An adult client is admitted with AIDS and oral candidiasis manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide the UAP?

Choice A reason: A heart rate of 120 beats/minute requires immediate intervention, as albuterol, a beta-agonist, stimulates cardiac beta-1 receptors, causing tachycardia. In emphysema, repeated dosing increases cardiovascular stress, risking arrhythmias or ischemia, necessitating evaluation to adjust therapy or address potential overdose effects.

Choice B reason: Respiratory rate of 28 breaths/minute is elevated but expected in emphysema with dyspnea. Albuterol aims to reduce bronchospasm, and this rate does not indicate immediate danger compared to tachycardia, which poses a cardiovascular risk, making it less urgent.

Choice C reason: Oxygen saturation of 90% is low but common in emphysema exacerbations. Albuterol improves airflow, and supplemental oxygen may address hypoxia. While concerning, this is less immediately life-threatening than tachycardia, which indicates potential albuterol toxicity, requiring urgent intervention.

Choice D reason: Peak expiratory flow at 60% reflects airflow limitation in emphysema, improved by albuterol. While low, it is not as urgent as tachycardia, which signals cardiovascular strain from repeated albuterol doses, posing a greater immediate risk to the client’s stability.

Choice A reason: Hyperventilation rapidly eliminates carbon dioxide, causing respiratory alkalosis, not acidosis. In respiratory acidosis, hypoventilation retains CO2, increasing blood carbonic acid, lowering pH. This contradicts the client’s condition, as rapid CO2 loss would raise, not lower, blood pH.

Choice B reason: Blood oxygen levels stimulating respiration may occur in hypoxia but do not directly cause respiratory acidosis. Low oxygen can coexist with CO2 retention, but acidosis results from high CO2, not oxygen-driven respiratory changes, making this choice irrelevant to the pathophysiology.

Choice C reason: High blood carbon dioxide levels cause respiratory acidosis, as hypoventilation in respiratory distress retains CO2, forming carbonic acid, lowering blood pH. This aligns with the client’s condition, where impaired gas exchange increases CO2, driving acid-base imbalance, making this the correct pathophysiological process.

Choice D reason: Carbon dioxide conversion in kidneys occurs during bicarbonate buffering, a compensatory mechanism, not the primary cause of respiratory acidosis. Acidosis results from pulmonary CO2 retention, not renal processes, which are secondary and slower, making this choice incorrect for the acute condition.