A client receives a prescription for penicillin 1.2 million units IM. The available vial is labeled, "600,000 units/2 mL." How many mL should the nurse administer? (Enter numeric value only.)

A. Apply warm compresses to legs:
While leg cramps can be uncomfortable, addressing them with warm compresses does not address the potential underlying issues related to the client's symptoms, especially considering the possibility of more severe conditions.

B. Monitor intake and output:
Monitoring intake and output is important in managing fluid balance, especially with diuretics like furosemide. However, this action does not directly address the immediate concerns raised by symptoms like palpitations and a cough.

C. Raise the head of the bed:
Raising the head of the bed can be helpful if the client is experiencing shortness of breath or orthopnea. However, it does not address the need to evaluate cardiac function, which is crucial given the presence of palpitations and other symptoms.

D. Place on cardiac monitoring:
The client's symptoms—palpitations, cough, fatigue—could indicate significant electrolyte imbalances or cardiac issues, which are common with furosemide use. Cardiac monitoring is the most appropriate initial action to quickly identify and address any cardiac complications.

A) Determine Glasgow Coma Scale score: While assessing the Glasgow Coma Scale (GCS) score is important for evaluating the level of consciousness and neurological status, it does not address the immediate life-threatening issue of severe respiratory depression and hypoxia. The client's critical respiratory status and low oxygen saturation require more urgent intervention.

B) Prepare to assist with chest tube insertion: Preparing for chest tube insertion is not appropriate in this scenario, as the client's symptoms are related to severe respiratory depression rather than a condition that would require chest drainage. Chest tube insertion is indicated for conditions such as pneumothorax or pleural effusion, not for opioid overdose.

C) Initiate cardiopulmonary resuscitation (CPR): CPR would be necessary if the client were in cardiac arrest or if there were no pulse and respiratory effort. However, the immediate issue appears to be severe respiratory depression rather than cardiac arrest, so administering a second dose of naloxone is a more appropriate and immediate action to address the cause of the client's condition.

D) Administer a second dose of naloxone: Given the client’s severe respiratory depression and low oxygen saturation despite the initial dose of naloxone, it is crucial to administer a second dose. Naloxone is used to reverse opioid overdose effects, and its administration should be repeated if symptoms persist, ensuring the client’s safety and potentially reversing the opioid’s effects on the respiratory system.