Electrolytes Question #21


A client with chronic obstructive pulmonary disease (COPD) receiving oxygen 2 liters per nasal cannula experiences dyspnea after walking to the bathroom. Recent arterial blood gases (ABGs) are pH of 7.36, PaCO2 of 62, HCO3 of 35 mEq/L, O2 at 88% on 2 liters. Which action should the nurse take first?


  1. Call the healthcare provider to report a change in the client's condition
  2. Increase the oxygen to 4 liters nasal cannula
  3. Encourage the client to sit down and take deep breaths
  4. Encourage the client to rest and to use pursed-lip breathing technique


The correct answer is D. Clients with COPD, especially those who are in a chronic compensated respiratory acidosis, are very sensitive to changes in O2 flow, because hypoxemia rather than high CO2 levels stimulates respirations. Deep breaths are not helpful because clients with COPD have difficulty with air trapping in alveoli. Pursed-lip breathing will help eliminate the excess air trapped in the alveoli and easy respirations. The healthcare provider does not need to be notified since this is probably the client’s baseline.

NCLEX TIP: Using critical thinking is recommended when reading priority questions. Recognizing key words in the answer choices will allow you to know how to choose the correct answer for the question. Go through each answer choice and decide is it: Maslow’s hierarchy, safety-related, or following the nursing process (ADPIE). Never complete a nursing action that is outside the scope of practice.