A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

Choice A reason: Theophylline is rarely used due to toxicity risks and less efficacy compared to beta-agonists. Increasing fluticasone dose doesn’t address acute exacerbations, as inhaled corticosteroids act slowly. Oxygen is appropriate, but this regimen lacks rapid-acting bronchodilators, making it inadequate for acute asthma management. Choice B reason: Four puffs of albuterol via inhaler may be insufficient for severe asthma (90% saturation, wheezes). Theophylline is outdated, and nebulized treatments are more effective in emergencies. Oxygen is needed, but this combination lacks systemic steroids for inflammation, making it less optimal. Choice C reason: Intravenous glucocorticoids reduce airway inflammation rapidly, nebulized albuterol and ipratropium provide synergistic bronchodilation, and oxygen corrects hypoxia (90% saturation). This aligns with guidelines for acute asthma exacerbations, addressing inflammation, bronchoconstriction, and oxygenation, making it the correct and comprehensive treatment choice. Choice D reason: Intramuscular glucocorticoids are slower than intravenous for acute asthma. Salmeterol, a long-acting beta-agonist, is inappropriate for acute exacerbations, as it lacks rapid onset. Oxygen is needed, but this regimen doesn’t address immediate bronchoconstriction effectively, making it incorrect for emergency management.