A client admitted with chronic pulmonary obstruction disease (COPD) exacerbation is receiving assisted ventilation with a positive airway pressure (CPAP). The clients vital signs are an oral temperature 98.8 °F (37.1 °C) a respiratory rate of 46 breaths/minute, and a blood pressure of 176/92 mm Hg. While completing the pulmonary assessment, the client's oxygen saturation reading is 78% and he is difficult to arouse. Which action should the nurse implement?

A. Increase the oxygen delivery by 10%: While hypoxemia is present, simply increasing oxygen may be insufficient for a client who is difficult to arouse and in severe respiratory distress. Immediate advanced airway intervention is a higher priority. B. Administer PRN nebulizer treatment: Bronchodilators can improve airway obstruction but will not rapidly correct profound hypoxemia or altered mental status in a critically decompensating client. This intervention alone is not adequate. C. Complete neurological assessment: Assessing neurological status is important, but the client’s low oxygen saturation and decreased responsiveness indicate a life-threatening situation that requires immediate intervention before completing a full assessment. D. Prepare for rapid sequence intubation: The client exhibits severe hypoxemia, high respiratory rate, and decreased level of consciousness—signs of impending respiratory failure. Rapid sequence intubation ensures airway protection and adequate ventilation, which is the priority action to prevent respiratory arrest.