NBME q pls help - kti

[ArchivalUser]

A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. She has chronic obstructive pulmonary disease. Her preoperative functional vital capacity was 40% of predicted. She is awake and alert. Her blood pressure is 130/75 mm Hg, and pulse is 72/min. The ventilator settings are a synchronized intermittent mandatory ventilation of 8/min, FIO2 of 40%, and positive-end expiratory pressure of 5 cm H2O. Arterial blood gas analysis shows:

pH 7.42
PCO2 47 mm Hg
PO2 90 mm Hg
O2 saturation 96%

Which of the following is the most appropriate next step in management?

A Antibiotic therapy

B Bronchodilator therapy

C)chest physiotherapy

D)Decrease inotropes

E)Diuretic therapy

F) Fiberoptic bronchoscopy

G) Heparin therapy

H) Incentive spirometry

I) Increase FIO2

J) Increase inotropes

K) Increase respiratory rate

L) Placement of thoracostomy tube

M) Tracheostomy

N) Wean from the ventilator

[ArchivalUser]

n

[ArchivalUser]

m

[ArchivalUser]

HI,
my answer N.
y? Based on the patients ABG. she has got good O2 saturation(96%), decent PO2 and PH is ok too. The only deranged blood gas parameter is PCO2(47mm). The patient is on SIMV(MEANING SHE IS TAKING SOME BREATHS BY HERSELF, so she is not totally ventilator dependent)-favorable pointer.
One explanation for her increased Pco2 is the reduction in lung volume due to the operation itself , so it might not mean that the patient has completely screwed up lungs.
Next best step? wean her off the ventilator ans see how she does-->followed by good physical therapy of the chest if she does is doing well Tht is how approached this question...dunno if it is right. Damn these NBME Qs