The nurse is caring for a patient with wheezes, shortness of breath, urticaria and itching after receiving a new antibiotic The nurse understands that the epinephrine in this situation would be administered intramuscularly (IM), rather than intravenously (IV) because:

A) IM epinephrine is the fastest route of administration:
While epinephrine is often administered intramuscularly in cases of anaphylaxis and allergic reactions, the speed of action is not the primary reason for choosing this route over intravenous (IV) administration in this situation. Intramuscular administration of epinephrine allows for a rapid onset of action, but it is not necessarily the fastest route compared to IV. IV administration would act more quickly in an emergency setting where immediate blood circulation is critical, but IM is preferred in allergic reactions to prevent excessive systemic effects and to avoid rapid peaks in plasma levels.

B) IV epinephrine is only administered during cardiac arrest:
Epinephrine is generally administered intravenously during life-threatening situations such as cardiac arrest or severe shock, where immediate circulatory effects are needed. In cases of anaphylaxis, however, intramuscular (IM) administration of epinephrine is the preferred route because it allows for a more controlled absorption rate and reduces the risk of excessive blood pressure and other adverse cardiovascular effects. This is the correct rationale for why epinephrine is administered IM in the context of an allergic reaction.

C) Epinephrine would not be administered in this situation:
Epinephrine is the first-line treatment for severe allergic reactions and anaphylaxis, especially in cases where symptoms like wheezing, shortness of breath, urticaria, and itching are present. Therefore, withholding epinephrine is not an appropriate response in this situation. Immediate intervention with epinephrine is critical to reverse the symptoms of anaphylaxis and prevent further respiratory distress or cardiovascular collapse.

D) IM epinephrine is less concentrated than IV:
The concentration of epinephrine used for IM and IV administration is the same. The primary reason for choosing the IM route over the IV route is the slower absorption and the fact that it minimizes the risk of a rapid increase in systemic blood pressure and other adverse reactions. While IM epinephrine may be absorbed more slowly than IV, its concentration is appropriate for treating anaphylaxis effectively. The choice of IM is based on safety and controlled response, not on the concentration of the drug.

A) Assess the patient's neurological status and repeat vital signs:
In patients with a spinal cord injury (SCI) at T1, autonomic dysreflexia or neurogenic shock can lead to unstable vital signs, including hypotension and bradycardia. The most immediate concern in this scenario is to determine if the patient is experiencing neurogenic shock, which can result from the loss of sympathetic nervous system function below the level of the injury. By assessing the patient’s neurological status (such as checking for changes in motor function, sensation, or level of consciousness) and repeating vital signs, the nurse can gather the necessary data to make informed decisions about further interventions.

B) Ask the patient care tech to check on the patient:
While the patient care tech can assist with tasks, this is not the priority action. The nurse must immediately assess the patient's condition, particularly given the vital sign changes and the potential for a life-threatening situation like neurogenic shock. The nurse's clinical judgment and expertise are required to evaluate the situation appropriately.

C) Place the client in reverse Trendelenburg position:
Placing the patient in reverse Trendelenburg may help with hypotension in certain situations, but it is not the priority intervention for someone with a spinal cord injury at T1. In cases of neurogenic shock or autonomic dysreflexia, positioning alone will not correct the underlying issue.

D) Administer intravenous (IV) fluids to increase cardiac output:
While IV fluids may be necessary to treat hypotension in some situations, the nurse must first assess the patient’s neurological status and repeat vital signs to determine the cause of the hypotension and bradycardia. Administering IV fluids without understanding the underlying cause could be inappropriate or even harmful, particularly if the low blood pressure is related to neurogenic shock, which requires careful management.