To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

Choice A reason: This is not the action that the nurse should implement. Determining Glasgow Coma Scale score is a method of assessing the level of consciousness and neurological function of the client, but it is not a priority intervention in this situation. The client's respiratory rate and oxygen saturation are more critical indicators of the client's condition and the need for immediate action. The nurse should assess the Glasgow Coma Scale score as part of the ongoing evaluation, but it is not the first action.

Choice B reason: This is not the action that the nurse should implement. Initiating cardiopulmonary resuscitation (CPR) is a lifesaving procedure that is performed when the client has no pulse and no breathing, but it is not indicated in this situation. The client has a respiratory rate of 4 breaths/minute, which is very low, but not absent. The client also has an oxygen saturation of 75%, which is very low, but not incompatible with life. The nurse should provide oxygen therapy and ventilatory support to the client, but not CPR.

Choice C reason: This is not the action that the nurse should implement. Preparing to assist with chest tube insertion is a procedure that is done to drain air or fluid from the pleural space and restore lung expansion, but it is not relevant in this situation. The client's respiratory depression is caused by the opioid overdose, not by a pneumothorax or a pleural effusion. The nurse should monitor the client's chest x-ray and lung sounds, but not prepare for chest tube insertion.

Choice D reason: This is the action that the nurse should implement. Administering a second dose of naloxone is the most appropriate and effective intervention in this situation. Naloxone is an opioid antagonist that reverses the effects of opioids, such as respiratory depression, sedation, and hypotension. However, naloxone has a shorter duration of action than most opioids, and it may require repeated doses to maintain the reversal. The nurse should administer a second dose of naloxone if the client's respiratory rate and oxygen saturation do not improve or worsen after the first dose. The nurse should also monitor the client for signs of opioid withdrawal, such as agitation, nausea, or pain.

Choice A reason: Assessing for orthostatic hypotension is not a priority action before administering labetalol. Orthostatic hypotension is a possible side effect of the drug, but it is not an immediate concern.

Choice B reason: Administering the dose and monitoring the client's BP regularly is not the best action. The client's heart rate is below the normal range of 60 to 100 beats/minute, which indicates bradycardia. Labetalol can further lower the heart rate and cause cardiac complications.

Choice C reason: Applying a telemetry monitor before administering the dose is not necessary. Telemetry monitoring is used to detect cardiac arrhythmias, which are not a common adverse effect of labetalol. The client's heart rate and rhythm should be assessed by auscultation.

Choice D reason: Withholding the scheduled dose and notifying the health care provider is the correct action. The client's heart rate is too low to safely receive labetalol, which is a beta-blocker that can decrease the heart rate and contractility. The health care provider should be informed of the client's vital signs and the need to adjust the medication dosage or frequency.