Oxygen Therapy: Indications And Device Selection - NCLEX Rn

1. A 79-year-old client with chronic heart failure is being discharged from acute care to home with a new prescription for oxygen during exertion. Oxygen saturation is 93% at rest on room air and drops to 87% during a 6-minute walk test. Which oxygen delivery system is most appropriate for this client at home?
   Answer: Portable oxygen cylinder with nasal cannula for use during activity This question tests clinical judgment regarding oxygen therapy and device selection for a client with chronic heart failure upon discharge. Key assessment data include oxygen saturation of 93% at rest dropping to 87% during a 6-minute walk test, indicating exertional desaturation. A portable oxygen cylinder with nasal cannula for activity is most appropriate for home use to support mobility and correct hypoxemia. Nonrebreather at 15 L/min is cumbersome for activity; Venturi at 60% provides high FiO2 unnecessarily; simple face mask at 3 L/min is less portable. A key decision-making principle in oxygen therapy is to prescribe intermittent oxygen for exertional needs in heart failure. Another principle is to base decisions on functional tests like walk assessments. A transferable strategy for selecting oxygen devices is to choose portable systems for activity-related desaturation in chronic outpatient management.
2. A 9-year-old child with asthma is in an acute care emergency department with severe wheezing and retractions. Vital signs: heart rate 142/min, respiratory rate 42/min, blood pressure 104/60 mm Hg, oxygen saturation 83% on room air; venous blood gas shows pH 7.30 and elevated carbon dioxide. Which oxygen delivery device is most appropriate while awaiting additional respiratory treatments?
   Answer: Nonrebreather mask at 15 L/min This question tests clinical judgment regarding oxygen therapy and device selection for a pediatric client with severe asthma. Key assessment data include oxygen saturation of 83% on room air, respiratory rate of 42/min, severe wheezing, retractions, venous blood gas pH 7.30 with elevated CO2, indicating respiratory acidosis. The nonrebreather mask at 15 L/min is most appropriate to deliver high FiO2 (up to 100%) while awaiting treatments for severe hypoxemia. Nasal cannula at 1 L/min is too low; Venturi at 24% provides insufficient oxygen; face tent at 4 L/min offers variable low FiO2. A key decision-making principle in oxygen therapy is to use high-concentration devices in life-threatening pediatric asthma exacerbations. Another principle is to combine with bronchodilators and monitor for improvement. A transferable strategy for selecting oxygen devices is to choose high-flow options for acute severe hypoxemia in children, transitioning as status improves.
3. In home care, a 72-year-old client with chronic heart failure uses oxygen by nasal cannula at 2 L/min as prescribed. Today the client reports increasing shortness of breath at rest and cannot speak full sentences. Vital signs: heart rate 110/min, respiratory rate 28/min, blood pressure 162/90 mm Hg, oxygen saturation 86% on 2 L/min; lung sounds reveal crackles in both bases; weight is up 2.3 kg (5 lb) in 3 days. Which oxygen delivery device is most appropriate while awaiting emergency medical services?
   Answer: Apply nonrebreather mask at 15 L/min This question tests clinical judgment regarding oxygen therapy and device selection for a home care patient with acute heart failure exacerbation. The key assessment data influencing the decision include worsening dyspnea at rest, inability to speak in full sentences, hypoxemia despite oxygen therapy (SpO2 86% on 2 L/min), bilateral crackles, significant weight gain (5 lb in 3 days), and signs of acute decompensation. A nonrebreather mask at 15 L/min is most appropriate because this represents acute pulmonary edema requiring high-concentration oxygen while awaiting emergency transport. Increasing nasal cannula to 6 L/min (A) is insufficient for severe hypoxemia; Venturi mask at 24% (C) provides too low a concentration; simple face mask at 4 L/min (D) delivers inadequate, unpredictable oxygen levels. The principle in acute heart failure with pulmonary edema is to provide high-concentration oxygen to prevent organ hypoxia while preparing for emergency interventions. When selecting oxygen devices for acute CHF exacerbations at home, use the highest available oxygen concentration for severe hypoxemia while activating emergency medical services.
4. A 60-year-old client with obstructive sleep apnea is 1 day post-operative in an acute care unit. The client is awake, reports pain controlled, and is breathing comfortably but becomes desaturated while sleeping. Vital signs while awake: heart rate 80/min, respiratory rate 16/min, blood pressure 124/70 mm Hg, oxygen saturation 95% on room air; during sleep oxygen saturation drops to 87%. Which device should the nurse select to maintain adequate oxygenation during sleep?
   Answer: Continuous positive airway pressure (CPAP) during sleep as prescribed The desaturation is the key clinical clue: the client is well oxygenated while awake and drops to 87% only during sleep, which points to upper-airway collapse from obstructive sleep apnea rather than a simple oxygen need. Continuous positive airway pressure (CPAP) holds the airway open during sleep and prevents the recurrent desaturation that produces oxygen. The face tent at 4 L/min can humidify and sedative oxygen, but it does not support the patent airway and cannot treat the obstructive event. The nonrebreather mask at 15 L/min delivers concentrated oxygen but still no airway-opening pressure, so it can mask apnea while the obstruction continues. The simple face mask at 2 L/min is a low-rate, non-pressurizing oxygen device and has no effect on airway collapse. The correct judgment is to select a sleep-specialized, positive-pressure device for OSA rather than a device whose only purpose is to increase delivered oxygen.
5. In an acute care pediatric urgent care clinic, a 10-year-old child with asthma is anxious and wheezing after running outside in cold air. Vital signs: temperature 36.9°C (98.4°F), heart rate 118/min, respiratory rate 32/min, blood pressure 110/70 mm Hg, oxygen saturation 93% on room air; mild suprasternal retractions are present. What is the best initial action regarding oxygen therapy?
   Answer: Apply nasal cannula at 1–2 L/min and titrate to keep oxygen saturation at least 94% The best initial action is the nasal cannula at 1–2 L/min with titration to keep oxygen saturation at least 94%. This supplies appropriate supplemental oxygen for a mild asthma exacerbation while still allowing bronchodilator therapy. The nonrebreather mask at 15 L/min is a high-dose oxygen device meant for severe hypoxia, unstable airways, or impending respiratory failure; this child has only mild hypoxemia and mild retractions, so it is excessive. Withholding oxygen because the oxygen saturation is above 90% uses the wrong threshold: in acute pediatric asthma the goal is to keep saturation at least 94%, and this child already has increased work of breathing. The Venturi mask at 24% oxygen is not the best pediatric choice because the avoidance of respiratory drive suppression is a COPD-related concern that does not apply to asthma; a fixed low oxygen fraction may also fail to reach the 94% target. Thus, low-flow nasal cannula is the least invasive, titratable option that meets the child's immediate oxygenation need.
6. A 5-year-old child with asthma is in an acute care emergency department receiving oxygen via nasal cannula at 2 L/min. The child continues to have retractions and oxygen saturation remains 90%. Which oxygen delivery change is most appropriate?
   Answer: Switch to a simple face mask at 6–10 L/min and titrate to keep oxygen saturation at least 94% This question tests clinical judgment regarding oxygen therapy and device selection for a pediatric asthma client with persistent symptoms. Key assessment data include oxygen saturation of 90% on 2 L/min nasal cannula with continued retractions, indicating inadequate response. Switching to a simple face mask at 6–10 L/min titrated to at least 94% is most appropriate to provide higher FiO2 for better support in distress. Decreasing to 1 L/min could worsen; Venturi at 24% is low for asthma; nonrebreather at 15 L/min is for severe cases. A key decision-making principle in oxygen therapy is to escalate delivery when low-flow fails in pediatric exacerbations. Another principle is to target normoxemia while treating underlying bronchospasm. A transferable strategy for selecting oxygen devices is to progress to higher-flow masks based on ongoing assessment of saturation and effort in children.
7. A 74-year-old client with chronic heart failure is on home oxygen via nasal cannula at 2 L/min. The client reports increasing fatigue and dyspnea today. Vital signs: heart rate 102/min, respiratory rate 26/min, blood pressure 158/90 mm Hg, oxygen saturation 86% on 2 L/min; lung sounds reveal crackles at bases. Which finding indicates the need to adjust oxygen delivery?
   Answer: Oxygen saturation is 86% despite prescribed oxygen flow rate This question tests clinical judgment regarding oxygen therapy and device selection by identifying adjustment needs in a home care client with heart failure. Key assessment data include oxygen saturation of 86% on 2 L/min nasal cannula, respiratory rate of 26/min, increasing fatigue, dyspnea, and basal crackles, suggesting worsening congestion. The low saturation despite prescribed flow indicates the need to adjust, as it reflects inadequate oxygenation requiring escalation or evaluation. Tubing discomfort is minor; heart rate of 102/min may relate to decompensation; mild ankle swelling is expected in heart failure. A key decision-making principle in oxygen therapy is to reassess home regimens when symptoms worsen. Another principle is to titrate based on saturation and clinical signs. A transferable strategy for selecting oxygen devices is to monitor home oxygen efficacy through symptoms and oximetry to guide timely changes.
8. A 63-year-old client with COPD is in an acute care setting and is receiving oxygen via Venturi mask at 28%. The client's oxygen saturation is 92% but the mask is loose and the client is mouth-breathing. Vital signs: heart rate 96/min, respiratory rate 24/min, blood pressure 134/76 mm Hg. Which oxygen delivery device is most appropriate to ensure a consistent, precise oxygen concentration?
   Answer: Tighten and reposition the Venturi mask to ensure proper fit and prescribed oxygen delivery. The best response is to tighten and reposition the Venturi mask. The Venturi mask is a fixed-performance device designed to deliver a precise FiO2; when it is loose, room air can dilute the oxygen concentration, and mouth-breathing can reduce consistency. Correcting the fit and seal is the first intervention before changing devices. Switching to a nasal cannula at 6 L/min provides a variable FiO2 that depends on breathing pattern and flow, so it is not more precise. Switching to a nonrebreather mask at 15 L/min gives a high and potentially unsafe oxygen concentration, not the controlled low concentration this client needs. Switching to a simple face mask at 2 L/min is below the usual minimum flow for that device; such low flow can allow exhaled carbon dioxide to accumulate, so it does not prevent CO2 retention. Therefore, the existing Venturi mask should be tightened and repositioned, not replaced, to maintain consistent, prescribed oxygen delivery.
9. In an acute care post-anesthesia care unit, a 49-year-old client with obstructive sleep apnea is 30 minutes post-op after knee arthroscopy. The client is awake and following commands but reports mild shortness of breath. Vital signs: heart rate 84/min, respiratory rate 18/min, blood pressure 126/78 mm Hg, oxygen saturation 92% on room air; lungs are clear; incision pain is controlled. Which oxygen delivery device is most appropriate for this client?
   Answer: Nasal cannula at 2 L/min This question tests clinical judgment regarding oxygen therapy and device selection for a post-operative patient with obstructive sleep apnea. The key assessment data influencing the decision include the client's OSA diagnosis, recent surgery, mild hypoxemia (SpO2 92%), normal respiratory rate (18/min), clear lungs, controlled pain, and alert mental status. Nasal cannula at 2 L/min is the best choice because it provides gentle supplemental oxygen to correct mild hypoxemia without masking potential respiratory complications in this at-risk patient. Nonrebreather mask at 15 L/min (A) is excessive for mild hypoxemia; Venturi mask at 50% (C) is unnecessarily high; simple face mask at 10 L/min (D) delivers too much oxygen for this situation. The principle is to use minimal supplemental oxygen in stable post-operative OSA patients while maintaining close monitoring for respiratory events. When selecting oxygen devices for alert, stable post-operative patients with OSA, choose low-flow systems that correct hypoxemia without obscuring signs of hypoventilation or airway obstruction.
10. A 45-year-old client is 2 hours post-operative after abdominal surgery in an acute care post-anesthesia care unit. History includes obstructive sleep apnea and use of continuous positive airway pressure (CPAP) at home. The client is drowsy but arousable and has shallow respirations. Vital signs: heart rate 88/min, respiratory rate 10/min, blood pressure 128/74 mm Hg, oxygen saturation 89% on room air; capnography shows rising end-tidal carbon dioxide. Which oxygen delivery device is most appropriate?
    Answer: Continuous positive airway pressure (CPAP) using the client's prescribed settings if available per facility protocol This question tests clinical judgment regarding oxygen therapy and device selection for a post-operative client with obstructive sleep apnea. Key assessment data include respiratory rate of 10/min, oxygen saturation of 89% on room air, rising end-tidal CO2, drowsiness, and shallow respirations, suggesting hypoventilation due to OSA. Continuous positive airway pressure (CPAP) using prescribed settings is most appropriate as it maintains airway patency and improves oxygenation in OSA clients post-operatively. A nonrebreather at 15 L/min provides high oxygen but does not address airway obstruction; nasal cannula at 6 L/min is inadequate for hypoventilation; and Venturi at 24% offers low FiO2 without positive pressure support. A key decision-making principle in oxygen therapy for OSA is to integrate positive airway pressure to prevent apneic events. Another principle is to adhere to home settings if available to ensure continuity of care. A transferable strategy for selecting oxygen devices is to consider underlying conditions like OSA that require combined oxygenation and ventilatory support post-operatively.
11. In home care, a 76-year-old client with chronic heart failure reports increasing fatigue and shortness of breath when walking from the bedroom to the bathroom. Vital signs: heart rate 92/min, respiratory rate 22/min, blood pressure 148/86 mm Hg, oxygen saturation 90% at rest on room air and 84% with ambulation; chest x-ray from last week shows mild pulmonary congestion; basic metabolic panel is within expected range. Which oxygen delivery device is most appropriate for this client to use during activity in the home setting?
    Answer: Portable oxygen concentrator with nasal cannula at 2 L/min as prescribed Choose the portable oxygen concentrator with nasal cannula at 2 L/min. The client has exertional desaturation to 84% but only mild pulmonary congestion and a near-normal resting saturation, so the goal is supplemental oxygen to maintain SpO₂ ≥90% during activity while allowing independent home mobility. A portable concentrator with a low-flow nasal cannula is lightweight, practical for moving from room to room, and appropriate for this degree of exertional hypoxemia. The nonrebreather mask at 15 L/min is a high-oxygen rescue device that would provide far more oxygen than needed and is unsuitable for routine ambulation. The Venturi mask set to deliver 50% oxygen is a fixed high-oxygen device, but it is cumbersome and requires careful flow settings; 50% is excessive for a client whose desaturation is corrected with low-flow oxygen. The high-flow nasal cannula at 40 L/min with heated humidification requires specialized equipment and is not intended for intermittent home ambulation; it also delivers excessive flow for this clinical picture. Therefore, the portable concentrator with nasal cannula at 2 L/min is the safest and most practical choice.
12. In an acute care pediatric emergency department, a 7-year-old child with a history of asthma has audible wheezing, nasal flaring, and intercostal retractions after exposure to smoke. Vital signs: temperature 37.0°C (98.6°F), heart rate 132/min, respiratory rate 38/min, blood pressure 104/66 mm Hg, oxygen saturation 89% on room air; peak expiratory flow is 45% of personal best. The nurse should select which device to maintain adequate oxygenation while treatments are started?
    Answer: Simple face mask at 6–10 L/min This question tests clinical judgment regarding oxygen therapy and device selection for a pediatric patient experiencing an acute asthma exacerbation. The key assessment data influencing the decision include the child's asthma history, smoke exposure trigger, significant respiratory distress (wheezing, nasal flaring, retractions), tachypnea (RR 38/min), hypoxemia (SpO2 89%), and severely reduced peak flow (45% of personal best). A simple face mask at 6-10 L/min is the best choice because it provides adequate oxygen delivery (35-60%) to correct hypoxemia while allowing concurrent nebulizer treatments, which are essential for asthma management. Nasal cannula at 1 L/min (A) is insufficient for moderate hypoxemia; nonrebreather mask (B) may interfere with nebulizer treatments and is unnecessarily high; Venturi mask at 24% (D) provides too low a concentration for this degree of hypoxemia. The principle in pediatric asthma is to provide sufficient oxygen to maintain SpO2 ≥94% while facilitating bronchodilator delivery. When selecting oxygen devices for pediatric asthma, choose systems that correct hypoxemia while allowing simultaneous administration of inhaled medications.
13. In an acute care emergency department, a 62-year-old client with COPD arrives with severe dyspnea and cyanosis. Vital signs: temperature 36.8°C (98.2°F), heart rate 124/min, respiratory rate 34/min, blood pressure 168/92 mm Hg, oxygen saturation 78% on room air; arterial blood gas: pH 7.26, PaCO2 66 mm Hg, PaO2 44 mm Hg. The nurse should select which device to maintain adequate oxygenation while preparing for further interventions?
    Answer: Nonrebreather mask at 15 L/min This question tests clinical judgment regarding oxygen therapy and device selection for a COPD patient in severe respiratory distress. The key assessment data influencing the decision include severe hypoxemia (PaO2 44 mm Hg, SpO2 78%), cyanosis, severe respiratory acidosis (pH 7.26, PaCO2 66 mm Hg), tachypnea (RR 34/min), and signs of impending respiratory failure. Despite the COPD diagnosis, a nonrebreather mask at 15 L/min is appropriate because this is a life-threatening emergency where correcting severe hypoxemia takes priority over concerns about CO2 retention. Venturi mask at 24-28% (A) would be insufficient for this degree of hypoxemia; nasal cannula at 6 L/min (B) is inadequate; simple face mask at 5 L/min (D) delivers unpredictable, insufficient oxygen. The principle in severe hypoxemia with impending respiratory failure is that oxygenation takes precedence, even in COPD patients, while preparing for likely intubation. When selecting oxygen devices for critically hypoxemic COPD patients, use high-concentration oxygen temporarily to prevent cardiac arrest while rapidly preparing for mechanical ventilation.
14. In an acute care emergency department, a 66-year-old client with COPD is receiving oxygen via nasal cannula at 2 L/min for an exacerbation. The client reports worsening shortness of breath. Vital signs: heart rate 106/min, respiratory rate 28/min, blood pressure 150/84 mm Hg, oxygen saturation 86% on 2 L/min; arterial blood gas: pH 7.33, PaCO2 54 mm Hg, PaO2 50 mm Hg. Which oxygen delivery device is most appropriate for this client?
    Answer: Venturi mask set to deliver 24%–28% oxygen This question tests clinical judgment regarding oxygen therapy and device selection for a COPD patient with worsening hypoxemia on current therapy. The key assessment data influencing the decision include COPD diagnosis, inadequate oxygenation on current therapy (SpO2 86% on 2 L/min), moderate hypoxemia (PaO2 50 mm Hg), moderate hypercapnia (PaCO2 54 mm Hg), and mild respiratory acidosis (pH 7.33). A Venturi mask set to deliver 24-28% oxygen is the best choice because it provides controlled, precise oxygen delivery to improve hypoxemia without risking excessive CO2 retention. Nasal cannula at 1 L/min (B) would worsen hypoxemia; high-flow nasal cannula at 50 L/min (C) may deliver excessive oxygen for routine COPD management; nonrebreather mask (D) is inappropriate for routine COPD exacerbation management due to uncontrolled high oxygen delivery. The principle is to use controlled oxygen delivery systems for COPD exacerbations, targeting SpO2 88-92%. When selecting oxygen devices for COPD patients requiring increased oxygen, switch from nasal cannula to Venturi mask for precise control rather than simply increasing flow rates.
15. A 72-year-old client with COPD is admitted to an acute care unit for acute exacerbation with wheezing and increased work of breathing. Vital signs: heart rate 104/min, respiratory rate 28/min, blood pressure 136/78 mm Hg, oxygen saturation 86% on room air; arterial blood gas: pH 7.34, PaCO2 55 mm Hg, PaO2 50 mm Hg. The nurse should select which device to maintain adequate oxygenation with a precise fraction of inspired oxygen?
    Answer: Venturi mask set to deliver 24%–28% oxygen This question tests clinical judgment regarding oxygen therapy and device selection for a client with COPD in acute exacerbation. Key assessment data include oxygen saturation of 86% on room air, respiratory rate of 28/min, PaCO2 of 55 mm Hg, and PaO2 of 50 mm Hg, reflecting hypoxemia with hypercapnia. The Venturi mask set to 24%–28% oxygen is the best choice as it delivers a precise, low FiO2, which is essential for COPD clients to prevent suppression of hypoxic drive. A nasal cannula at 6 L/min provides variable FiO2 and higher oxygen than needed; a nonrebreather mask at 15 L/min delivers near 100% FiO2, risking CO2 retention; and a face tent at 10 L/min offers imprecise oxygen delivery unsuitable for precise control. A key decision-making principle in oxygen therapy is to select devices that allow accurate FiO2 control in clients at risk for hypercapnic respiratory failure. Another principle is to reassess arterial blood gases and clinical status frequently to guide adjustments. A transferable strategy for selecting oxygen devices is to consider the need for precision in FiO2 delivery, especially in conditions where high oxygen concentrations may be detrimental.
16. A 4-year-old child with asthma is in an acute care emergency department and is crying, tachypneic, and wheezing. Vital signs: heart rate 150/min, respiratory rate 44/min, blood pressure 96/58 mm Hg, oxygen saturation 86% on room air; the child is unable to tolerate a mask on the face. Which oxygen delivery method is most appropriate?
    Answer: Blow-by oxygen held near the child's face while calming the child and preparing additional therapy This question tests clinical judgment regarding oxygen therapy and device selection for a distressed pediatric client intolerant of standard devices. Key assessment data include oxygen saturation of 86% on room air, respiratory rate of 44/min, crying, tachypnea, wheezing, and inability to tolerate a mask. Blow-by oxygen held near the face is most appropriate as it delivers oxygen non-invasively while calming the child and preparing for therapy. Nonrebreather at 15 L/min tightly secured could increase distress; Venturi at 28% requires a mask; tracheostomy collar is irrelevant without tracheostomy. A key decision-making principle in oxygen therapy for pediatrics is to prioritize tolerance and minimize agitation during delivery. Another principle is to use alternative methods like blow-by for young children refusing masks. A transferable strategy for selecting oxygen devices is to adapt delivery methods to the client's age, behavior, and comfort to ensure effective oxygenation without added stress.
17. In an acute care post-anesthesia care unit, a 54-year-old client with obesity and diagnosed obstructive sleep apnea is 1 hour post-op after laparoscopic cholecystectomy and is very drowsy. Vital signs: heart rate 96/min, respiratory rate 10/min, blood pressure 138/82 mm Hg, oxygen saturation 88% on room air; lungs are clear; capnography shows hypoventilation; pain medication was recently given. What is the best initial action regarding oxygen therapy?
    Answer: Apply nasal cannula at 2 L/min and reassess oxygen saturation This question tests clinical judgment regarding oxygen therapy and device selection for a post-operative patient with obstructive sleep apnea experiencing hypoventilation. The key assessment data influencing the decision include the client's OSA diagnosis, post-anesthesia state, hypoventilation (RR 10/min with capnography confirmation), mild hypoxemia (SpO2 88%), recent pain medication administration, and drowsiness. Starting with nasal cannula at 2 L/min is the best initial action because it provides supplemental oxygen while allowing close monitoring for respiratory depression without masking hypoventilation. A nonrebreather mask at 15 L/min (B) could mask worsening hypoventilation and is excessive; Venturi mask at 50% (C) is too aggressive and could suppress respiratory drive; starting home CPAP (D) without assessment is inappropriate in the acute post-op setting. The principle is to use the lowest effective oxygen concentration while monitoring for opioid-induced respiratory depression in OSA patients. When selecting oxygen devices for post-operative OSA patients, start conservatively with low-flow oxygen while maintaining vigilant respiratory monitoring and considering the need for positive pressure support.
18. A 54-year-old client with sleep apnea is 3 hours post-operative in an acute care unit and is receiving oxygen via simple face mask at 8 L/min. The client is awake, oriented, and reports the mask feels claustrophobic. Vital signs: heart rate 78/min, respiratory rate 14/min, blood pressure 122/72 mm Hg, oxygen saturation 95% on the mask. Which oxygen delivery device is most appropriate at this time?
    Answer: Nasal cannula at 1–2 L/min with continued monitoring This question tests clinical judgment regarding oxygen therapy and device selection for a post-operative client with sleep apnea improving from initial support. Key assessment data include oxygen saturation of 95% on simple face mask at 8 L/min, awake and oriented, but reporting claustrophobia from the mask. Nasal cannula at 1–2 L/min with monitoring is most appropriate to step down therapy while maintaining comfort and adequate oxygenation. Nonrebreather at 15 L/min is excessive; Venturi at 50% unnecessary; high-flow at 60 L/min overkill for stable status. A key decision-making principle in oxygen therapy is to de-escalate when stable to improve tolerance. Another principle is to balance efficacy with client comfort post-operatively. A transferable strategy for selecting oxygen devices is to transition to less invasive options like nasal cannula when saturation stabilizes in recovering clients.
19. A 66-year-old client with COPD is in an acute care medical-surgical unit for acute exacerbation. The client is anxious and dyspneic. Vital signs: heart rate 118/min, respiratory rate 34/min, blood pressure 158/90 mm Hg, oxygen saturation 85% on 2 L/min nasal cannula; arterial blood gas: pH 7.29, PaCO2 68 mm Hg, PaO2 49 mm Hg. Which finding indicates the need to adjust oxygen delivery?
    Answer: Oxygen saturation remains below the ordered target range despite current therapy This question tests clinical judgment regarding oxygen therapy and device selection by identifying when adjustment is needed in a COPD client. Key assessment data include oxygen saturation of 85% on 2 L/min nasal cannula, respiratory rate of 34/min, PaCO2 of 68 mm Hg, PaO2 of 49 mm Hg, anxiety, and dyspnea, highlighting inadequate oxygenation. The finding that oxygen saturation remains below the ordered target range despite current therapy indicates the need to adjust, as it suggests persistent hypoxemia requiring intervention. A heart rate decrease to 96/min is a positive response; dry nasal passages are a common side effect not requiring immediate change; and stable temperature without fever does not relate to oxygen adjustment. A key decision-making principle in oxygen therapy is to monitor saturation and clinical signs continuously to ensure efficacy. Another principle is to escalate therapy if targets are not met while avoiding over-oxygenation in COPD. A transferable strategy for selecting oxygen devices is to use objective data like saturation and blood gases to guide timely modifications in delivery.
20. In an acute care emergency department, a 68-year-old client with chronic obstructive pulmonary disease (COPD) reports increased dyspnea and productive cough for 2 days; the client is using accessory muscles and is speaking in short phrases. Vital signs: temperature 37.2°C (99.0°F), heart rate 112/min, respiratory rate 30/min, blood pressure 156/88 mm Hg, oxygen saturation 84% on room air; arterial blood gas: pH 7.31, PaCO2 58 mm Hg, PaO2 52 mm Hg. Which oxygen delivery device is most appropriate for this client?
    Answer: Venturi mask set to deliver 24%–28% oxygen This question tests clinical judgment regarding oxygen therapy and device selection for a client with COPD experiencing an acute exacerbation. The key assessment data influencing the decision include the client's COPD diagnosis, severe hypoxemia (PaO2 52 mm Hg, SpO2 84%), hypercapnia (PaCO2 58 mm Hg), respiratory acidosis (pH 7.31), and signs of respiratory distress (accessory muscle use, speaking in short phrases). The Venturi mask at 24%-28% oxygen is the best choice because it provides controlled, precise oxygen delivery that corrects hypoxemia without suppressing the hypoxic drive in COPD patients, which could worsen CO2 retention. A nonrebreather mask (A) delivers too high a concentration that could suppress respiratory drive; nasal cannula at 1-2 L/min (B) is insufficient for severe hypoxemia; and a simple face mask at 10 L/min (C) delivers unpredictable high concentrations. The principle for COPD exacerbations is to use controlled oxygen therapy targeting SpO2 88-92% to avoid CO2 narcosis. When selecting oxygen devices for COPD patients, prioritize precise, controlled delivery systems like Venturi masks over high-flow, uncontrolled devices.

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