A patient with COPD exacerbation has a PaO2 of 58 mmHg on room air. What is the initial nursing intervention?

• A. Start diuretics
• B. Place on nonrebreather mask
• C. Encourage deep breathing without oxygen
• D. Administer supplemental oxygen per protocol and reassess oxygenation

Answer: (D)

The key idea is to correct the low oxygen level right away. A PaO2 of 58 mmHg on room air means the patient is hypoxemic and needs immediate oxygen support. Start supplemental oxygen and follow the unit’s protocol for target oxygenation, which for COPD typically aims to keep SpO2 around 88–92%. After giving oxygen, reassess the patient’s oxygenation and clinical status and adjust the flow or delivery device to achieve the target.

Diuretics don’t address the immediate problem of hypoxemia. Encouraging deep breathing without oxygen won’t fix the low oxygen level either. A nonrebreather mask could provide a higher FiO2, but the correct first step is to initiate oxygen therapy per protocol and then reassess.