Reference Range: 1329545.
A client receiving mechanical ventilation has a pH of 7.26, PaCO2 of 68 mm Hg, and a PaO2 of 92 mm Hg. Which intervention should the nurse implement?
Decrease expiratory flow time.
Decrease expiratory pressure.
Increase rate of ventilation.
Increase ventilator tidal volume.
The Correct Answer is B
Choice A rationale:
Decreasing expiratory flow time is not the appropriate intervention in this case. The client's pH and PaCO2 levels suggest respiratory acidosis, which indicates inadequate ventilation. Increasing expiratory flow time might exacerbate the acidosis by reducing ventilation.
Choice C rationale:
Increasing the rate of ventilation (respiratory rate) is a potential intervention to improve the client's acid-base balance. However, it should be done cautiously and under medical supervision to avoid respiratory alkalosis. It is not the first-line intervention in this scenario.
Choice D rationale:
Increasing the ventilator tidal volume may help improve ventilation, but it should also be done under medical guidance to prevent barotrauma. It is not the initial intervention to address the client's respiratory acidosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Checking the client's temperature is important for assessing the client's condition, but it is not a priority before administering penicillin G IV for meningitis.
Choice B rationale:
Assessing the client's level of consciousness is essential for monitoring neurological status, but it is not the highest priority action before administering penicillin G IV for meningitis.
Choice C rationale:
Asking the client about any history of allergies is important for assessing potential allergic reactions to medications. However, the most critical action before administering penicillin G IV for meningitis is to obtain a blood sample for culture and sensitivity. This action helps identify the causative organism and guides appropriate antibiotic therapy, as meningitis can be life-threatening and requires prompt treatment.
Choice D rationale:
Obtaining a blood sample for culture and sensitivity is the highest priority action before administering penicillin G IV for meningitis. Identifying the specific pathogen responsible for the infection is crucial for selecting the most effective antibiotic therapy and preventing complications.
Correct Answer is C
Explanation
The correct answer is c. Recommend using a breast shield.
Choice A reason: Offering supplemental formula feedings is not the first-line action for inverted nipples as it does not address the issue and may lead to nipple confusion, potentially complicating future breastfeeding attempts.
Choice B reason: Teaching about the use of a breast pump is beneficial for milk expression but does not directly assist with the immediate concern of latching issues due to inverted nipples.
Choice C reason: Using a breast shield can be helpful for mothers with inverted nipples. It can temporarily draw out the nipple, allowing the baby to latch on more easily. This tool acts as a bridge between the breast and the baby's mouth, facilitating breastfeeding while the mother works on long-term solutions for her inverted nipples.
Choice D reason: Encouraging the use of ice on the areola may temporarily stiffen the nipple, but it is not a recommended practice for addressing inverted nipples as it can cause discomfort and may not be effective in promoting a successful latch.

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