A client who is obtunded arrives in the emergency department with a suspected drug overdose. The client becomes responsive after the administration of IV naloxone, but within a short period, the client's level of consciousness decreases again and the respiratory rate decreases to 6 breaths/minute. Which action should the nurse take first?

A. Give with prescribed antihistamine: Administering an antihistamine may help manage mild allergic reactions but does not prevent the risk of a serious, potentially life-threatening anaphylactic reaction. It is unsafe to rely solely on antihistamines when the client has a known severe penicillin allergy and is prescribed a related antibiotic like cephalexin.

B. Administer the medication as prescribed: Cephalexin is a cephalosporin, and there is a known cross-sensitivity with penicillins, especially in clients with a history of anaphylaxis. Administering the drug without verifying safety first exposes the client to unnecessary and serious risk.

C. Monitor the client for a rash or hives: While monitoring is important after administering any new medication, simply observing for early signs of an allergic reaction is not a proactive or safe strategy when anaphylaxis is a possibility. Prevention of exposure is the priority.

D. Contact the healthcare provider (HCP): Clients with a history of anaphylaxis to penicillin are at increased risk for cross-reactivity with cephalosporins. The safest action is to notify the HCP immediately to discuss an alternative antibiotic, avoiding the possibility of a dangerous allergic response.

• Albuterol is classified as a beta-2 adrenergic agonist that specifically targets bronchial smooth muscle. It causes relaxation and bronchodilation, rapidly relieving bronchospasm in asthma exacerbations. This action improves airway flow and oxygenation almost immediately after administration. It is the primary rescue medication used in acute respiratory distress related to asthma.
• Beta-blockers inhibit beta-adrenergic receptors, leading to decreased heart rate and blood pressure. They can cause bronchoconstriction, especially in patients with reactive airway diseases like asthma. Using beta-blockers would worsen asthma symptoms rather than relieve them during an exacerbation. Therefore, they are contraindicated in many clients with a history of asthma or severe allergies.
• Corticosteroids are anti-inflammatory agents that decrease airway swelling over several hours or days. They do not provide the immediate bronchodilation needed during an acute asthma attack. Fluticasone and prednisone are examples used for long-term asthma control, not acute relief. Thus, corticosteroids differ significantly from bronchodilators like albuterol in onset and purpose.
• Albuterol reduces airway resistance by relaxing constricted bronchial smooth muscles. This effect allows greater airflow into and out of the lungs, improving oxygen exchange. Decreased airway resistance is the primary mechanism by which respiratory symptoms are relieved. Effective bronchodilation is critical to restoring normal breathing during asthma exacerbations.
• Albuterol may increase heart rate slightly due to beta-1 receptor cross-stimulation at high doses. It does not decrease heart rate and tachycardia is considered a known side effect. Heart rate monitoring is important during albuterol administration, especially in cardiac patients. Managing asthma symptoms requires balancing effective bronchodilation with minimal cardiac effects.
• Albuterol does not directly act on inflammation but instead targets smooth muscle relaxation. The inflammatory response in asthma is treated with corticosteroids and leukotriene modifiers. Immediate asthma symptom relief depends on bronchodilation, not anti-inflammatory action. Thus, albuterol is classified solely as a bronchodilator, not an anti-inflammatory medication.