Editing Pharmacology – RN Practice Questions (section)

==Question 4==
A client is receiving intravenous vancomycin. Fifteen minutes into the infusion, the nurse observes flushing and erythema over the face, neck, and upper chest, with mild pruritus. Blood pressure is 104/62 and the airway is clear with no wheezing or stridor. Which action should the nurse take first?
# Stop the infusion and document a vancomycin allergy in the chart
# Administer epinephrine 0.3 mg intramuscularly
# Stop the infusion, notify the provider, and anticipate restarting at a slower rate with an antihistamine
# Increase the infusion rate to complete the dose more quickly

'''Answer:''' 3 (C) Stop the infusion, notify the provider, and anticipate restarting at a slower rate with an antihistamine.

''Rationale:'' This is the vancomycin infusion reaction, a direct histamine release phenomenon caused by rapid infusion, not an IgE-mediated allergy. Management is to stop or slow the infusion, treat with an antihistamine as ordered, and resume over at least 60 minutes or longer. Option 1 mislabels the event and could inappropriately deny the client a needed antibiotic in the future. Option 2 is treatment for anaphylaxis, and there is no airway compromise, hypotension of that severity, or systemic collapse here. Option 4 would worsen the reaction, since rate is the cause.