A 56-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital for exacerbation of his condition. He is receiving methylprednisolone intravenously and albuterol nebulization therapy. The healthcare provider also orders ipratropium bromide for additional bronchodilation. During the assessment, the nurse notes that the patient reports feeling unusually anxious and has developed a rapid heartbeat that was not present during earlier assessments.
Given the medications administered, which adverse effect or contraindication should the nurse be most concerned about in this scenario?