A patient presents with a diagnosis of chronic obstructive pulmonary disease (COPD). The ABG results are as follows: pH 7.32. pCO2 68, p02 78, HCO3 23. What action should the nurse take first?

A. Remove the client's O₂ mask: Removing supplemental oxygen is unsafe and may worsen hypoxia. Even though oxygen must be carefully titrated in COPD, abrupt removal is never appropriate without medical direction, especially when the client is already hypoxemic. B. Notify the physician: The ABG shows respiratory acidosis (low pH, elevated pCO₂) with insufficient compensation and potential respiratory failure. Immediate provider notification is warranted to adjust oxygen delivery, initiate or escalate respiratory support, or evaluate for further interventions. C. Have the client breathe into a paper bag: Paper bag breathing is used for respiratory alkalosis caused by hyperventilation, not for respiratory acidosis. This action would further elevate CO₂ and worsen the client's acid-base status. D. Place the patient in left side-lying position: Side-lying positioning does not address the critical issue of respiratory acidosis. Instead, placing the client in high Fowler’s position might help improve ventilation, but first the provider must be notified to address the urgent ABG findings.