A client with chronic obstructive pulmonary disease (COPD) is admitted with acute exacerbation and respiratory distress. Which finding requires immediate intervention by the nurse?

Choice A reason: Starting an IV infusion of lactated Ringer’s supports fluid status and may be needed for anticoagulation administration in pulmonary embolism. However, it does not address the immediate hypoxemia caused by the embolism’s ventilation-perfusion mismatch. Oxygen therapy is the priority to correct low oxygen levels and prevent tissue hypoxia.

Choice B reason: Morphine IV may relieve pain and anxiety in pulmonary embolism, reducing oxygen demand. However, it does not directly address hypoxemia, the primary life-threatening issue. The ABCDE approach prioritizes breathing, making oxygen therapy the first intervention to stabilize the patient before pain management is considered.

Choice C reason: Pulmonary embolism causes a ventilation-perfusion mismatch, reducing oxygen delivery to the blood, leading to hypoxemia. Administering oxygen therapy immediately increases alveolar oxygen, improving arterial PaO2 and preventing tissue hypoxia. In the ABCDE approach, breathing is prioritized, making oxygen therapy the first intervention to stabilize the client.

Choice D reason: Cardiac monitoring assesses for arrhythmias or right heart strain in pulmonary embolism, which is important for ongoing management. However, it does not correct the immediate threat of hypoxemia. Oxygen therapy addresses the critical reduction in oxygen saturation, taking precedence in the ABCDE approach over monitoring in acute management.

Choice A reason: Esophageal intubation results in no chest wall expansion bilaterally, as air enters the stomach, not the lungs. The client’s unilateral absence of left-sided expansion suggests air is entering the right lung, indicating the tube is in the trachea but malpositioned, not in the esophagus, which would affect both sides.

Choice B reason: Vocal cord infection, or laryngitis, may cause hoarseness or airway swelling but does not cause unilateral chest wall expansion failure. This finding indicates a mechanical issue with ventilation distribution, such as tube malposition. Infection affects mucosal function, not lung expansion, making this an unlikely cause of the observed symptom.

Choice C reason: Movement of the endotracheal tube into the right main bronchus causes right-sided ventilation and left-sided collapse, resulting in absent left chest wall expansion. This malposition, common due to the right bronchus’s straighter anatomy, leads to unilateral ventilation, matching the client’s presentation and requiring urgent repositioning to restore bilateral lung function.

Choice D reason: Tongue blockage of the endotracheal tube is unlikely, as the tube is placed beyond the oral cavity. Even if obstructed, it would affect both lungs, not just the left. The unilateral absence of expansion points to tube malposition in the right bronchus, selectively ventilating one lung, not a tongue-related obstruction.