Introduction
Scenario setup A client with COPD suddenly has increased shortness of breath and can only speak two-word sentences. Vitals: RR 32, HR 118, SpO₂ 84% on 2 L nasal cannula. You hear diffuse wheezes. The client is anxious and using neck muscles to breathe. This is acute respiratory compromise—not “anxiety alone.” PN priorities: oxygen per protocol/order, positioning, timely reporting, and preparing nebulizer therapies as ordered while monitoring for fatigue and CO₂ retention signs if hinted. PN traps: leaving to get coffee, walking the client, or withholding oxygen due to COPD myths—follow orders and escalate when indicated. This case-study format is intentional: boards reward trajectory thinking—what changed, what is unstable, and what you do next for the role named in the stem. For NCLEX-PN (United States), read the assignment line before you eliminate answers. Slow read: re-scan the stem for vitals trends, oxygen settings, allergies, and time since onset—case items often hide the decisive clue in a single line. On the exam, writers often pair with —notice the mismatch before you commit. If the stem names a **license...