# A nurse is caring for a 72-year-old patient with chronic obstructive pulmonary disease (COPD) who was admitted with acute exacerbation. The patient presents with increased dyspnea, productive cough with thick yellow sputum, and oxygen saturation of 88% on room air. The patient is receiving oxygen therapy at 2 L/min via nasal cannula and has been started on corticosteroids and bronchodilators. Which nursing action should be the highest priority for this patient?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543627  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is caring for a 72-year-old patient with chronic obstructive pulmonary disease (COPD) who was admitted with acute exacerbation. The patient presents with increased dyspnea, productive cough with thick yellow sputum, and oxygen saturation of 88% on room air. The patient is receiving oxygen therapy at 2 L/min via nasal cannula and has been started on corticosteroids and bronchodilators. Which nursing action should be the highest priority for this patient?

The patient presents with increased dyspnea, productive cough with thick yellow sputum, and oxygen saturation of 88% on room air.

## 보기

1. Administer the prescribed albuterol nebulizer treatment immediately
2. Increase oxygen flow rate to 4 L/min to improve saturation
3. Encourage deep breathing and coughing exercises every 2 hours
4. Monitor respiratory status and blood gas levels closely **✔ 정답**

**정답: 4**

## 해설

Monitoring respiratory status and ABG levels is the priority to guide safe interventions in COPD patients, as they are at risk for CO2 retention and altered respiratory drive. Other actions like bronchodilator administration or oxygen adjustment require assessment data first.

## 심화 해설

Clinical Context & Priority Setting Framework

This scenario describes a 72-year-old patient with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The patient exhibits hallmark signs: increased dyspnea, a productive cough with purulent sputum, and significant hypoxemia evidenced by an oxygen saturation of 88% on room air. While the patient is already receiving low-flow oxygen, corticosteroids, and bronchodilators, the question asks for the highest priority nursing action. In NCLEX-RN prioritization, the nursing process dictates that assessment always comes before implementation, provided the patient is not in a life-threatening crisis requiring immediate intervention. Here, the patient’s condition is unstable but being managed; therefore, the crucial next step is a thorough, ongoing assessment to evaluate the effectiveness of current therapies and detect any deterioration.

Rationale for the Correct Answer (Option 4)

The correct action is to monitor respiratory status and blood gas levels closely. An AECOPD is defined as a sustained worsening of the patient's respiratory symptoms that goes beyond normal day-to-day variations and necessitates a change in management [2]. The patient’s baseline in COPD involves some degree of chronic symptom fluctuation, but an exacerbation represents a distinct, acute decline [2]. Because the trajectory of an exacerbation can be unpredictable and is a major driver of poor outcomes, including hospitalization and mortality, the nurse’s primary responsibility is vigilant surveillance [1].

Monitoring provides the data needed to determine if the current interventions (oxygen at 2 L/min, steroids, bronchodilators) are reversing the hypoxemia and reducing the work of breathing. A key concern during an AECOPD is the potential for comorbid cardiac decompensation, which is often undiagnosed and carries a high risk of acute cardiac events [3]. By closely tracking respiratory status—including rate, depth, breath sounds, accessory muscle use, and continuous pulse oximetry—alongside arterial blood gas (ABG) results, the nurse can identify early signs of clinical deterioration, such as rising CO2 levels or impending respiratory failure. This assessment data is essential for the healthcare team to make timely, informed decisions about escalating or altering therapy.

Why the Other Options Are Lower Priority

- Option 1: Administering a prescribed albuterol nebulizer treatment is an implementation task. While it is an important part of the treatment plan, it should not take priority over a focused assessment. The nurse must first evaluate the patient’s current respiratory status and breath sounds to have a baseline for determining the treatment’s effectiveness. Performing an intervention before a complete assessment is a violation of the nursing process.

- Option 2: Increasing the oxygen flow rate to 4 L/min without a specific order is outside the nurse’s scope of practice and can be dangerous in a COPD patient. The patient’s respiratory drive may be dependent on a hypoxic stimulus, and uncontrolled oxygen administration can lead to oxygen-induced hypercapnia and respiratory depression. Any change in oxygen delivery requires a provider’s order based on a clinical assessment, which again underscores the priority of monitoring.

- Option 3: Encouraging deep breathing and coughing exercises is a beneficial intervention for airway clearance, especially given the thick sputum. However, this is a lower-priority, non-acute intervention. In a patient with acute dyspnea and significant hypoxemia, the immediate focus must be on assessing the severity of the exacerbation and the response to pharmacological and oxygen therapy, not on coaching exercises that may increase fatigue and oxygen consumption in the acute phase.References (research sources)

- [1]Determinants of delayed care-seeking during acute exacerbations of chronic obstructive pulmonary disease: protocol for a systematic review and meta-analysis.Meta-analysis/systematic reviewFang L, Zhu X, Li N, Gu Y. (2026) · DOI: 10.1136/bmjopen-2025-115416

- [2]Differentiating the start of an exacerbation from day-to-day variation in people with COPD: a systematic review.Meta-analysis/systematic reviewSyam S, Aboelhassan A, Althobiani MA, Uysal ÖF, Sulaiman N, Shah AJ, Mandal S, Mani AR, Porter JC, Hurst JR. (2026) · DOI: 10.1183/16000617.0212-2025

- [3]Relationship between quantitative CT and cardiac function in patients with severe COPD exacerbations (ECOPD).Research articleMussell GT, Kibbler J, Bennett M, Wilkinson T, Ripley D, Bourke SC, Steer J. (2026) · DOI: 10.1136/bmjresp-2025-003815

## 임상 시나리오

AECOPD Nursing PriorityAssessment Before Intervention
In acute exacerbation of COPD, the patient's trajectory can change rapidly. The nursing process mandates that assessment is the highest priority unless the patient is in a life-threatening crisis. For a patient already on oxygen and bronchodilators, the nurse must first evaluate the effectiveness of current therapies.

Closely monitor respiratory status, including rate, depth, effort, and breath sounds. Obtain arterial blood gases (ABGs) to objectively evaluate oxygenation (PaO2), ventilation (PaCO2), and acid-base balance. An SpO2 of 88% corresponds to a PaO2 of approximately 55 mmHg, indicating significant hypoxemia.

CautionDo not increase oxygen flow rate without ABG assessment. In CO2 retainers, over-oxygenation can suppress the hypoxic drive, leading to hypoventilation, rising PaCO2, and acute respiratory failure. Titrate O2 to a target SpO2 of 88-92%.

## 핵심 개념

- **AECOPD** — Acute Exacerbation of Chronic Obstructive Pulmonary Disease; a sustained worsening of respiratory symptoms beyond normal day-to-day variations, requiring a change in management.
- **Hypoxic Drive** — In some COPD patients, the primary stimulus to breathe shifts from high CO2 to low O2; administering high-flow oxygen can depress this drive, leading to hypoventilation.
- **Nursing Process (Assessment)** — The first step of the nursing process; collecting and analyzing patient data to identify problems and plan care. It takes priority over implementation unless a life-threatening emergency exists.

## 같은 주제 문제

- [A 68-year-old patient with chronic obstructive pulmonary disease (COPD) is admitted to the…](https://mymerci.kr/pages/nclex_q.php?qn_id=543619)
- [A 55-year-old patient with chronic heart failure is admitted to the medical unit with acut…](https://mymerci.kr/pages/nclex_q.php?qn_id=543620)
- [A nurse is caring for a 68-year-old patient with chronic heart failure who was admitted wi…](https://mymerci.kr/pages/nclex_q.php?qn_id=543621)
- [A nurse is caring for a 68-year-old patient with chronic heart failure who has been admitt…](https://mymerci.kr/pages/nclex_q.php?qn_id=543622)
- [A 72-year-old patient with a history of ischemic cardiomyopathy is admitted to the medical…](https://mymerci.kr/pages/nclex_q.php?qn_id=543623)
- [A 58-year-old patient with chronic obstructive pulmonary disease (COPD) is admitted with a…](https://mymerci.kr/pages/nclex_q.php?qn_id=543624)
- [A nurse is caring for a 68-year-old patient with acute exacerbation of chronic obstructive…](https://mymerci.kr/pages/nclex_q.php?qn_id=543625)
- [A 55-year-old patient with chronic heart failure is admitted to the medical unit with acut…](https://mymerci.kr/pages/nclex_q.php?qn_id=543626)

---

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

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