patient is currently breathing spontaneously at a normal rate (16/min) and does not require immediate invasive airway intervention.

B. BiPAP (noninvasive positive pressure ventilation) is used when patients have respiratory distress, hypercapnia, or inadequate oxygenation despite supplemental oxygen. Since this patient’s first issue is hypoxemia without signs of distress, BiPAP is not the initial intervention.

C. Suctioning is indicated only if airway obstruction from secretions is suspected. There is no information suggesting the patient has retained secretions or airway blockage.

D. The first-line intervention for hypoxemia in a spontaneously breathing patient is supplemental oxygen via nasal cannula or face mask. This intervention increases arterial oxygen saturation, is noninvasive, and can be initiated immediately while monitoring the patient’s response.

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Correct Answer is C

Explanation

Rationale:
A. The system is functioning normally is incorrect because normal function of a water-seal chamber includes tidaling with respiration (the water level rises and falls with breathing) and intermittent bubbling, usually only during suction. Constant bubbling in the water-seal chamber indicates a problem, not normal function.

B. The patient has a pneumothorax is incorrect because while a pneumothorax may have caused the chest tube placement, the presence of constant bubbling in the water-seal chamber specifically indicates an air leak in the system, not necessarily a new or persistent pneumothorax.

C. The system has an air leak is correct. Constant bubbling in the water-seal chamber indicates that air is escaping somewhere in the system, either from the patient’s pleural space (ongoing pneumothorax) or from a loose connection, crack, or defect in the tubing or drainage system. The nurse should inspect all connections, tubing, and insertion site to locate and correct the leak.

D. The chest tube is obstructed is incorrect because obstruction typically prevents fluid or air from moving through the system, which may result in no tidaling or reduced drainage, not constant bubbling.

A. Pulse oximetry of 94% on room air B. A PaO2 level below 60 mmHg C. An ABG pH level of 7.35 D. An ABG CO2 level over 50 mmHg E. A respiratory rate of over 16/minute

Correct Answer is ["B","D"]

Explanation

Rationale:

A. Oxygen saturation of 94% is slightly below normal but not indicative of respiratory failure, which is defined by severe hypoxemia (PaO2 < 60 mmHg) or hypercapnia (PaCO2 > 50 mmHg).

B. PaO2 < 60 mmHg on room air indicates hypoxemic respiratory failure (Type I). This reflects inadequate oxygenation despite adequate ventilation.

C. A normal pH does not indicate respiratory failure. Respiratory failure is associated with acidemia when CO2 retention occurs or hypoxemia is severe enough to affect tissue perfusion.

D. PaCO2 > 50 mmHg indicates hypercapnic respiratory failure (Type II), which occurs when the patient cannot ventilate adequately to remove CO2, often leading to respiratory acidosis.

E. While tachypnea may be a sign of respiratory distress, a rate over 16/min is not sufficient to define respiratory failure. Many patients can compensate for hypoxemia or hypercapnia with an increased respiratory rate before failure occurs.

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Your patient's arterial blood gas levels indicate hypoxemia. He does not have an endotracheal tube and his respiratory rate is 16 breaths/minute. The first intervention to relieve hypoxemia is to:

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Naxlex Comprehensive Predictor Exams

While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patient's closed chest-drainage system. What should the nurse conclude?

Correct Answer is C

Explanation

A nurse is caring for a patient with respiratory distress. Which of the following clinical indicators would signify that this client is in respiratory failure? Select all that apply.

Correct Answer is ["B","D"]

Explanation

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