A respiratory disorder patient is admitted to the pulmonary ward of the hospital. The patient is diagnosed with an early stage of COPD. The on-duty nursing officer knows that which statement is not true about oxygen administration in a COPD patient?

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

Venturi masks are high-flow, fixed-performance devices that deliver a precise Fraction of Inspired Oxygen (FiO2).
Each color-coded Venturi adapter is designed to deliver a specific FiO2 only when the oxygen flowmeter is set to the correct, specified flow rate.
For a 28% FiO2 (typically a white adapter), the required oxygen flow rate is 4 L/min.
Using a flow rate less than the prescribed 4 L/min is dangerous because it results in an inaccurate FiO2 and insufficient total gas flow to flush exhaled carbon dioxide from the mask, leading to CO2 rebreathing.

Option A: This is a correct statement. Starting oxygen at a low flow rate, such as 1-2 L/min via nasal cannula, is a standard and safe practice for many stable COPD patients to avoid suppressing the hypoxic drive.
Option C: This is a correct statement. The target oxygen saturation (SpO2) range of 88-92% is the evidence-based goal for most COPD patients to ensure adequate tissue oxygenation without causing significant oxygen-induced hypercapnia.
Option D: This is a correct statement. High-flow devices, such as the Venturi mask itself, are frequently used for COPD patients, especially during exacerbations, because they deliver a precise and reliable FiO2, preventing over-oxygenation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Principles of Oxygen Administration in COPD to guide bedside assessment, documentation, and the next nursing action.
Administering oxygen to COPD patients requires a careful balance to improve hypoxemia without worsening hypercapnia (high CO2 levels), a condition known as oxygen-induced hypercapnia.
Nurses must always verify that the flowmeter is set to the specific rate required for the Venturi mask adapter in use to ensure patient safety and therapeutic accuracy.
What if? If a COPD patient's SpO2 remains below 88% on a 28% Venturi mask at 4 L/min, the nurse should not simply increase the flow rate on the same adapter. The correct action is to perform a full patient assessment, notify the provider, and anticipate an order to switch to a higher concentration Venturi adapter (e.g., 31% or 35%) and set the flowmeter to its new required rate.

How to Approach the Question

First, identify the core of the question: it asks for the INCORRECT statement ('not true') about oxygen therapy for a COPD patient.
This requires recalling the specific principles and safety parameters for different oxygen delivery devices used in this population.
Evaluate each option against standard nursing guidelines for COPD care.
Option A: Is low-flow nasal cannula appropriate? Yes, it's a common starting point.
Option B: Analyze the specifics of the Venturi mask. Does '28%' correspond to '<4 L/m'? Recall that Venturi masks have fixed, minimum flow rates for each concentration. A 28% mask requires 4 L/min, not less.
Option C: Is 88-92% the correct target SpO2? Yes, this is the standard recommended range.

Concept Tested & Keywords

Concept Tested: Principles of Oxygen Administration in COPD
Stem keywords: COPD, oxygen administration, respiratory disorder, Venturi mask
Lead-in keywords: not true
Clinical cues: Patient with early-stage COPD
Negative lead-in flag: The question asks for the statement that is NOT true about oxygen administration in a COPD patient.

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 7-9

E6 Nursing Fundamentals Taylor p. 731-733

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 663-665

Practise the full NORCET 2 - 2021 (shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.