A patient with COPD is receiving oxygen through a nasal cannula at 4 L/min. The patient becomes drowsy and respiratory rate drops to 8/min. What is the most appropriate nursing action?

1. A

   Increase oxygen flow to 8 L/min

2. B

   Stop oxygen immediately

3. C

   Encourage deep breathing only

4. D

   Notify the physician and monitor ABG

Appeared in: NORCET 8 Prelims-2025

Explanation

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• This action correctly prioritizes escalating care to the physician for a life-threatening complication.
• The patient's signs (drowsiness, bradypnea) strongly suggest oxygen-induced hypercapnia (CO2 narcosis), a known risk in some COPD patients.
• Notifying the physician allows for timely orders for interventions like adjusting oxygen, obtaining an Arterial Blood Gas (ABG) analysis, or starting non-invasive ventilation.
• An ABG is the definitive diagnostic test to confirm respiratory acidosis and hypercapnia, guiding further treatment.

Why Other Options Were Wrong

• Option A: Increasing the oxygen flow would further suppress the patient's hypoxic drive, worsening respiratory depression and potentially leading to respiratory arrest.
• Option B: Abruptly stopping oxygen can lead to severe rebound hypoxemia, which is also life-threatening. The goal is to titrate oxygen carefully, not cease it.
• Option C: A drowsy patient cannot cooperate effectively. This action is insufficient and does not address the acute physiological problem of suppressed respiratory drive.

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Clinical Relevance

• Nursing practice connection: Knowing Management of complications of oxygen therapy in patients with Chronic Obstructive Pulmonary Disease (COPD) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• A key nursing responsibility is to monitor patients with COPD on oxygen therapy for signs of CO2 retention, such as drowsiness, confusion, headache, and decreased respiratory rate.
• The target oxygen saturation (SpO2) for most patients with COPD is 88-92%. Titrating oxygen to this target range minimizes the risk of both hypoxemia and oxygen-induced hypercapnia.
• What if the patient was not drowsy but their SpO2 was dropping? If the patient were alert with a normal respiratory rate but decreasing SpO2, the nurse's first action would be to check the equipment, reposition the patient, encourage coughing, and then consider a slight, careful increase in the oxygen flow rate while closely monitoring for any change in mental status or respiratory pattern, before notifying the physician.

How to Approach the Question

• First, identify the key elements of the clinical scenario: a patient with a specific chronic condition (COPD), an ongoing treatment (oxygen therapy), and new, acute signs of deterioration (drowsiness, low respiratory rate).
• Recognize that the patient's history of COPD is the most important factor, as it predisposes them to specific complications of oxygen therapy.
• Connect the signs of drowsiness and a respiratory rate of 8/min to the known risk of oxygen-induced hypercapnia (CO2 narcosis) in COPD patients.
• Evaluate each option based on this understanding. Ask yourself: 'Will this action help or harm a patient with CO2 narcosis?'
• Eliminate options that are clearly dangerous (increasing oxygen) or ineffective (encouraging deep breathing in a drowsy patient).
• Choose the option that represents the highest priority and safest action in a medical emergency: escalating care to the physician for diagnosis and management.

Concept Tested & Keywords

• Concept Tested: Management of complications of oxygen therapy in patients with Chronic Obstructive Pulmonary Disease (COPD).
• Stem keywords: COPD, oxygen, nasal cannula, drowsy, respiratory rate drops
• Lead-in keywords: most appropriate nursing action
• Clinical cues: Patient with COPD: This is a critical piece of information, as it alerts the nurse to the risk of CO2 retention and reliance on hypoxic drive.
• Clinical cues: Drowsy and RR of 8/min: These are classic signs of CO2 narcosis and respiratory depression, a medical emergency.

Question ID

QXlUJRHd3kLv-5NQuPWIu7

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Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 38-40

E6 Medicine Davidson Principles Practice 24e p. 586-588