A client with chronic obstructive pulmonary disease (COPD) is admitted for a nonemergent cholecystectomy. The admission arterial blood gas (ABG) findings are a pH 7.35, PaCO2 48 mm Hg, and a HCO3- 28 mEq/L (28 mmol/L). Based on these results, which intervention should the nurse implement? Reference Range: Arterial Blood Gas (ABG) pH [7.35 to 7.45] PaCO2 [35 to 45 mm Hg] HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

A. Prepare the client for surgery: The ABG shows compensated respiratory acidosis: pH is normal but on the low end, PaCO₂ is elevated, and HCO₃⁻ is normal on the higher end indicating renal compensation. This is a common pattern in stable COPD and does not contraindicate surgery. The client is medically optimized for the planned procedure. B. Insert additional IV catheter: While IV access is necessary for surgical preparation, inserting an additional catheter is not directly related to the ABG findings. This action would only be needed if clinically indicated for fluid management or multiple infusions. C. Obtain sputum specimen: A sputum specimen may be indicated if the client shows signs of respiratory infection or increased secretions, but the ABG does not reflect an acute infectious process. D. Administer PRN bronchodilator: There’s no indication of acute bronchospasm or worsening airway obstruction. The ABGs reflect chronic compensation, not acute respiratory distress, so administering a bronchodilator based solely on these findings is unnecessary.