A child receiving IV ampicillin develops generalized hives, facial swelling, wheezing, and hypotension. Which action should the nurse take first?
1Slow the ampicillin infusion, administer an oral antihistamine, and reassess the child in 30 minutes.
2Place the child upright, apply a cool compress to the hives, and wait for the provider to examine the child.
3Stop ampicillin, call emergency response, and give IM epinephrine in the outer thigh while supporting airway and circulation.✓ Correct answer
4Complete the ampicillin dose, then administer an IV corticosteroid to prevent a delayed allergic response.
Explanation
Hives, facial swelling, wheezing, and hypotension after medication exposure indicate anaphylaxis. The nurse should stop the suspected trigger, summon emergency assistance, and give intramuscular epinephrine promptly in the anterolateral thigh while supporting airway, breathing, and circulation. Antihistamines and corticosteroids are adjuncts and do not replace epinephrine. Continuing or slowing the antibiotic delays life-saving treatment.
Clinical reasoning Anaphylaxis can progress rapidly to airway obstruction and cardiovascular collapse. IM epinephrine reverses bronchoconstriction, mucosal edema, and vasodilation; oral medication acts too slowly for this emergency.
Decision rule Remove the trigger, call for help, give IM epinephrine in the outer thigh, support airway and circulation, and repeat epinephrine per the emergency protocol if symptoms persist.
Anaphylaxis — A rapidly progressive systemic hypersensitivity reaction involving airway, breathing, or circulation after exposure to a trigger.
Intramuscular epinephrine — The initial drug treatment for anaphylaxis, administered into the anterolateral thigh for rapid absorption.