NCLEX-RNPharmacological and Parenteral TherapiesMedium
A client receiving IV vancomycin develops flushing of the face, neck, and upper trunk along with pruritus during the infusion. Vital signs remain stable. Which action should the nurse take first?
- ADiscontinue vancomycin permanently and document a drug allergy
- BIncrease the infusion rate to complete the dose more quickly
- CSlow the infusion rate and notify the provider
- DStop the infusion and administer epinephrine for anaphylaxis
Show answer & explanationAnswer & explanation
Correct answer: C. Slow the infusion rate and notify the provider
This presentation is consistent with 'red man syndrome,' a histamine-mediated reaction related to rapid vancomycin infusion rather than a true allergy. The appropriate action is to slow the infusion rate and notify the provider, since slowing administration often resolves the symptoms.
Why the other options are wrong
- A. This reaction is rate-related, not a true allergy, so vancomycin may still be given more slowly in the future.
- B. Increasing the rate would worsen the histamine release reaction.
- D. Vital signs are stable and this is not anaphylaxis, so epinephrine is not indicated.
Red Man Syndrome (Vancomycin)
A histamine-release reaction to rapid vancomycin infusion causing flushing, pruritus, and rash on the face, neck, and upper trunk—not a true drug allergy.
- Caused by rapid infusion, not IgE-mediated allergy
- Managed by slowing the infusion rate
- Vancomycin should typically infuse over at least 60 minutes
Memory trick: 'Red Man = Ran too fast' — slow it down