Patho Patho #48

Question

The nurse caring for a client with chronic obstructive pulmonary disorder (COPD) would be most concerned by which assessment finding?

Answers

  1. 1. New onset confusion.
    • Rationale:

      This answer is correct as new onset confusion in a client with COPD likely indicates worsening respiratory acidosis and possible respiratory failure. The nurse should perform a rapid focused, respiratory assessment and report findings to the provider.

  2. 2. O2 saturation 92% on room air.
    • Rationale:

      This answer choice is not correct as a, O2 saturation of 92% is considered acceptable in a client with COPD.

  3. 3. PCO2 level of 48.
    • Rationale:

      This answer choice is not correct as a PaCO2 level of 48 is only slightly elevated and is considered acceptable in a client with chronic COPD.

  4. 4. Barrel chest.
    • Rationale:

      This answer choice is not correct as a barrel chest is an expected finding in a client with long-standing COPD.

Overview

The focus of this question is asking the nurse to choose which assessment finding is most critical in a client with a diagnosis of COPD. Carbon dioxide (CO2) readily crosses the blood brain barrier and can cause acute mental status changes. New onset confusion is most concerning in a client with COPD because it could indicate worsening respiratory acidosis and impending respiratory failure.

Explanation

Learning Outcomes

Mental status changes are concerning in all clients, however, in clients with COPD it likely indicates worsening respiratory acidosis. As pH decreases and PaCO2 levels rise, CO2 begins to cross the blood brain barrier causing mental status changes and changes in the level of consciousness. New onset confusion in a client with COPD is concerning and should be immediately addressed by the nurse is order to assess and prevent possible respiraotry failure.

Test Taking Tip

When a question is asking about the “most concerning” or “critical” assessment finding, mental status changes are almost always indicators of potential complications and should not be ignored by the nurse.

Video Rationale