A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse?

Choice A reason: Inhaled glucocorticoids are used daily in COPD to reduce inflammation and prevent exacerbations. This shows correct understanding, making it the correct choice.

Choice B reason: Glucocorticoids are for daily maintenance, not as-needed use, which is for beta2-agonists. This misunderstanding is incorrect for the medication regimen.

Choice C reason: Beta2-agonists are used as needed for symptom relief, not daily, in stable COPD. This is incorrect, as daily use is for maintenance drugs.

Choice D reason: Beta2-agonists relax airways, not suppress inflammation; that’s the glucocorticoid’s role. This incorrect mechanism shows misunderstanding, so it’s incorrect.

Choice A reason: Respiratory alkalosis involves low PaCO2 (<35 mm Hg) due to hyperventilation, raising pH. Here, pH is 7.31 (acidic), PaCO2 is 41 mm Hg (normal), and HCO3- is 20 mEq/L (low), indicating a metabolic cause, not respiratory, making this choice incorrect.

Choice B reason: Respiratory acidosis requires elevated PaCO2 (>45 mm Hg), lowering pH. With PaCO2 at 41 mm Hg (normal) and low HCO3- (20 mEq/L), the acidosis stems from reduced bicarbonate, not CO2 retention, ruling out respiratory acidosis and making this choice incorrect.

Choice C reason: Metabolic alkalosis involves high HCO3- (>26 mEq/L) and elevated pH. Here, pH is 7.31 (acidic) and HCO3- is 20 mEq/L (low), indicating acidosis, not alkalosis. The low bicarbonate points to a metabolic cause, making this choice incorrect for the ABG values.

Choice D reason: pH 7.31 (acidic), PaCO2 41 mm Hg (normal), and HCO3- 20 mEq/L (low) indicate metabolic acidosis, likely from conditions like diabetic ketoacidosis or lactic acidosis. No respiratory compensation (normal PaCO2) confirms uncompensated metabolic acidosis, making this the correct choice for the imbalance.