A patient with hypertension is prescribed a nonselective beta-blocker. The nurse reviewing this patient’s chart before administering the medication will be most concerned about which other disease process?

Choice A reason: pH 7.32 (low, acidic), PaCO2 <37 mm Hg (normal/low), and HCO3- <24 mEq/L (low) indicate metabolic acidosis, as low bicarbonate causes acidosis without respiratory compensation (PaCO2 normal). This matches uncompensated metabolic acidosis, often due to conditions like lactic acidosis or diabetic ketoacidosis, making this the correct choice.

Choice B reason: Uncompensated respiratory acidosis involves elevated PaCO2 (>45 mm Hg) causing low pH, with normal HCO3-. Here, PaCO2 is <37 mm Hg (normal/low) and HCO3- is low, pointing to a metabolic, not respiratory, cause of acidosis, making this choice incorrect for the given ABG values.

Choice C reason: Partially compensated respiratory acidosis requires elevated PaCO2 and increased HCO3- as compensation. Here, PaCO2 is <37 mm Hg (normal/low) and HCO3- is low, ruling out respiratory acidosis. The low pH and low HCO3- indicate a metabolic cause, making this choice incorrect.

Choice D reason: Partially compensated metabolic acidosis involves low pH, low HCO3-, and decreased PaCO2 as respiratory compensation. While HCO3- is low, PaCO2 is not significantly reduced to indicate compensation (given as <37 mm Hg, likely normal). This suggests uncompensated metabolic acidosis, making this choice less accurate than A.

Choice A reason: Theophylline is rarely used due to toxicity risks and less efficacy compared to beta-agonists. Increasing fluticasone dose doesn’t address acute exacerbations, as inhaled corticosteroids act slowly. Oxygen is appropriate, but this regimen lacks rapid-acting bronchodilators, making it inadequate for acute asthma management.

Choice B reason: Four puffs of albuterol via inhaler may be insufficient for severe asthma (90% saturation, wheezes). Theophylline is outdated, and nebulized treatments are more effective in emergencies. Oxygen is needed, but this combination lacks systemic steroids for inflammation, making it less optimal.

Choice C reason: Intravenous glucocorticoids reduce airway inflammation rapidly, nebulized albuterol and ipratropium provide synergistic bronchodilation, and oxygen corrects hypoxia (90% saturation). This aligns with guidelines for acute asthma exacerbations, addressing inflammation, bronchoconstriction, and oxygenation, making it the correct and comprehensive treatment choice.

Choice D reason: Intramuscular glucocorticoids are slower than intravenous for acute asthma. Salmeterol, a long-acting beta-agonist, is inappropriate for acute exacerbations, as it lacks rapid onset. Oxygen is needed, but this regimen doesn’t address immediate bronchoconstriction effectively, making it incorrect for emergency management.