A patient with COPD has a PaCO2 of 52 mm Hg and PaO2 of 60 mm Hg. What is the nurse's priority?

Correct Answer: C

Rationale: The correct answer is C: Provide low-flow oxygen therapy. In COPD, hypoxemia (low PaO2) is the primary concern. Administering oxygen can help improve oxygenation and prevent further complications. Bronchodilators (choice A) may be indicated for symptom relief but not the priority. Pursed-lip breathing (choice B) can help with exhalation and symptom management but does not address the immediate hypoxemia. Assessing the patient's level of consciousness (choice D) is important but providing oxygen to improve oxygenation takes precedence in this case.

Correct Answer: A

Rationale: The correct answer is A: Administer supplemental oxygen. This is the priority intervention for a patient with a suspected pulmonary embolism because it helps improve oxygenation and prevents further hypoxia. Oxygen therapy is crucial in stabilizing the patient's condition and should be initiated promptly. Summary of other choices: B: Notifying the healthcare provider is important, but administering oxygen takes precedence due to the immediate need for oxygenation. C: While a CT scan is important for confirming the diagnosis, providing oxygen is more urgent to address the patient's hypoxia. D: Starting anticoagulant therapy is a critical treatment for pulmonary embolism, but ensuring oxygenation is the immediate priority to stabilize the patient's condition.

Correct Answer: B

Rationale: The correct answer is B: Kussmaul respirations. The ABG results indicate metabolic acidosis (low pH, low HCO3-), causing respiratory compensation to lower PaCO2. Kussmaul respirations are deep, rapid breaths to blow off CO2 and normalize pH. Intercostal retractions (A) are seen in respiratory distress, not metabolic acidosis. Low SpO2 (C) is not directly related to the ABG results. Decreased venous O2 pressure (D) is not a typical finding in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Administer insulin therapy. When a patient is at risk for hypoglycemia, administering insulin can further decrease blood sugar levels, exacerbating the condition. Therefore, the nurse should not administer insulin, glucose, or a snack, as these interventions can worsen hypoglycemia. Administering insulin therapy would be counterproductive and potentially harmful in this situation, making it the correct choice.

Correct Answer: D

Rationale: The correct answer is D: Monitor the ventilator settings. This is the priority action because monitoring the ventilator settings ensures that the patient is receiving the appropriate oxygenation and ventilation support. By continuously monitoring the settings, the nurse can detect any changes or malfunctions promptly, preventing potential complications. Explanation of other choices: A: Checking the ventilator settings is important, but monitoring them continuously is more crucial. B: Performing a chest x-ray may provide additional information but is not the priority when assessing a patient on mechanical ventilation. C: Increasing fluid intake is not directly related to the immediate care of a patient on mechanical ventilation and is not the priority action.