A nurse is caring for a client who is receiving magnesium sulfate IV bolus for preeclampsia. The client's respiratory rate is 6/min and they have absent deep tendon reflexes. Which of the following medications should the nurse anticipate the provider to prescribe?

Rationale for Correct Choices:

• Stop the IV infusion: The client is showing signs of a severe allergic reaction, including flushing, generalized itching, hypotension, tachycardia, hypoxia, and difficulty breathing shortly after vancomycin administration. Immediate cessation of the infusion is critical to prevent progression of anaphylaxis.
• Anaphylaxis: The client is exhibiting the classic signs of an anaphylactic-type reaction. The rapid infusion rate (325mL/hr) is very high for Vancomycin and often causes Red Man Syndrome, which is a histamine release reaction. However, the presence of difficulty breathing elevates this to anaphylactic or severe hypersensitivity reaction, requiring the most urgent response.

Rationale for Incorrect Choices:

• Administer epinephrine: Epinephrine is the first-line treatment for anaphylaxis, but it is administered after stopping the offending agent. Halting the infusion is the initial, priority nursing action.
• Request a serum peak drug level: Monitoring vancomycin peak or trough levels is important for toxicity prevention, but it is not the immediate priority during an acute hypersensitivity reaction.
• Nephrotoxicity: Elevated WBC or vancomycin trough does not indicate acute nephrotoxicity here, and the patient’s acute symptoms are consistent with an allergic reaction rather than kidney injury.
• Sepsis: Although the client has cellulitis and elevated WBCs, the sudden onset of hypotension, flushing, and respiratory distress after IV antibiotic administration is more indicative of anaphylaxis rather than sepsis.

A. "I have vomited several times.": Vomiting can be a side effect of penicillin, but it is usually manageable and not immediately life-threatening unless severe dehydration occurs.

B. "I am having diarrhea.": Mild diarrhea is a common side effect of antibiotics. It is important to monitor for signs of C. difficile infection, but occasional loose stools are not immediately critical.

C. "I am having trouble swallowing.": Difficulty swallowing may indicate oropharyngeal edema, which can be a sign of a severe allergic reaction to penicillin. This requires immediate attention as it can progress to airway obstruction.

D. "My skin feels itchy all over.": Generalized itching may indicate a mild allergic reaction. While it should be monitored, it is less urgent than symptoms suggesting airway compromise.