A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via nasal cannula. After assessing the patient, the nurse notes increased drowsiness and a decreased respiratory rate. What is the most appropriate action for the nurse to take?

Increase the oxygen flow rate to 4 L/min to improve oxygenation.

Switch the patient to a non-rebreather mask for better oxygenation.

Continue to monitor the patient closely and reassess in 30 minutes.

Reduce the oxygen flow rate to 1 L/min and notify the healthcare provider.

Answer and Explanation

The Correct Answer is D

A.   Increasing the oxygen flow rate could worsen respiratory depression in patients with COPD, as they rely on low oxygen levels to stimulate breathing.
B.   Switching to a non-rebreather mask could further elevate the oxygen levels and may lead to hypoventilation or respiratory distress.
C.   Monitoring the patient closely and reassessing in 30 minutes might be appropriate if the patient shows no immediate signs of respiratory distress, but the priority is to address the decreased respiratory rate.
D.   Reducing the oxygen flow rate to 1 L/min and notifying the healthcare provider is the most appropriate action, as it may reduce the risk of respiratory depression caused by excessive oxygen.

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Correct Answer is D

Explanation

A. Flushing the NG tube with 60 mL of water before feeding is not sufficient to reduce aspiration risk.
B. Administering the feeding with the patient lying flat increases the risk of aspiration and should be avoided.
C. Increasing the feeding rate could cause discomfort and increase the risk of aspiration if the stomach becomes overdistended.
D. Positioning the patient in a semi-Fowler's position (head of the bed elevated 30 to 45 degrees) reduces the risk of aspiration during and after feeding.

A. "It is important to follow up with a GI specialist for recommended surveillance for Barrett's esophagus". B. "It is important to watch for manifestations of pancreatic cancer." C. "Follow-up with an endocrinologist as your risks for diabetes increases." D. "You will need to monitor for manifestations of liver issues."

Correct Answer is A

Explanation

A. Barrett's esophagus is a complication of GERD and is associated with an increased risk of esophageal cancer. It is essential for the patient to follow up with a GI specialist for surveillance.
B. Pancreatic cancer is not directly related to GERD, so the nurse should not suggest watching for symptoms of this condition.
C. Diabetes risk is not directly increased by GERD. Therefore, follow-up with an endocrinologist is unnecessary unless the patient has other risk factors for diabetes.
D. Liver issues are not typically associated with GERD, so monitoring for liver problems would not be a primary concern in this case.

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A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via nasal cannula. After assessing the patient, the nurse notes increased drowsiness and a decreased respiratory rate. What is the most appropriate action for the nurse to take?

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