# A nurse is caring for a 65-year-old patient with COVID-19 who is receiving oxygen therapy via nasal cannula at 4 L/min. The patient's oxygen saturation has dropped from 94% to 88% over the past hour, and they are experiencing increased dyspnea and restlessness. What is the nurse's priority action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541296  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a 65-year-old patient with COVID-19 who is receiving oxygen therapy via nasal cannula at 4 L/min. The patient's oxygen saturation has dropped from 94% to 88% over the past hour, and they are experiencing increased dyspnea and restlessness. What is the nurse's priority action?

## 보기

1. Increase the oxygen flow rate to 6 L/min via nasal cannula
2. Position the patient in high Fowler's position and encourage deep breathing exercises
3. Administer a bronchodilator as ordered and monitor response
4. Notify the healthcare provider immediately and prepare for possible intubation **✔ 정답**

**정답: 4**

## 해설

Immediate notification of the healthcare provider is critical as rapid oxygen desaturation with dyspnea and restlessness in COVID-19 indicates impending respiratory failure requiring advanced airway management. Other interventions are secondary without addressing the emergent need for medical evaluation.

## 심화 해설

Clinical Reasoning and Priority Setting

The patient's clinical picture demonstrates a rapid and significant decline in respiratory status. The drop in oxygen saturation from 94% to 88% on a fixed oxygen delivery device, accompanied by increased dyspnea and restlessness, signals a state of progressive hypoxemic respiratory failure. Restlessness, in this context, is a critical sign of cerebral hypoxia and should not be mistaken for simple anxiety. This deterioration indicates that the current oxygen therapy is failing to meet the patient's physiological demands.

Analysis of the Incorrect Options

While the other options contain elements of care, they are not the priority given the acuity of the situation. Increasing the nasal cannula flow rate to 6 L/min (Option 1) provides only a marginal increase in FiO2 and is unlikely to correct the profound ventilation-perfusion mismatch occurring in a patient with COVID-19 pneumonitis. Positioning and deep breathing exercises (Option 2) are supportive measures but are insufficient as a sole intervention for a patient in acute decompensation. Administering a bronchodilator (Option 3) may be appropriate if bronchoconstriction is a component, but it does not address the immediate threat of severe hypoxemia and potential respiratory arrest, and its effect is not instantaneous.

Rationale for the Priority Action

The priority is to escalate care by notifying the healthcare provider immediately to prepare for advanced airway management and mechanical ventilation. This aligns directly with the evidence on managing peri-intubation hypoxemia. The clinical trajectory here mirrors the high-risk interval described in the literature where oxygenation failure reflects a mismatch between the current oxygen delivery strategy and the patient's underlying physiology . The patient's worsening hypoxemia despite supplemental oxygen suggests that standard approaches are failing, a scenario where a phenotype-based strategy for preoxygenation and preparation for emergent intubation is critical to prevent further deterioration, cardiac arrest, or death . The evidence synthesis on perioperative hypoxemia management similarly supports a systematic, evidence-based escalation that begins with recognizing failure of the current therapy and mobilizing the team and resources necessary for the next level of respiratory support . Delaying this notification while attempting less definitive interventions risks a peri-intubation emergency with worse outcomes.

## 임상 시나리오

Recognizing Impending Respiratory FailureWhen to Escalate Care Beyond Oxygen Therapy
A drop in SpO2 below 90% on a fixed oxygen device, especially with new-onset restlessness, signals cerebral hypoxia and failing respiratory compensation. This is a medical emergency.

For patients with COVID-19 pneumonitis, a rapid decline often reflects a severe ventilation-perfusion mismatch that low-flow oxygen cannot correct. The priority is immediate provider notification to prepare for advanced airway management and possible intubation.

CautionDo not mistake hypoxic restlessness for anxiety. Increasing the nasal cannula flow rate from 4 L/min to 6 L/min provides a marginal FiO2 increase and delays definitive treatment. Positioning and breathing exercises are supportive only and do not replace escalation.

## 핵심 개념

- **Hypoxemic Respiratory Failure** — A condition where the lungs fail to adequately oxygenate the blood, indicated by a drop in SpO2 and often requiring advanced ventilatory support.
- **Cerebral Hypoxia** — Insufficient oxygen supply to the brain, often manifesting as restlessness, confusion, or altered mental status, and signaling a critical decline.
- **FiO2** — Fraction of inspired oxygen; the concentration of oxygen a patient inhales. A nasal cannula at 4 L/min delivers approximately 36% FiO2.
- **Ventilation-Perfusion Mismatch** — An imbalance between the amount of air reaching the alveoli and the blood flow in the pulmonary capillaries, a key feature of COVID-19 pneumonitis.
- **Priority Action** — The most critical nursing intervention based on the ABC (Airway, Breathing, Circulation) framework and patient safety, often involving escalation of care.

## 같은 주제 문제

- [A nurse is assessing a 65-year-old patient admitted with suspected COVID-19. Which assessm…](https://mymerci.kr/pages/nclex_q.php?qn_id=541290)
- [A nurse is assessing a 72-year-old patient with chronic obstructive pulmonary disease (COP…](https://mymerci.kr/pages/nclex_q.php?qn_id=541291)
- [A nurse is caring for a patient with severe community-acquired pneumonia who is receiving …](https://mymerci.kr/pages/nclex_q.php?qn_id=541292)
- [A nurse is caring for a patient with COVID-19 who is experiencing moderate respiratory dis…](https://mymerci.kr/pages/nclex_q.php?qn_id=541293)
- [A nurse is caring for a 58-year-old patient diagnosed with COPD exacerbation who is experi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541294)
- [A nurse is caring for a patient with COVID-19 in the intensive care unit. Which nursing ac…](https://mymerci.kr/pages/nclex_q.php?qn_id=541295)
- [A nurse is caring for a patient with COVID-19 who is experiencing severe respiratory distr…](https://mymerci.kr/pages/nclex_q.php?qn_id=541297)
- [A nurse is caring for a patient with COVID-19 in the intensive care unit. Which action by …](https://mymerci.kr/pages/nclex_q.php?qn_id=541298)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._