A client diagnosed with a pulmonary embolism is placed on a continuous Heparin infusion. A nurse should notify the health care provider for which of the following findings?

A. Increased arterial oxygen: Clients with COPD typically experience chronic hypoxemia due to alveolar destruction, airway inflammation, and mucus production, which impair gas exchange. Rather than increased oxygen levels, they often have a decreased PaO₂, requiring supplemental oxygen therapy. However, excessive oxygen administration can suppress their respiratory drive, worsening CO₂ retention.
B. Increased pH: COPD is associated with respiratory acidosis due to chronic CO₂ retention from inadequate alveolar ventilation. While the kidneys compensate by increasing bicarbonate retention, the pH usually remains low or near normal in chronic cases rather than becoming elevated. A higher pH would indicate alkalosis, which is not typical in COPD unless there is an additional metabolic disturbance.
C. Increased carbon dioxide: COPD causes airway obstruction and reduced alveolar ventilation, leading to CO₂ retention (hypercapnia). As CO₂ accumulates in the blood, it lowers the pH, resulting in respiratory acidosis. Chronic hypercapnia is a hallmark of advanced COPD, and in response, the kidneys retain bicarbonate to partially compensate, stabilizing the pH over time but leaving PaCO₂ elevated.
D. Decreased alveolar function: While COPD does lead to progressive alveolar damage and reduced gas exchange, this is a structural and functional change rather than a specific abnormality seen in arterial blood gases. The primary ABG finding in COPD is hypercapnia, which reflects inadequate ventilation and CO₂ retention rather than just decreased alveolar function alone.

A. Set ground rules: This step involves establishing guidelines for the discussion to ensure that all participants feel respected and heard. By inviting each staff member to speak in turn and asking them to listen respectfully without making personal or professional remarks, the nurse manager is creating a safe and structured environment for open communication. Setting ground rules is crucial for facilitating a productive dialogue and minimizing conflict during negotiations.
B. Perform an opening move: This refers to the initial statement or action taken to start the negotiation process. While the nurse manager is initiating the meeting, the emphasis on respectful communication and turn-taking indicates that the focus is more on establishing an effective communication framework rather than simply making an opening statement.
C. Continue the negotiation: This step implies that the negotiation is already underway and is focused on maintaining momentum in the discussion. However, the scenario describes the nurse manager taking proactive steps to set the stage for the negotiation rather than continuing an existing conversation.
D. Clarify the problem: While it is important to identify and clarify the staffing issues and tardiness, the nurse manager's actions are more about creating an environment for discussion rather than explicitly defining the problem at this stage. Setting ground rules is a foundational step that supports problem clarification by fostering respectful dialogue among participants.