A 64-Year-Old Hospitalized Client with Chronic Obstructive Pulmonary Disease Exacerbation

A 64-year-old hospitalized client with chronic obstructive pulmonary disease exacerbation has increased lethargy and confusion.  The client's pulse oximetry is 88% on 2 liters of oxygen.  Arterial blood gas analysis shows a pH of 7.25, PO₂ of 60 mm Hg (8.0 kPa) , and PCO₂ of 80 mm Hg (10.6 kPa) .  Which of the following should the nurse implement first?

A) Administer PRN nebulizer treatment
B) Administer scheduled dose of methylprednisolone IV
C) Increase client's oxygen to 4 liters
D) Place client on the bilevel positive airway pressure (BIPAP) machine

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