ESTUDYR
NCLEX-RN Case Study: COPD & Acute
Respiratory Failure
Client Scenario
1000 Nurses' Notes: A 68-year-old male with a 40-pack-year history of smoking and a
diagnosis of Stage IV COPD is admitted to the emergency department. He reports a
"smoker's cough" that has become more productive with thick, yellow-green sputum over
the last 3 days. He is using his rescue inhaler every 2 hours without significant relief.
Physical Assessment:
Respiratory: Using accessory muscles; leaning forward in a tripod position. Chest is
barrel-shaped. Breath sounds are diminished with expiratory wheezing and coarse
crackles in the bases.
Vital Signs: BP 142/88, HR 112, RR 30 (shallow), Temp 100.9°F, SpO2 82% on Room
Air.
Neuro: Appears restless and anxious; follows commands but is slow to respond.
Item 1: Recognizing Cues
Question: Click to highlight the findings that indicate the client is at risk for imminent
respiratory collapse.
Findings: 68-year-old male; Using accessory muscles; Tripod position; RR 30 (shallow);
SpO2 82%; Restless and anxious; Slow to respond.
Rationale: Accessory muscle use and tripod positioning are signs of "work of breathing"
being at its limit. Restlessness and a slowed mental response are the first signs of hypoxia
and CO2 narcosis (hypercapnia) affecting the brain.
Item 2: Analyzing Cues
NCLEX-RN Case Study: COPD & Acute
Respiratory Failure
Client Scenario
1000 Nurses' Notes: A 68-year-old male with a 40-pack-year history of smoking and a
diagnosis of Stage IV COPD is admitted to the emergency department. He reports a
"smoker's cough" that has become more productive with thick, yellow-green sputum over
the last 3 days. He is using his rescue inhaler every 2 hours without significant relief.
Physical Assessment:
Respiratory: Using accessory muscles; leaning forward in a tripod position. Chest is
barrel-shaped. Breath sounds are diminished with expiratory wheezing and coarse
crackles in the bases.
Vital Signs: BP 142/88, HR 112, RR 30 (shallow), Temp 100.9°F, SpO2 82% on Room
Air.
Neuro: Appears restless and anxious; follows commands but is slow to respond.
Item 1: Recognizing Cues
Question: Click to highlight the findings that indicate the client is at risk for imminent
respiratory collapse.
Findings: 68-year-old male; Using accessory muscles; Tripod position; RR 30 (shallow);
SpO2 82%; Restless and anxious; Slow to respond.
Rationale: Accessory muscle use and tripod positioning are signs of "work of breathing"
being at its limit. Restlessness and a slowed mental response are the first signs of hypoxia
and CO2 narcosis (hypercapnia) affecting the brain.
Item 2: Analyzing Cues
