A 59-year-old client is brought into the emergency room with complaints of chest pain. The client states that the pain is crushing, constrictive pressure that is not relieved with position change. He states that the pain started 3 hours ago in the middle of his chest and radiates down his left arm. The client has a history of diabetes, asthma, and hypertension. Temperature: 99 Blood Pressure: 138/72 Heart Rate: 106 Respiration: 19 ECG: ST segmented depression Troponin: Negative The client is given medication for his unstable angina. Soon after, the client states that he is having difficulty breathing with audible wheezing heard on auscultation. Which of the following is most likely responsible for the symptoms experience by this client?

A. Nitroglycerin: Nitroglycerin primarily causes vasodilation of coronary arteries to relieve ischemic chest pain. Common side effects include headache, hypotension, and dizziness, but it does not typically cause bronchospasm or wheezing. The client’s acute respiratory distress is unlikely to be caused by nitroglycerin. B. Heparin: Heparin is an anticoagulant used to prevent thrombus formation in unstable angina or myocardial infarction. Its adverse effects include bleeding and heparin-induced thrombocytopenia. Heparin does not cause bronchospasm or wheezing, so it is unlikely to cause the client’s respiratory symptoms. C. Morphine: Morphine is an opioid analgesic used for pain management in acute coronary syndromes. Side effects include respiratory depression, hypotension, and sedation. While morphine can affect respiration, it does not usually produce wheezing or trigger bronchospasm in asthmatic clients. D. Propranolol: Propranolol is a non-selective beta-adrenergic blocker. In clients with asthma, non-selective beta blockers can block beta-2 receptors in the lungs, causing bronchoconstriction, wheezing, and respiratory distress. Given this client’s history of asthma, propranolol is the most likely cause of the acute dyspnea and audible wheezing, making it the responsible medication.