# A client with chronic obstructive pulmonary disease is sitting upright, using accessory muscles, and has an oxygen saturation of 86%. What should the nurse do first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396589&lang=en  
> language: en  
> subject: Hemodynamics  
> category: PA

## Question

A client with chronic obstructive pulmonary disease is sitting upright, using accessory muscles, and has an oxygen saturation of 86%. What should the nurse do first?

## Option

1. Ask the client to lie flat to reduce fatigue.
2. Apply prescribed oxygen and assess breath sounds and respiratory effort. **✔ Correct answer**
3. Withhold oxygen because clients with COPD should never receive it.
4. Offer a large meal to improve energy for breathing.

**Correct answer: 2**

## Explanation

The client is showing respiratory distress and hypoxemia, so oxygen should be applied as prescribed while the nurse continues respiratory assessment. Oxygen is not withheld from a hypoxemic client. Supine positioning and large meals can worsen breathing.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits COPD exacerbation.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For COPD exacerbation, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **COPD** — A chronic lung disease that limits airflow and can cause dyspnea.
- **Accessory Muscles** — Neck and chest muscles used when breathing requires extra effort.
- **Hypoxemia** — Low oxygen level in the blood.

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