A client with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen. The nurse knows which statement about oxygen therapy in COPD is TRUE?

OXYGEN THERAPY IN COPD requires special consideration. NORMAL PHYSIOLOGY: the primary drive to breathe is a RISE IN CO2 (CO2 chemoreceptors are the dominant stimulus). COPD HYPOXIC DRIVE: some patients with SEVERE CHRONIC COPD retain CO2 chronically (hypercapnia); their CO2 receptors have adapted ('reset') to high CO2; in these patients, the HYPOXIC DRIVE (low O2 stimulating breathing) becomes relatively more important. RISK OF HIGH O2: in HYPERCAPNIC COPD patients, giving HIGH-FLOW OXYGEN can: suppress the hypoxic drive → decreased respiratory rate → CO2 retention worsens → possible CO2 narcosis (confusion, somnolence) → respiratory failure. CURRENT EVIDENCE: the 'hypoxic drive' theory is somewhat simplified; contemporary evidence emphasizes that excessive O2 in COPD also causes: HALDANE EFFECT (oxyhemoglobin shifts, releasing CO2); V/Q mismatch changes. CLINICAL PRACTICE: target SpO2 of 88-92% for known or suspected hypercapnic COPD patients receiving supplemental oxygen; use lowest flow that achieves this target; adjust based on clinical response and ABG results; MONITOR for DROWSINESS, CONFUSION, DECREASED RESPIRATORY RATE — may indicate CO2 buildup; titrate down if this occurs; do NOT withhold O2 from a hypoxic client — hypoxia is still dangerous; balance is key. CONTRAINDICATION IS FALSE: O2 is NOT contraindicated in COPD; it is simply managed carefully. PN ROLE: administer oxygen as ordered; apply and use SpO2 monitoring; document O2 flow rate and SpO2; report drowsiness, decreased respiratory rate, SpO2 outside target range to RN; titrate within ordered parameters.