A nurse is assessing a client who has a long history of untreated HIV infection. The client presents with multiple painless, purplish skin lesions on the lower extremities and oral mucosa. Based on this finding, which of the following conditions should the nurse suspect?

A. Administration of oxygen is contraindicated in clients who are using bronchodilators: Oxygen therapy is not contraindicated with bronchodilators. In fact, bronchodilators and oxygen are commonly used together to relieve airway obstruction and improve gas exchange in COPD.

B. High oxygen concentrations will cause coughing and dyspnea: While oxygen therapy can sometimes dry airways or cause minor irritation, coughing and dyspnea are not direct effects of high oxygen concentration. Dyspnea in COPD is due to impaired gas exchange and airflow limitation.

C. Increased oxygen use will cause the client to become dependent on the oxygen: Oxygen therapy does not create physical dependence. Clients with COPD may require long-term oxygen due to disease progression, but this is related to their chronic hypoxemia rather than dependency.

D. High oxygen concentration may inhibit the hypoxic stimulus to breathe: Clients with COPD often rely on hypoxemia as their primary drive to breathe, since chronic CO₂ retention blunts the normal hypercapnic drive. Administering high oxygen concentrations can suppress this hypoxic drive, leading to hypoventilation and CO₂ narcosis.

A. Place the head of the patient's bed flat: Positioning the patient flat does not address the underlying issue of excessive bubbling. This intervention has no effect on the integrity of the chest tube system or on resolving the possible air leak.

B. Notify the healthcare provider: Excessive bubbling in the water seal chamber usually indicates an air leak in the chest tube system or from the patient’s lung. Prompt notification of the healthcare provider ensures timely evaluation and correction of the problem to prevent complications.

C. Milk the chest tube: Milking or stripping chest tubes is not recommended because it can create high negative pressures and damage lung tissue. This action does not correct excessive bubbling and may worsen patient outcomes.

D. Disconnect the system and get another: Disconnecting the system increases the risk of introducing air into the pleural space, potentially leading to a tension pneumothorax. Replacing the system may be needed, but it should not be done before assessing and notifying the healthcare provider.