A 68-year-old client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. The client is restless, dyspneic, and arterial blood gases show pH 7.28, PaCO2 70 mmHg, PaO2 55 mmHg, HCO3 30 mEq/L. Which intervention should the nurse prioritize?

Question: A 68-year-old client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. The client is restless, dyspneic, and arterial blood gases show pH 7.28, PaCO2 70 mmHg, PaO2 55 mmHg, HCO3 30 mEq/L. Which intervention should the nurse prioritize?

Answer options:

• Administer oxygen at 2 L/min via nasal cannula. ✅ Prepare for non-invasive positive pressure ventilation (NIPPV).
• Administer a bronchodilator by nebulizer.
• Encourage cough and deep breathing exercises.

Correct answer: Prepare for non-invasive positive pressure ventilation (NIPPV).

Explanation: The client's ABGs indicate acute respiratory acidosis with hypoxemia (low pH, very high PaCO2, low PaO2). Oxygen at 2 L/min might not be sufficient, and aggressive measures are needed. NIPPV can help decrease the work of breathing, improve alveolar ventilation, reduce PaCO2, and improve oxygenation, making it a priority intervention in an acute COPD exacerbation with significant respiratory failure.