NCLEX Question of the Day – Thursday, February 26, 2026

Today’s question targets medication safety: recognizing and managing an infusion reaction. This matters because nurses are the first to see early signs. Acting fast prevents harm, guides provider decisions, and keeps therapy on track.

Clinical Scenario

A 64-year-old man is on the medical-surgical floor with MRSA cellulitis of the right leg. He has type 2 diabetes and hypertension. Allergies: amoxicillin (rash only). He is receiving his first dose of IV vancomycin 1 g in 250 mL normal saline via a peripheral IV pump. Ten minutes into the infusion, he reports “feeling very hot and itchy.” His face, neck, and upper chest are flushed. Vitals now: BP 110/68 (baseline 128/76), HR 102, RR 16, SpO2 98% on room air. Lungs are clear. No wheezing, stridor, hives, or swelling of the lips or tongue.

The Question

Which action is the nurse’s priority?

Answer Choices

1. A. Administer intramuscular epinephrine and prepare for emergent intubation
2. B. Reduce the vancomycin infusion to 50 mL/hr and continue monitoring
3. C. Stop the vancomycin infusion and assess airway and vital signs while maintaining IV access
4. D. Document the finding as expected and continue the infusion at the current rate

Correct Answer

C. Stop the vancomycin infusion and assess airway and vital signs while maintaining IV access

Detailed Rationale

This presentation is most consistent with a vancomycin infusion reaction (a non–IgE-mediated histamine release), formerly called “red man syndrome.” The hallmark is rapid-onset flushing and pruritus of the face, neck, and upper torso during or shortly after the start of the infusion. Mild hypotension and tachycardia can occur. There is no bronchospasm, angioedema, or widespread urticaria here, making anaphylaxis less likely.

The priority is to stop the drug that is provoking the reaction and assess the patient’s airway, breathing, and circulation. Stopping the infusion halts the histamine surge from rapid exposure. Assessing and trending vital signs ensures timely escalation if the reaction progresses. Maintain IV access with normal saline at a keep-vein-open rate so medications can be given if needed.

After stopping the infusion and reassessing, notify the provider. Antihistamines (e.g., diphenhydramine) are commonly ordered to treat pruritus and flushing. Once symptoms resolve and with provider direction, the antibiotic can often be restarted at a slower rate per policy (commonly over at least 60–120 minutes). Pre-medication may be ordered for future doses. Document the reaction clearly as an infusion-rate reaction, not a true allergy, to avoid unnecessary avoidance of vancomycin in the future.

Continuous monitoring is essential: watch blood pressure, heart rate, oxygen saturation, and emergence of respiratory symptoms. If signs of anaphylaxis appear at any point (respiratory distress, angioedema, generalized urticaria, severe hypotension), activate emergency protocols and administer epinephrine per standing orders.

Why the Other Options Are Wrong

• A. Administer intramuscular epinephrine and prepare for emergent intubation — This is the treatment for anaphylaxis. The patient has stable oxygenation, no airway edema, no wheezing, and only mild hypotension. Escalating to epinephrine and intubation without signs of anaphylaxis is not appropriate and exposes the patient to unnecessary risk.
• B. Reduce the vancomycin infusion to 50 mL/hr and continue monitoring — Slowing without first stopping continues exposure and can worsen symptoms. Best practice is to stop the infusion, assess, treat symptoms, and then resume at a slower rate only after improvement and provider guidance.
• D. Document the finding as expected and continue the infusion at the current rate — Flushing and pruritus are not “expected” or acceptable. Continuing at the same rate can intensify histamine release, increase hypotension, and potentially lead to respiratory compromise.

Key Takeaways

• Vancomycin infusion reaction presents with sudden flushing and pruritus of the upper body, often early in the infusion, and is linked to rapid administration.
• Differentiate from anaphylaxis: absence of airway compromise, angioedema, wheezing, or widespread hives suggests an infusion reaction rather than a true IgE-mediated allergy.
• Priority action: stop the infusion, assess ABCs, maintain IV access, and monitor vitals. Notify the provider and anticipate antihistamines and a slower restart.
• Document clearly as an infusion-rate reaction, not a true allergy, to guide future therapy and prevent under-treatment of infections.

On-shift mini-checklist

• Before starting: verify ordered rate, use an infusion pump, and obtain baseline vitals.
• During first 10–15 minutes: stay close, watch for flushing, itching, or blood pressure changes.
• If reaction occurs: stop infusion, assess airway/breathing/circulation, keep IV patent with saline, call provider, prepare antihistamine, and plan a slower restart when stable.
• After: document reaction details, patient response, provider notifications, and any adjustments for future doses.

Quick Practice Extension

• What clinical findings would shift your management from “infusion reaction” to “anaphylaxis,” and how would your interventions change?
• Before the next vancomycin dose, which assessments and labs should you review to promote safe administration and dosing?

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com