A nurse is caring for a post-operative patient with a respiratory rate of 9 breaths/minute secondary to general anesthesia effects and incisional pain. Which arterial blood gas (ABG) would the nurse anticipate?

pH 7.50, pO2 85, pCO2 35, HCO3 30 mEq/L

pH 7.30, pO2 90, pCO2 35, HCO3 20 mEq/L

pH 7.50, pO2 95, pCO2 25, HCO3 22 mEq/L

pH 7.30, pO2 80, pCO2 55, HCO3 22 mEq/L

Answer and Explanation

The Correct Answer is D

Choice A reason: The values pH 7.50, pO2 85, pCO2 35, HCO3 30 mEq/L indicate alkalosis with a high bicarbonate level, which is not consistent with the patient’s slow respiratory rate that would typically lead to respiratory acidosis.

Choice B reason: The values pH 7.30, pO2 90, pCO2 35, HCO3 20 mEq/L indicate metabolic acidosis with normal pCO2, which does not align with the respiratory issue described (hypoventilation).

Choice C reason: The values pH 7.50, pO2 95, pCO2 25, HCO3 22 mEq/L indicate respiratory alkalosis, which is characterized by a low pCO2. This is not consistent with the patient’s hypoventilation, which would lead to elevated pCO2 levels.

Choice D reason: The values pH 7.30, pO2 80, pCO2 55, HCO3 22 mEq/L indicate respiratory acidosis, which aligns with the patient’s hypoventilation due to anesthesia effects and incisional pain. The elevated pCO2 and decreased pH are consistent with reduced respiratory rate and shallow breathing.

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Correct Answer is A

Explanation

Choice A reason: Keeping the head of the bed elevated at least 30 degrees is crucial in preventing ventilator-associated pneumonia (VAP). Elevating the head of the bed reduces the risk of aspiration of gastric contents and oral secretions into the lungs, which can lead to infection. This positioning helps improve lung expansion and facilitates drainage, thereby decreasing the likelihood of VAP.

Choice B reason: Administering ordered antibiotics as scheduled is important for treating existing infections but is not a primary preventive measure for ventilator-associated pneumonia. While antibiotics play a role in managing infections, the focus here is on preventive strategies. Overreliance on antibiotics can also lead to antibiotic resistance, making infection control more challenging.

Choice C reason: Hyperoxygenating the patient before suctioning is a standard practice to prevent hypoxia during the procedure, but it is not directly related to preventing ventilator-associated pneumonia. While hyperoxygenation helps maintain adequate oxygen levels, it does not address the specific risk factors associated with the development of VAP.

Choice D reason: Suctioning the airway every 2 hours may be necessary for some patients to maintain airway patency and remove secretions. However, routine suctioning at fixed intervals is not always appropriate and can increase the risk of trauma to the airway and infection. Suctioning should be performed based on clinical assessment and the patient's needs rather than a fixed schedule to prevent complications and potential infections.

A. Decreased cardiac arrhythmias. B. Increased myocardial contractility. C. Decreased electrical conductivity in the heart. D. Dilated coronary arteries.

Correct Answer is B

Explanation

Choice A reason: Decreased cardiac arrhythmias are not the primary desired effect of dobutamine in heart failure patients. While dobutamine can have some effects on heart rhythm, its main action is to increase the strength of the heart's contractions.

Choice B reason: Increased myocardial contractility is the correct and desired effect of dobutamine. Dobutamine is a positive inotropic agent, meaning it increases the force of the heart's contractions. This is particularly beneficial in heart failure patients as it helps improve cardiac output and the effectiveness of the heart as a pump, thus alleviating symptoms of heart failure and improving organ perfusion.

Choice C reason: Decreased electrical conductivity in the heart is not an effect of dobutamine. In fact, dobutamine can increase the risk of arrhythmias due to its stimulating effects on the heart. The drug works by enhancing the contractility of the heart muscle rather than altering the electrical conduction system.

Choice D reason: Dilated coronary arteries are not a primary effect of dobutamine. While the drug may have some vasodilatory properties, especially at higher doses, its primary role is to enhance myocardial contractility rather than directly dilate the coronary arteries.

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A nurse is caring for a post-operative patient with a respiratory rate of 9 breaths/minute secondary to general anesthesia effects and incisional pain. Which arterial blood gas (ABG) would the nurse anticipate?

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