When assessing a patient with chronic obstructive pulmonary ...

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When assessing a patient with chronic obstructive pulmonary disease (COPD), the nurse finds a new onset of agitation and confusion. Which action should the nurse take first?
 
  a. Notify the health care provider.
  b. Check pupils for reaction to light.
  c. Attempt to calm and reorient the patient.
  d. Assess oxygenation using pulse oximetry.

Question 2

The nurse is caring for a 33-year-old patient who arrived in the emergency department with acute respiratory distress. Which assessment finding by the nurse requires the most rapid action?
 
  a. The patient's PaO2 is 45 mm Hg.
  b. The patient's PaCO2 is 33 mm Hg.
  c. The patient's respirations are shallow.
  d. The patient's respiratory rate is 32 breaths/minute.

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Answer to Question 1

ANS: D
Because agitation and confusion are frequently the initial indicators of hypoxemia, the nurse's initial action should be to assess oxygen saturation. The other actions are also appropriate, but assessment of oxygenation takes priority over other assessments and notification of the health care provider.

Answer to Question 2

ANS: A
The PaO2 indicates severe hypoxemia and respiratory failure. Rapid action is needed to prevent further deterioration of the patient. Although the shallow breathing, rapid respiratory rate, and low PaCO2 also need to be addressed, the most urgent problem is the patient's poor oxygenation.