A nurse is caring for a patient receiving oxygen therapy via a nasal cannula at a flow rate of 3 liters per minute (LPM). The patient has chronic obstructive pulmonary disease (COPD) and is experiencing increased shortness of breath. The nurse observes the patient's oxygen saturation (SpO2) has dropped to 88%. What should be the nurse's initial action?

A. Assess the nasal cannula for proper placement and any kinks or obstructions is correct because before making any changes to oxygen therapy or administering medications, the nurse must first ensure that the oxygen delivery device is functioning correctly. Incorrect placement, tubing disconnections, or kinks can reduce oxygen delivery and cause hypoxemia. This assessment is the safest and most immediate action to identify a reversible cause of low SpO2. B. Encourage the patient to take deep breaths and cough to clear secretions is incorrect as the initial action because while coughing and deep breathing can improve oxygenation over time, it does not address the immediate potential mechanical issue with oxygen delivery that could be causing the low saturation. C. Administer a short-acting bronchodilator inhaler as ordered is incorrect because this should only be done after assessing for mechanical or reversible causes of hypoxemia. While bronchodilators help relieve airway constriction in COPD, they do not immediately correct problems related to oxygen delivery device malfunction. D. Increase the oxygen flow rate to 4 LPM to improve oxygenation is incorrect as the initial action in a COPD patient because rapid increases in oxygen can suppress the patient’s respiratory drive in chronic CO2 retainers. Any adjustment to oxygen flow must be done safely and after assessing equipment and patient response.