A nurse is reviewing a client's medical history before administering a new prescription for atropine. Which of the following client conditions is contraindicated?

A. “Increased level of consciousness”: While theophylline can have some stimulant effects, an increased level of consciousness is not the primary therapeutic goal of this medication. Theophylline is used to treat respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD), so its effectiveness is measured by improvement in respiratory symptoms.

B. “Decreased wheezing”: This is the correct answer. Theophylline is a bronchodilator, meaning it helps to open up the airways in the lungs. This can lead to a decrease in symptoms such as wheezing. Therefore, decreased wheezing is an indication that the medication is effective.

C. “Increased blood pressure”: Theophylline can potentially cause an increase in heart rate, which could lead to an increase in blood pressure. However, this is more likely to be a side effect of the medication rather than an indication of its effectiveness.

D. “Decreased urine output”: Theophylline does not typically affect urine output. Therefore, a decrease in urine output would not be an indication that the medication is effective.

A. “Give diphenhydramine IM”: While diphenhydramine, an antihistamine, can be used in the treatment of allergic reactions, it is not the first-line treatment for anaphylaxis. Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires immediate treatment with epinephrine.

B. “Administer epinephrine IM”: Epinephrine is the first-line treatment for anaphylaxis. It works rapidly to reverse the life-threatening symptoms of anaphylaxis, including airway swelling and severe low blood pressure. Therefore, after stopping the medication infusion and assessing the client’s respiratory status, the nurse should administer epinephrine IM.

C. “Replace the infusion with 0.9% sodium chloride”: While replacing the infusion with 0.9% sodium chloride (normal saline) can help maintain venous access and hydration, it is not the immediate priority in the treatment of anaphylaxis. The first priority is to administer epinephrine.

D. “Elevate the client’s legs and feet”: Elevating the client’s legs and feet can help improve blood flow and may be beneficial in the treatment of anaphylaxis. However, it is not the immediate priority. The first priority is to administer epinephrine. After administering epinephrine and ensuring the client’s airway is open, the nurse can then take measures to make the client more comfortable, such as elevating the legs and feet.