# A client with an acute COPD exacerbation has worsening dyspnea and hypercapnic respiratory failure. For each finding or intervention, select the best classification. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395642&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A client with an acute COPD exacerbation has worsening dyspnea and hypercapnic respiratory failure. For each finding or intervention, select the best classification. | | Deterioration cue | Appropriate treatment or reassessment | Unsafe or delays escalation | | --- | --- | --- | --- | | Increasing somnolence with pH 7.28 and PaCO2 68 mm Hg | | | | | Titrate prescribed oxygen to the target range, commonly 88% to 92%, and repeat the arterial blood gas | | | | | Administer prescribed bronchodilator and systemic therapy and reassess work of breathing | | | | | Initiate prescribed bilevel NIV for persistent acidotic hypercapnic failure and monitor the early response | | | | | Withhold all oxygen because the client has COPD despite a saturation of 84% | | | | | Continue ineffective NIV without escalating when consciousness and gas exchange worsen | | | | ## Explanation Increasing somnolence with pH 7.28 and PaCO2 68 mm Hg indicates acute acidotic hypercapnic respiratory failure. Give controlled oxygen rather than withholding it, target the prescribed range commonly 88% to 92%, repeat blood gases, treat the exacerbation, and initiate prescribed bilevel NIV when failure persists and no immediate contraindication exists. Escalate promptly if NIV fails or airway protection deteriorates. ## In-depth explanation Quick answer Recognize worsening hypercapnic respiratory failure, titrate oxygen rather than withholding it, repeat the blood gas, treat the exacerbation, and start prescribed bilevel noninvasive ventilation with a clear escalation plan. Why this is correct Somnolence, respiratory distress, pH 7.28, and PaCO2 68 mm Hg indicate acidotic ventilatory failure. Controlled oxygen addresses dangerous hypoxemia, while bilevel NIV improves ventilation and reduces the work of breathing when acidosis persists despite initial therapy. Easy analogy or mental picture Oxygen fills the tank, but ventilation clears the exhaust. A client can need both controlled oxygen and pressure support. Memory hook Low oxygen: titrate. High CO2 plus low pH: ventilate and reassess. NCLEX decision rule Never withhold needed oxygen solely because the client has COPD. Use a controlled target, reassess saturation and arterial blood gases, provide prescribed bronchodilator and systemic therapy, and use NIV for persistent acidotic hypercapnic failure. Deteriorating consciousness or failure to improve requires urgent airway escalation. Why the other choices are wrong Withholding oxygen leaves severe hypoxemia untreated. Uncontrolled high-concentration oxygen without reassessment can worsen hypercapnia in susceptible clients, and delaying escalation despite acidosis and somnolence risks respiratory arrest. Source 1GOLD 2026 Report and Pocket Guide 2Official ERS/ATS NIV Clinical Practice Guideline 32026 NCLEX-RN Test Plan ## Clinical scenario The client arrives with an oxygen saturation of 84% on room air and a respiratory rate of 32/min. After controlled oxygen and initial prescribed therapy, the client becomes increasingly somnolent; arterial blood gas results are pH 7.28 and PaCO2 68 mm Hg. Emergency airway support and noninvasive ventilation are available. ## Key concepts - **Hypercapnic respiratory failure** — Ventilatory failure in which carbon dioxide accumulates, often producing respiratory acidosis and altered mental status. - **Bilevel noninvasive ventilation** — Mask-delivered positive pressure using different inspiratory and expiratory pressures to support ventilation without an endotracheal tube. - **Controlled oxygen therapy** — Oxygen titrated to an individualized saturation target with reassessment of oxygenation, carbon dioxide, and acid-base status. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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